Sacroiliitis

Up to 25% of chronic lower back pain can be attributed to the sacroiliac (SI) joint. Also, several studies have shown that following lumbar spine surgery, some patients develop problems with the SI joint.

The sacroiliac joint links the iliac bone (pelvis) to the sacrum. The joint helps to transfer weight between the body and the legs. It is stabilized by ligaments and muscle restricting SI joint motion to about 2-4 degrees.

Patients with SI pain complain of lower back pain below L5 just off midline, referred leg pain, hip and groin pain, instability, trouble sleeping, and pain going from sitting to standing. The diagnosis is made by a consistent history, reproduction of the pain with physical exam maneuvers, and a diagnostic injection of lidocaine into the joint.

Treatment starts with physical therapy and exercise. Additional treatments include steroid injections and nerve ablation. Some patients undergo surgery to stabilize the joint. Www.sibone.com is an excellent resource for patient education on sacroiliitis.

References:

1. Bernard TN, Kirkaldy-Willis WH. Recognizing specific characteristics of nonspecific low back pain. Clinical Orthopedics 1987;217:266–80.

2. Cohen, Steven P. Sacroiliac Joint Pain: A Comprehensive Review of Anatomy, Diagnosis, and Treatment. Anesth Analg 2005; 101:1440-1453.

3. Ha, Kee-Yong, et.al. Degeneration of sacroiliac joint after instrumented lumbar or lumbosacral fusion. Spine 2008; 33(a): 1192-1198.

4. DePalma, M*. Etiology of chronic low back pain in patients having undergone lumbar fusion. Pain Medicine 2011; 12:732-39. *Conducts clinical research for SI-BONE Inc.

5. Liliang, et.al. Sacroiliac joint pain after lumbar and lumbosacral fusion. Pain Medicine 2011; 12:565-70.

6. http://www.sibone.com

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