During my training (residency and fellowships), the sacro-iliac joint (SI joint) and sacro-iliac pain was rarely addressed. This complicated piece of anatomy is responsible for transferring weight from the legs to back/ torso and vice versa. The stresses across the joint can easily be 2-3 times greater than your body weight. However, this area is often ignored because we have little understanding how the SI joint can cause pain.
Historically, the SI joint was thought to be the major source of leg, back, and sacro-iliac pain. Orthopedic textbooks in the 1950’s devoted more discussion to sacroiliac issues than to lumbar spine pain. The first published article for SI surgery was in 1926 titled “End-result study of arthrodesis of the sacroiliac joint for arthritis- traumatic and atraumatic” by Smith-Peterson and Rogers. As imaging (X-rays, CT scans, MRI) has become more popular, the lumbar spine has become more of a culprit for low back and leg pain. Interestingly, during this period of better imaging, spine surgery has become more common.
As we become more familiar with areas that can cause low back or leg pain (lumbar discs, pinched nerves, hip joints, spine joints); the SI joint has received renewed attention as a source of pain. It has been estimated that 20-25% of chronic low back pain may be related to the SI joint and nearly 50% of failed back surgeries may be related to the SI joint as a pain generator.
Conservative treatment for this problem includes physical therapy, stabilization belts, anti-inflammatories and injections. Usually these treatments help control the pain. The big problem is when pain and limitations persist despite using all conservative measures. Up until recently, we had no good surgical answer.
New technology has arrived which allows a minimally invasive technique to fuse (immobilize) the SI joint. This procedure allows for a quicker recovery (same day or overnight) with minimal complications. Over 25,000 patients have been treated with this procedure to date.
As a surgeon evaluating low back and leg pain, SI disease is a very real issue that needs to be considered in patients. Surgery is not an answer for everyone however, if the SI joint can be isolated as a pain source and conservative measures have failed; surgery may be an option.
-Dr. Paul Saiz, MD