Minimally Invasive Sacroiliac Joint Surgery

A. Low back pain is a common symptom that affects many people during their lifetime. For some, low back pain can be an acute, short-term problem. Others experience chronic, long-term symptoms. There are many structures in the lower back and pelvic area that can cause pain. Most commonly, people think of a “slipped disc” as a cause of low back pain. The word “sciatica” may be used when describing low back pain. Occasionally, hip problems can be confused with low back conditions. In fact, there are many causes of back pain, including arthritis of the back, osteoporosis, and a poorly aligned spine. The sacroiliac (SI) joint can be a significant contributor to pain in the lower back, pelvic region, buttocks, or legs.

A. The SI joint is located in the pelvis, linking the iliac bone (pelvis) to the sacrum (lowest part of the spine above the tailbone).

A. The function of the SI joint is to transfer weight and forces due to movement from your upper body through the pelvis to your legs and vice versa. Your pelvis acts as a central base through which large forces are transferred and dissipated. The primary role of the sacroiliac joint is to provide stability for the pelvis and to bear the load of the upper body.

A. If the motion in your pelvis is asymmetric, then dysfunction can occur in your SI joint. You could have asymmetric motion if your legs are significantly different in length. This can be congenital or caused due to an injury or illness such as polio or scoliosis. Other conditions that can predispose you to SI joint dysfunction include having one leg that is weaker, such as seen with hip osteoarthritis. These biomechanical conditions, or even wearing inappropriate footwear, can alter your gait and cause repetitive stress to your SI joint and related structures. Other potential causes of SI joint problems include degenerative disease, history of trauma, pregnancy/childbirth, and other unknown reasons.

A. The SI joint is a type of joint known as a synovial joint. This type of joint has free nerve endings that can cause chronic pain if the joint degenerates or does not move properly. The SI joint has been long known to cause pain in the lower back and buttocks. Like any other joint in the body, the SI joint can become arthritic or its support ligaments can become loose or injured. When this happens, people can feel pain in their back, especially with lifting, running or even walking. In these cases, the pain is felt in the back, sometimes similar to the pain caused by a “disc” or spinal arthritis.

A. It is commonly reported in clinical literature that up to 33% of all low back pain is caused by the SI joint. Many risk factors are associated with lower back pain, and many are directly associated with lumbar disc injury. These may include, smoking, poor physical condition, positive family history, and occupational lifting.

A. Many people have low back pain due to the sacroiliac (SI) joint that begins spontaneously. However, over half the time SI joint pathology can be related to a specific event, often an injury. It is difficult to directly relate any specific functioning difficulty (including walking, sitting, standing, sleeping on the affected side, job activity, bowel movements, cough, sneeze, etc.) to the SI joint as a source of pain. The most significant indication is the specific location of the pain below the L5 joint.

A. Women may be at increased risk for SI joint problems because of their broader pelvises, the greater curve of their necks, and shorter limb lengths. In addition, pregnancy often leads to stretching of the pelvis, specifically in the SI ligaments. Injury from accidents is another predisposing factor for SI joint pain.

A. If you have trouble sleeping comfortably, or frequently experience your knee giving way, pain in certain lying or bending positions, or tenderness in your buttocks, you may have SI joint disruption or dysfunction.

A. Doctors do not always look for the SI joint as a source of lower back pain, although many articles have been written about it. Sometimes your back pain may have been previously diagnosed as lumbar spinal pain. However, if your symptoms don't fit what the doctor can see on an MRI, this may indicate that your pain is coming from a place other than the lumbar spinal region. Your doctor may determine if your SI joint is the source of your pain by ruling out other sources of pain as well as running specific tests.

A. The most important information you can give your doctor is the exact location of your pain. Try to notice when the pain occurs and how intensely you feel it in various locations, including your low back, buttocks, and legs. Also, be sure to tell your doctor about any previous injury that may have either directly affected your pelvis, or caused you to walk asymmetrically.

A. Your doctor will consider all the information you provide, including any history of injury, location of your pain, and problems standing or sleeping. Your doctor will also give you a physical examination. You may be asked to stand or move in different positions and point to where you feel pain. Your doctor may manipulate your joints or feel for tenderness over your SI joint. All of these can help establish a diagnosis of SI joint dysfunction. In addition, X-rays, a CT scan, or MRI may be helpful in diagnosis of sacroiliac (SI) joint dysfunction. It is also important to remember that more than one condition (like a disc or hip problem) can co-exist with SI joint dysfunction and your doctor will need to check for other factors that may be causing your pain. The most reliable method to accurately determine the cause of SI joint pain is to inject the SI joint with painkillers. Your doctor will deliver the injection with either fluoroscopic guidance or CT guidance to ensure that the needle is accurately placed in the SI joint. If, following the injection, your pain is decreased by more than 75%, then it can be concluded that the SI joint is either the source, or a major contributor, to your low back pain. If the level of pain does not change after the injection, it is less likely that the SI joint is the cause of your low back pain.

A. It is not always easy to diagnose SI joint dysfunction. Sometimes your physical findings may indicate a SI joint dysfunction, but chronic changes may also be seen in your lumbar spine. Your doctor may discuss the difficulty of making a correct diagnosis in the presence of multiple abnormalities. To confirm the SI joint as the source of low back pain, injections are invaluable. Provocation tests are helpful for localizing the pain source.

A. There are several options for treating SI joint dysfunction. Some people respond to physical therapy, chiropractic manipulations, and exercises. Others require more interventional treatments including various oral medications or therapeutic injections. Usually pain improvement using these therapies is temporary and treatments may need to be performed repeatedly to treat recurrent pain. Long-term pain relief can be accomplished through a surgical procedure known as sacroiliac joint arthrodesis or sacroiliac (SI) joint fusion. This procedure reduces pain by stabilizing and fixing the joint and eliminating the joint motion.

A. SI joint fusion has been shown in clinical publications to resolve back pain with a high degree of reliability. By fusing the sacroiliac joint, the joint may immobilized in its intended position and weight-bearing function.