Posted on May 21, 2023
The sacroiliac (SI) joints bridge the lumbar spine and the pelvis. These joints bear a great deal of weight and are important in balancing your gait. As part of the pelvis, they undergo many stresses, and like other joints can degenerate.
The SI joints are often injured by falls onto the buttock or can occur after hip surgery. It is a more common occurrence in people who have scoliosis, flat feet, and patients who have lumbar spine fusions down to their sacrum (S1).
Often, people with sacroiliac problems have pain with changing positions, such as from sitting to standing. They can experience a lot of pain in the evening, especially when turning during sleep.
Because the joints stiffen with inactivity, the patient may feel extraordinarily stiff with more pain in the morning. For this reason, these same symptoms can occur after sitting for more than 30 minutes.
Initial treatment typically includes rest, anti-inflammatories, and physical therapy. Sometimes, a sacroiliac belt is recommended to help stabilize the joint.
If these treatments are not adequate, however, sacroiliac joint steroid injections can be undertaken. These are normally performed as two sequential injections. The first injection should lead to about 50% relief, and the second one should help with the remainder of the pain.
It is important to note that not all pain radiating over the sacroiliac area emanates from the sacroiliac joints. The pain can also be referred from the lumbar facet joints or from lower lumbar nerve pain that emanates from a disc protrusion or spinal stenosis. A careful review of your history, physical exam, as well as X-ray and MRI findings should differentiate these different causes.
Once the diagnosis of sacroiliac joint pain and dysfunction has been corroborated with injections, the sacroiliac joint can be reinjected every 3 to 6 months.
If the sacroiliac joint pain cannot be controlled with injections, there are several other options.
First, some insurances allow us to perform radiofrequency ablation or denervation of the joint. Initially, two diagnostic injections are performed by numbing the nerves going to the sacroiliac joints. This is followed by radiofrequency heat lesioning, which may need to be repeated every six months.
Alternatively, we can fuse the sacroiliac joints with a minimally invasive procedure. Through a small 1 to 2 inch incision, screws can be placed across the sacroiliac joint to stabilize and fuse the joint. Another option is to place bone “dowels” into the joint itself to promote fusion.
Finally, if these options are not indicated or unsuccessful, it is possible to place a Middle Cluneal Nerve Stimulator over the nerves going to the sacroiliac joint. This is done with a Peripheral Nerve Stimulator (PNS) wire placed under the skin tissues. By stimulating the wire electrodes, the pain signals from the sacroiliac joint traveling to the brain can be altered such that the pain ceases or is greatly diminished.
Call 239-437-8000 to learn more or visit: APMSS.net.