New Treatments For SI Pain

What is Sacroiliac (SI) Joint Dysfunction?

Sacroiliac (SI) joint dysfunction occurs with structural changes to the joint or changes to the relative positions of the sacrum and pelvis.  Symptoms may start when the SI joint has too much movement (hypermobility) or too little (hypomobility).

If these ligaments are torn, the pelvis can become unstable.  When these ligaments become damaged either due to normal wear and tear or by injury, they may have excessive motion. This excessive motion may inflame and disrupt the joint and surrounding nerves.

Some physicians may also refer to SI joint dysfunction by other terms like sacroiliitis, SI joint inflammation, SI joint syndrome, and SI joint strain.

SI Joint Dysfunction Symptoms

The most common symptom of SI joint dysfunction is pain in the lower back, buttock, or legs. This can present as sciatica-like symptoms (leg pain, burning, numbness, and tingling) that mimic discogenic or radicular low back pain.

Causes of SI Joint Dysfunction

The causes of SI joint dysfunction can be split into five categories:

  • Traumatic (lifting, fall, accident)
  • Biomechanical (leg length discrepancy, prior lumbar fusion)
  • Hormonal (pregnancy/childbirth)
  • Inflammatory joint disease (sacroiliitis)
  • Degeneration (age-related wear and tear)

Diagnosing SI joint Dysfunction

In order to diagnose SI joint dysfunction, your physician will typically start with a history and a physical examination.  During the physical examination, your physician may try to determine if the sacroiliac joint is the cause of pain through movement of the joint. If the movement recreates the pain, the SI joint may be the cause of the pain.

Your physician may also use X-rays, a CT scan, or MRI to help in diagnosing the sacroiliac joint. It is also important to remember that more than one condition (like a disc problem) can co-exist with SI joint dysfunction.

Finally, your physician may request SI joint injections as a diagnostic test.  SI joint injections involve injecting a numbing medication into the SI joint. If the injection alleviates your symptoms, then that means your SI joints are most likely the source of your pain.

Treatment Option for Sacroiliac (SI) Dysfunction

Treatments can vary depending on the severity of your symptoms and how much they limit your everyday activities. Below are some of the treatment options you may want to discuss with your doctor, depending on your symptoms.

Nonsurgical Treatment for SI Joint Dysfunction

As the first line of treatment, your doctor may prescribe any one or more of the following:

  • Medications like non-steroidal anti-inflammatory drugs, help relieve pain and reduce inflammation.
  • Physical therapy can help provide strengthening and pelvic stabilization exercises to reduce the movement in the SI joint.
  • SI Belt wraps around the hips to help squeeze the sacroiliac joints together. This supports and stabilizes the pelvis and sacroiliac joints.
  • SI joint injections can reduce inflammation and relieve pain. The steroid medication is injected into the back.
  • Chiropractic treatment

Surgical Treatment of Sacroiliac Joint Dysfunction

If symptoms persist due to instability, your physician may recommend stabilizing your joint with sacroiliac joint fixation.

Traditional Open Surgery

Traditional sacroiliac joint fixation involves open surgery that may take several hours. Open surgery typically involves a large incision to access the SI joint, conduct bone removal, and add in a bone graft to help the joint heal. Open surgery usually translates into several days of hospitalization.

Minimally Invasive Procedure (see video below)

The iFuse Implant System® is a minimally invasive option for patients suffering from SI joint dysfunction.

The iFuse procedure takes about an hour and involves three small titanium implants inserted surgically across the SI joint. The entire procedure is done through a small incision, with no soft tissue stripping and minimal tendon irritation. Patients may leave the hospital the next day after surgery and can usually resume daily living activities within six weeks, depending on how well they are healing and based on the physician’s orders.

The iFuse procedure offers several benefits compared to traditional SI joint surgery such as:

  • Minimal incision size
  • Immediate post-operative stabilization
  • Minimal soft tissue stripping
  • A potentially quicker recovery

Dr. Gerlach is leading the way in northern Colorado with innovative treatments for SI Joint Dysfunction. He is the first and only surgeon in the Boulder County and the Northwest Denver regions to have successfully completed several of these SI joint procedures and the outcomes have been very rewarding.

If you have questions about your back pain, contact us to schedule an appointment with one of OCR‘s expert physicians. Interested in hearing Dr. Gerlach talk more about SI Joint Dysfunction? Here’s a video of him going into more detail.

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