Mark W. McFarland, DO & Raj N. Sureja, MD
In our practice, we diagnose many patients who suffer from sacroiliac (SI) joint dysfunction, who may have been previously treated for idiopathic chronic low back pain. The National Institutes of Health states, “Sacroiliac joint (SIJ) pain is an underappreciated source of mechanical low back pain, affecting between 15 and 30% of individuals with chronic, nonradicular pain.” Why do so many people have issues with these small but active joints?
SI joints become painful when the cartilage within them erodes over time, causing arthritis. Pain then develops due to too much or too little movement in the joint. Some causes of SI joint pain are injury (sports, falls, car accidents), arthritis, pregnancy, infection, and stiffness in older age. A small percentage of people who have had lumbar spinal fusion surgery are also at risk for Adjacent Level Segment Disease, which can cause SI joint dysfunction.
Treatment for SI joint dysfunction starts conservatively, with the goal of reducing irritation and returning to normal motion and function. OTC NSAIDs or oral anti-inflammatory/steroids will be recommended, along with activity modification/rest and ice or heat intermittently. Once we have a handle on the acute inflammation, physical therapy and manual manipulation can help the patient with range of motion, strengthening and various modalities to promote healing.
If the patient doesn’t respond to these treatments, a therapeutic steroid injection into the SI joint will be recommended. Many patients get significant relief from these injections and find that they may only need to repeat them at quarterly intervals.
Radio Frequency Ablation is a procedure in which the nerves supplying the SI joint are cauterized. These nerves cannot transmit pain signals to the brain well, so pain is greatly reduced. In time, the nerves will regenerate, but the pain will not come back as intensely. Not all patients are candidates for this procedure, and it’s not covered by many insurance companies. It is a treatment option for those patients who don’t respond to other forms of treatment.
Lateral Open SI Joint Fusion is a surgical procedure not recommended by orthopaedists due to complications and the limp many patients have post-operatively.
Recent technological improvements have allowed the SI joint fusion implant (about the size of an almond) to be placed through a minimally invasive incision to become more “patient-friendly” with much improved outcomes. This posterior joint fusion procedure can be done now under local anesthetic in a sterile procedure room. The patient will only have an inch-long incision and will be able to walk out of the clinic shortly after the fusion procedure is complete, without the limp of SI fusion surgeries of the past.
SI joint fusion is not for every patient; there are risks and potential complications to consider. Not all insurances will cover SI joint fusion. However, for patients with chronic, recalcitrant pain radiating from the sacroiliac joint, this new, minimally invasive implant and procedure could be life-changing.
Mark W. McFarland, DO and Raj N. Sureja, MD are physicians with Orthopaedic and Spine Center in Newport News. Dr. McFarland is a Board certified and fellowship-trained orthopaedic spine surgeon. Dr. Sureja is a Board certified, fellowship-trained Interventional Pain Management Doctor. osc-ortho.com
