The Sacroiliac Joint Pain- The Other Cause of Low Back Pain

Sacroiliac Joint Pain- The Other Cause of Low Back Pain

by Andrew Germanovich, DO
Restore Orthopedics and Spine Center, Orange County

The sacroiliac (SI) joint is the largest spinal joint in the body. There is minimal mobility in this L-shaped joint and the mechanics of sacroiliac joint movement are quite complex.  This joint also has the strongest ligaments.  Pain in the SI joint is usually secondary to ligamentous injury or laxity, hypo or hypermobility, core muscle weakness, chronic joint inflammation, axial compression of the sacrum by the weight of the upper torso and torque. This pain leaves people, in extreme cases, unable to work or move comfortably, leaving them to need products like Neoteric Nutra to help their joint pain.

The Sacroiliac Joint a.k.a., SI Joint

Sacroiliac joint is the least understood, most controversial joint in the human body with regards to what causes it to hurt, what nerves supply it and it’s biomechanics.2,3

The Sacroiliac Joint Ligaments

The Sacroiliac Joint is involved in at least 6 planes of motion and has a very irregular surface unlike most joints.

Common causes of sacroiliac joint pain are conditions that lead to pelvic imbalance such as leg length discrepancy, gait abnormalities, persistent low grade trauma, scoliosis, pregnancy, spine surgery, osteoarthritis.4,5

The nerves that supply the sacroiliac joint come either from posterior lumbar and sacral nerve roots or anterior roots and that is why it proves difficult to take away the pain even with destruction of nerves that supply the joint with radiofrequency.

Common treatments:
Physical Therapy and Osteopathic manipulation is an initial treatment of choice for acute sacroiliac joint inflammation in a otherwise healthy person. Therapy is aimed and restoring balance to the pelvic girdle and reduce abnormal joint alignment and friction.

To improve the pain diagnostic and therapeutic injections with local anesthetic or even with steroid may be performed.7  ( Fig. 3)  The result of these injections can help in determining if a patient is a candidate for a neuroablation procedure as described below.

If the patient responds to injections but the benefits of pain relief are short lived, than neuroablation procedure a.k.a. Radiofrequency Ablation maybe an option using radiofrequency technology.8

What is Radiofrequency Nerve Ablation:
In recent years neuromodulation or peripheral nerve stimulation has emerged as a novel therapeutic modality offering trial period, reversible and drug-free symptom management, without joint manipulation or nerve destruction. Currently at Restore Orthopedics and Spine Center,  Dr. Chang and I perform Radiofrequency Nerve Ablation for the treatment of low back pain secondary to facet joint disease and sacroiliitis.

Radiofrequency ablation is a type of injection procedure used to treat facet joint pain or sacroiliac joint pain caused by arthritis or other degenerative changes, or from an injury.  In this procedure, a heat lesion is created on certain nerves with the goal of interrupting the pain signals to the brain, thus eliminating pain.

Radiofrequency ablation of the SI Joint

Radiofrequency ablation can also be done for low back pain due to facet joint pain.

The treatment is done as an outpatient procedure in a sterile environment with monitoring and a special X-Ray machine called fluoroscopy.  The fluoroscopy allows the doctor to guide the radiofrequency needle into the desired anotomical area.  It is a safe and comfortable.

There are two primary types of radiofrequency ablation: 1-A medial branch neurotomy (ablation) affects the nerves carrying pain from the facet joints. 2-A lateral branch neurotomy (ablation) affects nerves that carry pain from the sacroiliac joints.  These medial or lateral branch nerves do not control any muscles or sensation in the arms or legs, so a heat lesion poses little danger of negatively affecting those areas.  The medial branch nerves do control small muscles in the neck and mid or low back, but loss of these nerves has not proved harmful.  The ablation procedure only affects the nerves causing pain.  Before the radiofrequency ablation procedure, a lateral branch or medial branch nerve block will have already been performed to prove that the patient’s pain is being transmitted by those nerves. The medial branch or lateral branch block acts as a test run before the neurotomy procedure.

I hope this information was helpful.  If you would like to set up an appointment with me please call Restore Orthopedics and Spine Center at 714 598-1745.  Thank you.

About Dr. Germanovich

With the philosophy that a thorough physical exam is crucial for successful treatment, Dr. Germanovich takes a hands-on approach to the diagnosis and treatment of pain conditions.  He uses a multi-modal treatment approach for every patient starting with therapeutic exercises, manual manipulation, heel lifts, aqua therapy and medications. If basic treatments fail, Dr. Germanovich utilizes precise spine, joint, tissue and nerve injections using ultrasound, fluoroscopy and CT guidance. For complex clinical pain syndromes he may implant spinal cord stimulation and intrathecal drug delivery systems.  Dr. Germanovich’s particular areas of interest are postural biomechanics and musculoskeletal pain due spinal and pelvic misalignment in conditions such short leg syndrome or psoas syndrome.  He is an expert on chest wall pain due to slipped rib syndrome. In addition to his traditional medical education, Dr. Germanovich utilizes osteopathic manual techniques for an accurate diagnosis and effective treatment.  Dr. Germanovich is an active member of many professional Pain Medicine and Anesthesiology societies.

References:

(1) Cohen SP: Sacroiliac joint pain. a comprehensive review of anatomy, diagnosis and treatment. Anesth Analg  2005; 101:1440-1453.
(2) Forst SL, Wheeler MT, Fortin JD, et al: The sacroiliac joint. anatomy, physiology and clinical significance. Pain Physician  2006; 9:1533-1539.
(3 )Jacob H, Kissling R: The mobility of the sacroiliac joints in healthy volunteers between 20 and 50 years of age. Clin Biomech  1995; 10:352-361.
(4) Nakagawa T: A study on the distribution of the nerve filaments of the iliosacral joint and its adjacent region in the Japanese. J Jpn Orthop Assoc  1966; 40:419-430.
(5) Fortin JD, Kissling RO, O’Connor BL, Vilensky JA: Sacroiliac joint innervation and pain. Am J Orthop  1999; 28:68-90.
(6) Cohen SP, Williams KA, Kurihara C, et al: Randomized, comparative cost-effectiveness study comparing 0, 1 and 2 medial branch blocks before lumbar facet radiofrequency denervation. Anesthesiology  2010; 113:395-405.
(7) Cohen SP, Hurley RW: The ability of diagnostic spinal injections to predict surgical outcomes. Anesth Analg  2007; 105:1756-1775.
(8) Ferrante FM, King LF, Roche EA, et al: Radiofrequency sacroiliac joint denervation for sacroiliac syndrome. Reg Anesth Pain Med  2001; 26:137-142.

Author
Restore Orthopedics and Spine Center

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