Cindy is a 54 year old who came to clinic with severe right lower back pain. When I asked her where it hurt she said, “Right here,” pointing to a spot low on her back and just off to the side.
She said that her leg frequently “gave out” on her. She also would wake up at night frequently. She had trouble getting up stairs and getting out of a chair.
On physical exam, I could reproduce her pain with some maneuvers that put strain on the sacroiliac joint.
I looked at her lumbar MRI. She had some age related degenerative changes, but nothing that I thought explained her pain.
I sent her for a lidocaine injection into the sacroiliac joint. Her pain was 85% better for about 6 hours then gradually returned.
She spent about 6 months doing physical therapy and some repeat injections, this time with corticosteroids. Her pain improved, but only temporarily.
We eventually took her to surgery. The procedure took about 20 minutes. After surgery, she had pain in her hip (likely from the surgery), but the lower back pain was better. She went home the day of surgery.
3 months later she stated that her sacroiliac joint pain was much better and the post-surgical pain had subsided.