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Spine Conditions

Sacroiliac Joint Disorders

Sacroiliac (SI) joint disorders are a challenging condition affecting up to 30 percent of patients with chronic lower back pain. According to published scientific data, it is common for pain from the SI joint to feel like disc or lower back pain. For this reason, SI joint disorders should always be considered in lower back pain diagnosis.

The SI joint is located in the pelvis; it links the iliac bones (pelvis) to the sacrum (lowest part of the spine above the tailbone). It is an essential component for shock absorption to prevent impact forces from reaching the spine.

The SI joint is the function of the triangular-shaped sacrum and the pelvis. Structurally and mechanically, it is like a keystone that connects the torso to the pelvic ring/arch and legs.

The joints have limited mobility, but like any joint, may be susceptible to arthritic changes over time, especially in patients who have had prior lumbar fusions.

The SI joint is a significant cause of lower back pain and may affect populations in all age groups.  It may be due to direct trauma, a fall, a motor vehicle accident, or childbirth.  Clinical publications have identified the SI joint as a pain generator in 15-30 percent of chronic lower back pain patients. In addition, the SI joint is a pain generator in up to 43 percent of patients with continued or new-onset lower back pain after lumbar fusion.

Like any other joint in the body, the SI joint can degenerate or its supporting ligaments may be injured. When this happens, people can feel pain in their buttocks, lower back, groin, and even their legs. This is especially true with lifting, running, walking, or lying on the involved site.

It is important to note that on occasion, patients who have not had symptomatic relief from lumbar spine surgery may actually have had other issues to begin with. Pain in the lower back and buttocks may come from the SI joint, the hip, the spine, or any combination of these three interrelated potential pain generators.

Pain from SI joint dysfunction can be felt anywhere in the lower back, buttocks, or in the legs. Chronic SI joint pain or dysfunction can make it difficult to perform common daily tasks and can affect many aspects of a patient’s life.

Pain is often in the buttocks with radiation into the thigh or groin but can also be present in the low back. The following are typical symptoms of SI joint disorders:

  • Lower back pain
  • Pain, numbness, tingling, and weakness in lower extremity
  • Pelvis/buttock pain
  • Hip/groin pain
  • Feeling of leg instability (buckling, giving way)
  • Disturbed sleep patterns due to pain
  • Disturbed sitting patterns (unable to sit for long periods, sitting on one side)
  • Painful sitting
  • Painful sit-to-stand
  • Painful climbing stairs

Many people have pain that worsens over time; however, over half the time, SI joint pain can be related to a specific event, often an injury. It is difficult to relate any single specific functional difficulty (including walking, sitting, standing, sleeping on the affected side, job activity, bowel movements, cough, sneeze, etc.) directly to the SI joint as a source of pain.

Other causes may be due to

  • Trauma to the Lumbar Spine or Hips
  • Prior Lumbar Fusion
  • Pregnancy/Childbirth
  • Inflammatory Joint Disease (e.g. Sacroiliitis)
  • Degeneration Due to Age
  • Leg Length Discrepancy

Dr. Ball will consider all the information you provide, including any history of injury, location of your pain, and problems standing or sleeping. As part of your physical exam, he will ask you to stand or move in different directions and point to where you feel pain, and he may feel for tenderness over your SI joint.

A variety of tests performed during the physical examination may help reveal the SI joint as the cause of your symptoms. Sometimes, X-rays, CT-scan, or MRI may be helpful in the diagnosis of SI joint-related problems. It is also important to remember that more than one condition (like a disc problem) can coexist with SI joint disorders.

The most relied upon and accurate method to determine whether the SI joint is the cause of your lower back pain symptoms is to inject the SI joint with a local anesthetic. The injection is delivered with either fluoroscopy or CT guidance to verify the accurate placement of the needle in the SI joint. If your symptoms are decreased by at least 50 percent, it is likely that the SI joint is either the source of or a major contributor to your lower back pain. If your symptoms do not improve after SI joint injection, it is less likely that a problem with your SI joint is the cause of your lower back symptoms.

At a Glance

Dr. Hieu Ball

  • Double fellowship-trained orthopedic
  • Orthopedic surgery residency at Harvard Medical School
  • Over 20 years of spine surgery experience
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