A guide to Sacroiliac Joint Dysfunction

Sacroiliac Joint (SI Joint) Dysfunction can manifest in several ways. There are both surgical and non-surgical treatments. Our team has gathered some insights to help you make an informed decision. Please consult a professional physician for medical treatment. 

Causes

Recent studies have shown that the SI Joint can be associated with up to 30% of low back pain¹. Like all joints in the body, the SI Joint is susceptible to degeneration. The two most common age groups affected by SI joint pain are younger adults following sports injuries or pregnancy, and older adults from age-related degeneration. Patients who have undergone previous lumbar spine surgery are also considered at higher risk for SI Joint dysfunction as loads can be amplified onto the SI Joint².

1. Cohen SP, Chen Y, Neufeld NJ. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert Rev Neurother. 2013;13(1):99-116.

2. Falowski S, Sayed D, Pope J, Patterson D, Fishman M, Gupta M, Mehta P. A Review and Algorithm in the Diagnosis and Treatment of Sacroiliac Joint Pain. J Pain Res. 2020 Dec 8;13:3337-3348.

Symptoms

• Lower back pain
• Sensation, numbness, tingling, or weakness of lower extremity
• Hip/groin pain
• Pelvis/buttock pain
• Feeling of leg instability (buckling, giving way)
• Disturbed sleep patterns due to pain
• Inability to sit for long periods, sitting on one side

Diagnosis

A medical professional can perform a variety of tests during a physical examination to determine whether the SI joint is a source of your symptoms. They will ask you to point to where it hurts (Fortin Finger Test). Imaging like X-Rays, CT-scans, and/or MRIs are helpful in the diagnosis of SI joint-related problems.

You may be positioned in several potentially provocative positions to compress, distract, flex, extend, and rotate your joint to determine if the joint is the pain generator. Local anesthetic can also be injected into the joint as a final diagnostic tool which can also cause temporary relief. If your symptoms are decreased by at least 50%, the SI joint may either be the source, or a major contributor, to your lower back pain.

 Non-Surgical Treatments

Non-surgical options may include physical therapy, chiropractic medicine, oral medications, injections, as well as the use of a pelvic belt. Oftentimes, these conservative approaches can deliver long-lasting relief so long as patients are compliant.

However, some patients do not experience long-lasting relief from their symptoms and may require further intervention. Radiofrequency nerve ablation is another less invasive option that uses targeted heat from insulated needles to burn nerves, providing relief for up to 1 year.

If non-surgical treatments do not provide relief, your doctor may consider other options including minimally invasive surgery.

Minimally Invasive Surgery

Minimally invasive sacroiliac joint fusion involves the insertion of two or three titanium screws across the SI Joint and is designed to fuse and stabilize the joint. Based on your anatomy or medical history, screws may be placed across the joint from either a direct lateral approach or from a posterolateral oblique approach. The procedure is done through a small incision and takes less than one hour. Most commonly, patients are sent home the same day.

The incision should be kept dry for 7–10 days. Pain medication and antibiotics should be taken as prescribed. Walk as tolerated, but no lifting above 10 lbs. Smoking should be stopped. These postoperative protocols are general guidelines. Always follow the instructions from your provider for your own tailored discharge instructions.

Posterolateral Oblique Approach