SI Joint Fusion
If you feel lower back pain when you stand up, it could be your SI joint beginning to act up.
SI joint pain can start as a dull ache or a sharp pain that moves to your upper back, or down to your buttocks, groin and thighs. You might notice it as hip pain, lower right back pain, lower left back pain or middle back pain. Pain in your SI joint can be worse in the morning when you get up, then gets better during the day, only to reoccur the next morning.
Movement can intensify the discomfort and can lead to a muscle spasm as your body tries to protect itself. Any of these indications could signal the start of sacroiliac joint dysfunction, or sacroiliitis, which can eventually lead to disability.
There are a number of non-surgical, conservative treatment alternatives, and most patients will not need surgery to correct their SI joint pain. If those options fail, your Inspired Spine surgeon may recommend a break-through surgery, minimally invasive SI joint fusion.
What are the Sacroiliac (SI) Joints?
Your sacroiliac (SI) joints are the large synovial joints in the pelvis near the base of the spine that connect the sacrum and ilium, linking your pelvis and lower spine. They’re weight bearing joints, and act as shock absorbers for the spine.
Synovial joints are the most common type of joint in the body and have a fluid-filled space where the bones of the joint meet to enable fluid movement. They are an essential component for the transfer of weight and energies between your upper body and legs. SI Joints also contain strong internal and external ligaments and muscles that that are called upon to absorb a significant amount of energy and shock when the body is exposed to scenarios such as trauma.
What is Sacroiliitis (Chronic SI Joint Pain)?
The SI joints are related to many large and small muscles, all of which can be affected when the joints become loose and begin to move abnormally. The result can be inflammation of the connective synovial tissue, which frequently leads to pain radiating to your hips, buttocks, and all the way down the back of your thighs, ultimately leading to disability.
SI joint pain can be an early symptom of ankylosing spondylitis, an inflammatory form of arthritis that occurs in the spine.
What Are the Causes of SI Joint Pain?
SI joint pain and related issues can be caused by several circumstances, including a traumatic event such as a car accident, fall, high impact or injury-causing mishap that results in a disruption in the ligaments and the tissues that support and make up the SI joints. Other possible causes include:
- Wear and tear degeneration that can come with aging (also known as osteoarthritis)
- Ankylosing spondylitis, a progressive type of arthritis caused by inflammation that affects the spine and hips
- Other inflammatory conditions
- Pregnancy, either before or after the birthing process, due physiological changes in the body
- SI joint pain can result from degenerative scoliosis
If you’re suffering from chronic SI joint pain, you’re not alone. An estimated one-third to two-thirds of the American public suffer from chronic pain every day, meaning that millions of Americans are potentially suffering from sacroiliac joint issues.
What Are the Symptoms of Sacroiliitis?
As mentioned, sacroiliitis can result in a dull ache, or sharp, stabbing pain localized to one side of your back, groin, pelvis or tailbone, that can radiate down your thighs. You may find that pain is exacerbated by standing and walking but is alleviated when you sit or lie down.
Other symptoms can include:
- Pain in the buttocks
- Sciatic pain in the leg that is characterized by a cramping or burning pain that travels down your leg(s), as well as groin and/or hip pain
- Prickling or tingling sensations in the mentioned anatomical areas
- Insomnia and depression, if the pain and discomfort are serious enough
- Worsening symptoms resulting from sustained or prolonged standing, sitting or lying down, or movement such as rising from a sitting position, bending, twisting or turning in bed
- Symptoms can also be triggered by activities such as stair-climbing or climbing inclines
How Is SI Joint Pain Diagnosed?
Studies have shown that up to 25% of all chronic lower back pain is caused by sacroiliac joint dysfunction, but SI Joint problems can often be overlooked in diagnosis.
The surgeons here at Inspired Spine recognize that symptoms of SI joint dysfunction, varying from mild inflammation to instability of the joints, can mimic other causes of lower left back pain, lower right back pain and middle back pain such as a herniated disc or sciatica.
Conversely, symptoms normally associated with sciatic nerve pain can be caused instead by an underlying sacroiliitis issue. And, if the SI joint becomes inflamed, it can cause irritation in the portion of the sciatic nerve that runs directly in front of the joint. The key to determining the best course of treatment is an accurate diagnosis.
Conservative SI Joint Pain Treatments
Inspired Spine always researches and recommends the simplest, least-invasive approach that is appropriate to your specific condition. Conservative, non-surgical treatment for back pain relief can include:
- Rest, ice/cold packs or heat applied to the affected area(s)
- Non-steroidal anti-inflammatory medications (NSAIDs) like ibuprofen and aspirin can reduce inflammation leading to less pain. They do not however fully treat the root problem
- Physiotherapy. A good physiotherapist can often help significantly by prescribing manipulative or manual therapy that improve muscle function in the area, help loosen any stiff joints, and improve mobility, including lower back exercises aimed at strengthening the support structures and tissues around the SI joints.
- Steroid and anti-inflammatory may be injected into the joints to help relieve symptoms and reduce inflammation (like NSAIDs but a lot more powerful). Additionally, local anesthetics injected right into the joints can be used to immediately dull the pain by stopping nerves from firing.
- Neuroablation is a longer-term, radio frequency procedure, usually performed out-patient, to provide back pain relief.
Surgical Options: Minimally Invasive SI Joint Fusion
Should conservative SI joint pain treatments fail to significantly provide increased quality of life, Inspired Spine’s minimally invasive SI joint fusion procedure may be recommended.
This technique works by “fusing” the joint using a titanium rod or compression screws, or by bone graft, depending on the preference of the Inspired Spine surgeon. This inhibits movement in the joint…so will reduce mobility a bit…resulting in less pain.
The SI Joint Fusion Procedure
An SI joint fusion procedure generally takes an hour to complete. You will go under general anesthesia for the procedure, which is very safe and extremely effective. A small incision is made to access the SI joint. Using specialized instruments, the sacrum and pelvis are fused to ensure enough stability to support the spine, and to decompress any affected nerves.
After the surgery, you’ll be moved to the recovery area to regain consciousness. You’ll usually stay in the hospital for another day, and any pain or discomfort can be managed using intravenous pain medication. You will then be discharged with oral medication for pain the next day.
Management of SI joint pathology will depend on the duration and severity of your back pain, and the dysfunction you’re experiencing.
Inspired Spine vs. Traditional Spinal Surgery
The breakthrough SI joint fusion procedure at Inspired Spine is much less invasive than more traditional open surgery techniques used elsewhere.
Traditional SI joint fusion surgery involves an incision 7-8 inches long, opening muscle and tissue to get the SI joint, removing cartilage and taking a piece of the pelvic bone, then grafting it to the joint. This surgery can take up to 3 hours or more, and can result in a hospital stay of up to 5 days.
What Are the Advantages of SI Joint Fusion at Inspired Spine?
Using the minimally invasive SI joint fusion procedure, patients enjoy the advantages of less scarring due to smaller incisions, less blood loss, shorter hospital stays, and faster recovery time.
This procedure also avoids the necessity of bone harvesting, hence preserving both bone and ligaments. Our spinal fusion procedures aim to stabilize the SI joint(s) to be strong enough for activities such as standing, walking, and running.
To date there have been over 20,000 SI fusions performed in the US. This procedure is also suitable for the elderly. This is important since about 38% of patients with SI joint pain are over the age of 65 years old. This group is not likely to respond well to conservative treatment such as physical therapy due to the degenerative nature of the condition.