In this week's episode, Drs. Gurai and Joves discuss one of the under appreciated pain generators for low back pain- the sacroiliac joint (SI joint).

The sacroiliac joint is the place where the spine meets the pelvis. It is, as the name suggests, a joint between the sacrum (lowest portion of the spine) and the ilium (one of the bones of the pelvis). Medical studies attribute between 10 and 40 percent of back pain to the SI joint. The most common patients affected are pregnant women and patients with ankylosing spondylitis, though many patients present with pain from trauma, cummulative injuries, and acquired stress such as with prior lumbar fusion.

The SI joint is a complex structure with many possible pain generators- the bones, the joint (which is interesting because it has two components; an anterior diarthrodal joint with a complex capsule and a posterior syndesmosis with extracapsular ligaments and muscles involved), the ligaments (at least 11 different ones involved in stabilization), and of course the muscles.

SI joint pain generally is aching pain in the low back and buttock. It can radiate further down the leg or anteriorly towards the groin as well. The most consistent sign for SI mediated pain is pointing to the posterior superior iliac spine as the maximal point of tenderness, but there are multiple physical examination maneuvers a provider can utilize to provoke this pain.

Diagnostic injection is still considered the gold standard for diagnosis of true SI joint pathology. Once the appropriate diagnosis, we work through the normal treatment algorithms for pain diagnoses including conservative measures such as education, therapy and physical modalities such as bracing and low level laser therapy, and medications.

If these conservative treatments are not able to control the pain and improve the patient's quality of life, we move on to invasive procedures. Steroid injections into the joint are the standard of care and work very well for many patients. If steroid injections are either ineffective or don't last long enough, other needle based options such as radiofrequency ablation and platelet rich plasma injections are great options for more prolonged pain relief.

For patients that do not get the improvement that we're hoping, there are great surgical options to fuse the SI joint and prevent movement, which in turn should decrease the pain.

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This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve.