SI joint in low back pain

Post Lumbar Fusion and SI JointLower Back Complaints and the Sacroiliac (SI) Joint

According to a study by Bernard and Kirkaldy-Willis (1987), over twenty two percent (22%) of individuals who presented with lower back complaints actually had problems in their sacroiliac (SI) joint.1 There may be up to a million patients annually with low back complaints that have SI joint conditions like sacroiliac joint disruptions and degenerative sacroiliitis.
Studies by Cohen show that up to 25% of low back pain is sacroiliac joint in origin and that the diagnosis of sacroiliac joint disease is frequently overlooked by physicians.2

Weksler, et al., report that sacroiliac joint dysfunction can feel like discogenic or radicular low back pain.3 In fact, many low back pain patients go on to receive lumbar fusion surgery instead of sacroiliac joint fusion. In light of this, sacroiliac joint disease must be strongly considered in differential diagnosis of low back pain.

Studies by Ha, et al., show that the incidence of SI joint degeneration in patients who had undergone lumbar fusion surgery is 75% at 5 years post-surgery, based on imaging.4 Studies by DePalma and Liliang, et al., demonstrate that 40-61% of post-lumbar fusion patients were symptomatic for SI joint disorders based on diagnostic blocks.5,6

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Yet, despite the large number of patients with SI joint symptoms, most of the treatment focus in the spine has been centered on the disc. Orthopedic and neurosurgical residents are rarely taught to consider SI joint disruptions and degenerative sacroiliitis as the cause of a patient’s low back problems. In addition, few, if any, lumbar MRIs extend below S1 to examine the SI joint. However, there are a growing number of healthcare professionals that recognize the significance of the SI joint as a pain generator. 

  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. Weksler, Velan, et al. The role of SI joint dysfunction in the genesis of low back pain: the obvious is not always right. Archives of ortho and trauma surgery 2007 Dec; 10(127) 858-888.
  4. Ha, Kee-Yong, Degeneration of sacroiliac joint after instrumented lumbar or lumbosacral fusion. Spine 2008; 33(a): 1192-1198.
  5. DePalma, M. Etiology of chronic low back pain in patients having undergone lumbar fusion. Pain Medicine 2011; 12:732-39.
  6. Liliang, Sacroiliac joint pain after lumbar and lumbosacral fusion. Pain Medicine 2011; 12:565-70.


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