Sacroiliac SI Joint Dysfunction and Treatment Options
The SI joints are the major connection joints between the upper and lower body. They have a minor rocking motion, and if they are injured or deteriorated they can be a significant source of pain. The pain is caused by damage or injury to this joint that is located between the sacrum and the hip. Sacroiliac pain can mimic other conditions, such as a herniated disc or hip problem, so an accurate diagnosis is important to determine the source of pain. Clinical publications have identified the SI joint as a pain generator in 15-30% of chronic lower back pain patients. In addition, the SI joint is a pain generator in up to 43% of patients with continued or new onset lower back pain after a lumbar fusion.
Symptoms of SI Joint Pain
The signs and symptoms of SI pain start in the lower back and buttock, and may radiate to the lower hip, groin or upper thigh. While the pain is usually one sided, it can occur on both sides. Patients may also experience numbness or tingling in the leg or a feeling of weakness in the leg. Symptoms may worsen with sitting, standing, sleeping, walking or climbing stairs. Often the SI joint is painful sitting or sleeping on the affected side. Some people have difficulty riding in a car or standing, sitting or walking too long. Pain can be worse with transitional movements (going from sit to stand), standing on one leg or climbing stairs. Quite often patients can pinpoint where their pain is located (Fortin Finger Test, figure 1), or commonly lean to one side when sitting in a chair.
- Lower back pain near the hip and buttock
- Pain, numbness, tingling, weakness in legs
- Pelvic/buttock pain
- Hip/groin pain
- Feeling of leg instability (buckling, giving way)
- Disturbed sleep patterns due to pain
- Inability to sit for long periods, sitting on one side
- Pain going from sitting to standing
Sacroiliac joint pain is very real and very painful. Dr. Jeff LaPorte has a special interest in treating SI Joint conditions, including a surgical solution if needed.
What is the Sacroiliac SI Joint?
The Sacroiliac (SI) joints are located between the iliac bones and the sacrum, connecting the spine to the hips. The two joints provide support and stability, and play a major role in absorbing impact when walking and lifting. From the back, the SI joints are located below the waist where two dimples are visible.
Strong ligaments and muscles support the SI joints. There is a very small amount of motion in the joint for normal body flexibility. As we age our bones become arthritic and ligaments stiffen. When the cartilage wears down, the bones may rub together causing pain. The SI joint is a synovial joint filled with fluid. This type of joint has free nerve endings that can cause chronic pain if the joint degenerates or does not move properly.
Sacroiliac joint pain ranges from mild to severe depending on the extent and cause of injury. Acute SI joint pain occurs suddenly and usually heals within several days to weeks. Chronic SI joint pain persists for more than three months; it may be felt all the time or worsen with certain activities.
Other terms for SI joint pain include: SI joint dysfunction, SI joint syndrome, SI joint strain and SI joint inflammation.
Making a Diagnosis
A variety of tests performed during a 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. Dr. LaPorte will consider all the information you provide, including any history of injury, location of your pain, and problems standing, sitting, or sleeping.
The most relied upon method to accurately 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 will be delivered by a Pain Management Physician under fluoroscopy to verify accurate placement of the needle in the SI joint. If your symptoms are decreased by at least 50%, it can be concluded that the SI joint is either the source of or a major contributor to your lower back pain.
If the level of pain does not change after SI joint injection, it is less likely that the SI joint is the cause of your lower back pain.
Once the SI joint is confirmed as the cause of your symptoms, treatment can begin. Some patients respond to physical therapy, use of oral medications, or joint injection therapy. If nonsurgical treatments and joint injections do not provide long term pain relief then you and your surgeon may consider other options, including minimally invasive surgery.
Surgical Solution: Minimally Invasive SI Joint Fusion with the iFuse Implant System®
The iFuse Implant System® manufactured by SI-BONE®, Inc. is a minimally invasive surgical SI joint treatment option that provides stabilization and fusion of the SI joint for some causes of SI joint pain. This is accomplished by inserting triangular-shaped titanium implants across the joint to maximize post-surgical stability and weight bearing capacity. The procedure is done through a small incision and takes about an hour. SI joint treatment using the patented triangular design of the iFuse Implant™ has produced unparalleled clinical results. More than thirty published, peer-reviewed articles demonstrate safety and effectiveness of the iFuse Implant System. iFuse is the only SI joint fusion system with clinical studies demonstrating that treatment improved pain, patient function, and quality of life. There are potential risks associated with the iFuse Implant System. It may not be appropriate for all patients and all patients may not benefit. You can discuss the risks and if you are a good candidate for this specific surgery with your surgeon.
- Bernard TN, et al. Recognizing Specific Characteristics of Nonspecific Low Back Pain. Clin Orthop Relat Res. 1987;217:266–80.
- Schwarzer AC, et al. The Sacroiliac Joint in Chronic Low Back Pain. Spine. 1995;20:31–7.
- Maigne JY, et al. Results of Sacroiliac Joint Double Block and Value of Sacroiliac Pain Provocation Tests in 54 Patients with Low Back Pain. Spine. 1996;21:1889–92.
- Sembrano JN, et al. How Often Is Low Back Pain Not Coming From the Back? Spine. 2009;34:E27–32.
- DePalma MJ, et al. Etiology of Chronic Low Back Pain Patients Having Undergone Lumbar Fusion. Pain Med. 2011;12:732-9.
- Polly, D.W. et al., Neurosurgery. 2015. A list of additional published studies is available at www.si-bone.com/results – Dr. Polly is an investigator on a clinical research study sponsored by SI-BONE. He has no financial interest in SI-BONE. Research was funded by SI-BONE, Inc.
- Duhon, B . et al., Triangular Titanium Implants for Minimally Invasive Sacroiliac Joint Fusion: 2-Year Follow-Up from a Prospective Multicenter Trial. Int J Spine Surg. 2016;10:Article 13. – Dr. Duhon is a paid consultant of and conducts clinical research for SI-BONE Inc. Research was funded by SI-BONE, Inc.