Sacroiliac Disease | SI Joints as a Cause of Lower Back Pain | SI-BONE

SI joint in low back pain

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

15-30% of patients with chronic low back pain (LBP) have a component related to the SI joint.1-4,8 According to a study of 1293 patients by Bernard and Kirkaldy-Willis (1987), over twenty two percent (22.5%) 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 SI joint disruptions and degenerative sacroiliitis.
Studies by Cohen show that up to 25% of low back pain is of SI joint origin and that the diagnosis of SI joint disease is frequently overlooked by physicians.2 Schwarzer reports a prevalence LBP due to the SI joint of 30%.3

Weksler, et al., report that SI joint dysfunction can feel like discogenic or radicular low back pain.4 In fact, many low back pain patients go on to receive lumbar fusion surgery instead of SI joint fusion. In light of this, SI joint disease must be strongly considered in differential diagnosis of low back pain.

Studies by Ha, et al., show the incidence of SI joint degeneration in patients who had undergone lumbar fusion surgery is 75% at 5 years post-surgery, based on imaging.6 Studies by DePalma5 and Liliang7, demonstrate that 40-61% of post-lumbar fusion patients were symptomatic for SI joint disorders based on diagnostic blocks.

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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 SP. Sacroiliac Joint Pain: A Comprehensive Review of Anatomy, Diagnosis, and Treatment. Anesth Analg. 2005; 101:1440-1453.
  3. Schwarzer AC, et al. The sacroiliac joint in chronic low back pain. Spine. 1995;20:31–7.
  4. Weksler, Velan, et al. The role of SI joint dysfunction in the genesis of low back pain: the obvious is not always right. Arch Ortho Trauma Surg. 2007 Dec;127(10):858-888.
  5. DePalma, M*. Etiology of chronic low back pain in patients having undergone lumbar fusion. Pain Medicine. 2011; 12:732-39.
  6. Ha, Kee-Yong, et.al. Degeneration of sacroiliac joint after instrumented lumbar or lumbosacral fusion. Spine. 2008; 33(a): 1192-1198.
  7. Liliang, et.al. Sacroiliac joint pain after lumbar and lumbosacral fusion. Pain Medicine. 2011; 12:565-70.
  8. Sembrano JN, Polly DW. How often is low back pain not coming from the back? Spine. 2009;34:E27–32.
*Conducts clinical research for SI-BONE Inc.

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