SI Joint – A Cause for Low Back Pain (and Maybe Fusion)
SI Joint – A Cause for Low Back Pain (and maybe Fusion)
Presented at the 5th Mayo Clinic International Spine Symposium
Mauna Lani Bay Hotel, Big Island, Hawaii
January 31 – February 4, 2010
By Steven R. Garfin, MD
The sacroiliac (SI) joint is a source of pain in the lower back and buttocks in approximately 15-25% of the population, for which there has been no effective long-¬‐ term treatment. Diagnosing SI joint–mediated pain is difficult because the presenting complaints are similar to those of other causes of low back pain, including discogenic, spine and hip. Patients with SI joint–mediated pain typically report L5 and buttock pain, with most localizing their pain to the area around the posterior superior iliac spine (PSIS).
Imaging and laboratory tests primarily help exclude other sources of low back pain. Magnetic resonance imaging (MRI), computed tomography (CT), and bone scans of the SI joint cannot reliably determine whether the SI joint is the source of the pain. Controlled analgesic injection (diagnostic block) of the SI joint is considered the ‘gold standard’ in SI joint diagnosis.
Treatment modalities include medications, physical therapy (PT), bracing, orthopedic manual therapy, steroid injections, radiofrequency (RF) denervation, and arthrodesis (traditional open and minimally invasive). There are no published prospective data comparing the efficacy of any of these modalities. A new, minimally invasive surgical (MIS) arthrodesis option may provide an option for pain physicians with SI joint patients refractory to conservative care.
