WHAT IS SACROILIAC (SI) DISEASE?
The sacroiliac joint is located between the sacrum (the base of the spine) and the ilium (the lateral part of your pelvis). Like any joint, the SI joint is susceptible to aging, direct trauma, or any disease of the spine, sacrum or pelvis. Conversely, often SI disease is misdiagnosed as pelvic or back pain. Too much movement (hypermobility) causes discomfort in the lower back and/or hip, as well as the groin. Pain from too little movement (hypomobility) is often felt on one side of the low back, buttocks thigh. Hypomobility may also be a generator of “sciatic-like” pain in the leg.
ARE THERE RISK FACTORS FOR SI DISEASE?
Any movement (sports, job related or personal activities, etc.) placing stress on the back and pelvis can cause SI pain. Deconditioning of back muscles (lack of exercise), may contribute also. In women, hormones release to open the pelvis at birth, may lead to hypermobility often throughout the remainder of their lives. Weight gain and obesity place stress on the SI joints. After back surgery, especially if a lumbar fusion is performed, SI pain is also seen.
HOW IS SI DISEASE DIAGNOSED?
Mostly on clinical findings like local tenderness on palpation or movement of the SI joint. Imaging and x-rays are useful to rule our back, hip, or pelvic conditions. Generally injections provide information as to whether SI disease is present or not.
WHAT IS THE INITIAL TREATMENT FOR SI DISEASE?
Anti-inflammatory medications, physical and chiropractic treatments, and weight control are primary treatments. OPIOIDS ARE TO BE AVOIDED! Home treatment including stretching, muscle conditioning and aerobic exercise are also recommended.
SO… WHAT IF INITIAL TREATMENT FOR SI DISEASE DOESN’T WORK?
Interventional options remain the mainstay of advanced treatment of SI disease. In general, successful SI injections assure that the diagnosis is accurate. Unfortunately SI injections overwhelmingly are not a long-term solution. The following should be considered as such:
--Sacroiliac Radiofrequency Ablation (SI RFA): This procedures introduces a special radiofrequency needle into the region where the nerves within and adjacent to the SI joint. The needles create a controlled heat burn, disrupting pain signals being transmitted to the brain. Although SI RFA may last significantly longer than an injection (weeks to months), the pain invariably returns. SI RFA may be repeated, however it may be less effective when repeated multiple times.
--Sacroiliac Fusions (SI Fusion): Both hypo or hypermobility of the SI joint cause pain. SI fusion can eliminate pathologic movement in the former, and re-establish a normal Si joint space in the latter. Si fusion is a minimally invasive outpatient procedure that is as safe as it is effective, and done through a one to one and a half inch incision.
--Peripheral Nerve Stimulation (PNS): The Cluneal nerves adjacent to and above the SI joint are also responsible for SI pain. Direct electrical stimulation of the SI joint results in an immediate and significant reduction of discomfort. This is accomplished by placing two special wires (leads) in our office, for a three to five day trial. If there is enough pain relief, the leads can be implanted as an out patient procedure. Following this, the lead receives a signal from a transmitter that is worn on the body. You then control the level and type of stimulation.
IF YOUR PATIENT POSSIBLY HAS SACROILIAC JOINT PAIN… TALK TO OUR PROVIDERS ABOUT OPTIONS
Phone: 928-788-3333 THE TRISTATE PAIN INSTITUTE Fax: 928-788-3555