Chapter 3: The Importance of Diagnosing SI Joint Disorders in Surgical Practice

The clinical literature shows that between 15-30% of patients presenting with chronic low back pain have the sacroiliac joint as the source of their pain.1,2,3,4,5

The sacroiliac joint is subject to both internal and external forces and can be affected by a variety of processes or problems just like any other joint in the body. One of those problems could be an inflammatory arthritis or autoimmune problem such as rheumatoid arthritis or ankylosing spondylitis.

The SI joint can become degenerative because of trauma, either acute trauma such as a motor vehicle accident or a fall or a chronic repetitive trauma. In some series, up to 50% of the patients with sacroiliac joint disorders or pain had reported a precipitating traumatic event. The joint could also be subjected to increased stress as a result of being next to a lumbar fusion. We call that adjacent segment degeneration.

Another common problem with the sacroiliac joint is that it becomes hypermobile. This would typically occur in a middle-aged woman. Women are somewhat more ligamentously lax than men and it commonly occurs in women who've had multiple pregnancies.

It's very common for pain arising from the sacroiliac joint to present as pain coming from a facet source, a discogenic source, potentially an intra-pelvic or abdominal source, or even coming from the hip joint. A patient with sacroiliac joint disorders may even present with radicular symptoms with pain radiating down the leg.

Wexler has shown that there are many patients with sacroiliac joint disorders that have been misdiagnosed and ultimately come to have a lumbar fusion instead of treatment of the sacroiliac joint.

Sacroiliac joint disorders should always be considered in patients presenting with low back pain complaints. Many patients with sacroiliac joint disorders are mistreated for discogenic pain.


Dr. Reckling is an Employee of SI-BONE Inc.

The iFuse Implant System is intended for sacroiliac fusion for conditions including sacroiliac joint dysfunction that is a direct result of sacroiliac joint disruption and degenerative sacroiliitis. This includes conditions whose symptoms began during pregnancy or in the peripartum period and have persisted postpartum for more than 6 months. There are potential risks associated with the iFuse Implant System. It may not be appropriate for all patients and all patients may not benefit. For information about the risks, visit: www.si-bone.com/risks

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