Published on May 21, 2023
Advanced Pain Management and Spine Specialist Jonathan S. Daitch, MD, and Associates
The sacroiliac joint (SI) connects the lumbar spine to the pelvis. These joints bear a lot of weight and are important for balanced gait. As part of the pelvis, they endure a lot of stress and, like other joints, can degenerate.
The sacroiliac joint is often injured from falls or may occur after hip surgery. This condition is more common in patients with scoliosis, flat feet, and patients with lumbar spine fusion to the sacrum (S1).
Often, people with sacroiliac joint problems experience pain when changing positions, such as from sitting to standing. They experience a lot of pain at night, especially when turning over while sleeping.
Because joints become stiff from inactivity, patients may feel particularly stiff and have increased pain in the morning. Therefore, these same symptoms can occur after sitting for more than 30 minutes.
Initial treatment usually includes rest, anti-inflammation, and physical therapy. Sometimes, sacroiliac straps are recommended to help stabilize the joint.
However, if these treatments are not effective enough, sacroiliac joint steroid injections may be performed. These are usually administered as two consecutive injections. The first injection should relieve about 50% of the pain, and the second injection should help relieve the remaining pain.
It is important to note that not all pain in the sacroiliac region originates from the sacroiliac joints. Pain may also come from lumbar facet joints or lower lumbar nerve pain caused by disc herniation or spinal stenosis. A careful review of your medical history, physical examination, and X-ray and MRI findings should be able to differentiate between these different causes.
Once the diagnosis of sacroiliac joint pain and dysfunction is confirmed by injection, the sacroiliac joint can be reinjected every 3 to 6 months.
If your SI joint pain cannot be controlled with injections, there are several other options.
First, some insurances allow us to perform radiofrequency ablation or denervation joints. Initially, two diagnostic injections are given by anesthetizing the nerves leading to the sacroiliac joints. Next is radiofrequency thermal damage, which may need to be repeated every six months.
Or we can Fusion of sacroiliac joints Through minimally invasive surgery. Through small 1 to 2 inch incisions, screws can be placed in the sacroiliac joint to stabilize and fuse the joint. Another option is to place bone “pins” into the joint itself to promote fusion.
Finally, if these options are not indicated or are unsuccessful, you can place a mid knee nerve stimulator Crossing the nerves leading to the sacroiliac joints. This is through a Peripheral Nerve Stimulator (PNS) The wire is placed under the skin tissue. By stimulating the electrode wire, the pain signals transmitted from the sacroiliac joints to the brain can be changed, thereby stopping or greatly reducing the pain.
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