SI joint in low back pain
Lower 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.
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.