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 or thigh. Hypermobility 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?
If medications, exercise, and other therapies are not effective, and sacroiliac disease is confirmed after injections, three additional options remain: (1) Radiofrequency Ablation; (2) Peripheral Nerve Stimulation; and (3) Sacroiliac Fusions. Let’s explore SI fusions further…
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. When initially developed, SI fusions were open operative procedures, with long hospitalizations and recovery times.
The SI fusion we currently offer is an outpatient procedure that is minimally invasive, done entirely through a one to one and a half inch incision. Immediately after the procedure, you should be able to walk out of the building. Furthermore, SI fusion does not preclude any patient from undergoing future SI injections, radiofrequency treatments, or peripheral nerve stimulator implants if needed. It is hoped that the fusion itself however, will alleviate the need for future procedures, necessitate less medication, and greatly enhance daily activities and overall quality of life.