The sacroiliac (SI) joint is a strong weight bearing joint in the pelvis that connects the sacrum and pelvis. There are two joints, one on each side of the sacrum. This joint is reinforced by strong surrounding ligaments. Both joints move together as single unit to transmit upper body forces and provide shock absorption for the spine. A series of ridges and valleys in the joint fit together like a lock and key, much like if you put your knuckles together. There is a small amount of movement in this joint to allow for a walking gait pattern in normal human locomotion. Just like other joints in the body, this joint can become inflamed, unstable and dysfunctional.
Over the past several years, there has been increasing awareness and recognition of SI joint inflammation as a potential and common source of low back pain. A 2009 study published in Spine by Sembrano et al. found that up to 25% of patients presenting to a spine clinic had significant pain from the hip or SI joint. In 2011, DePalma et al in Pain Medicine identified the SI joint as a low back pain generator in 43%, and possibly as high as 61%, of patients with continued back pain after a lumbar fusion.
Pain can be from inflammation of the sacroiliac joint, called sacroiliitis. This is commonly felt as pain on one side of the lower back to the right or left of midline where the joint is located. The inflamed joint can become dislocated, as if the lock and key grooves are in the wrong position. When SI joint dysfunction is severe, pain can refer to the hip, groin, buttocks, and even down the back of the thigh. Pain may be worse with movements that stress that joint, such as standing up from a seated position, walking up an incline, elliptical exercise, prolonged sitting or walking, or twisting when rolling in bed at night. SI joint dysfunction or inflammation can mimic pain similar to degenerative hip disease, hip bursitis, lumbar disc herniation, or pinched nerves.
Initial conservative treatment options for the SI joint typically involve physical therapy, medication and injection management. Physical therapy works on manually readjusting the SI joint when it is immobilized or dislocated and provides stabilization exercises to long term management. Medications such as NSAIDs may be used to decrease overall inflammation. Localized steroid injections into the SI joint can provide targeted therapy to reduce pain and inflammation and allow physical therapy to make further progress. If the SI joint favorably responds to steroid injections but the benefits only last temporarily, another non-operative treatment exist called radiofrequency ablation, RFA.
Chronic SI Joint Pain Surgery
When non-surgical treatments for the SI joint fail, surgical options provide permanent stability and pain reduction. Our surgeons remain on the forefront of providing innovative evidence-based spine treatments. Our very own Dr. Christopher Good was the first surgeon in North America to perform robotic guidance sacroiliac fusion in June 2013. Our collective expertise in SI fusion techniques and involvement in SIFI allows the Virginia Spine Institute to offer an array of treatment options for our patients suffering from sacroiliac related pain.