Diagnosis and interventional pain management options for sacroiliac joint pain

Chuang, Ching‑Wei; Hung, Sheng-Kai; Pan, Po‐Ting; Kao, Ming‐Chang

doi:10.4103/tcmj.tcmj_54_19

Cited by 28 publications

(32 citation statements)

References 42 publications

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“… 13 Minimally invasive (MIV) procedures have grown in popularity since 2008 and have mostly replaced open surgical fusions (OSF). 14 – 18 This is due to improved outcomes, reduced recovery times, higher union rates (OSF has non-union rates of 9–41%), and reduced risk of serious complications (OSF complication rates of 30% compared to 13.7% for MIV). 19–21 MIV SIJ fusion can be performed using two approaches: lateral or posterior.…”

Section: Introductionmentioning

confidence: 99%

Pain Relief Salvage with a Novel Minimally Invasive Posterior Sacroiliac Joint Fusion Device in Patients with Previously Implanted Pain Devices and Therapies

Deer¹,

Rupp²,

Budwany³

et al. 2021

JPR

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Background Sacroiliac joint (SIJ) pain is a common cause of low back pain, a problem experienced by two-thirds of adults in the United States population. Traditionally, the management of persistent SIJ-related pain has involved conservative therapies (physical therapy, topical medications, oral anti-inflammatory medications), interventional therapies (SIJ steroid injections or ablation), and surgery (SIJ fusion; open and lateral approach). Recent advancements in technology have paved the way for SIJ fusion via a posterior approach, which aims to minimize complications and enhance recovery. Objective The purpose of this study is to introduce the concept of the posterior approach to SIJ fusion as a feasible adjunct and salvage technique for patients with inadequate pain relief from other minimally invasive surgical procedures, and to validate its efficacy through a retrospective multicenter data analysis. Design Multicenter retrospective observational study. Methods Patients with refractory SIJ pain were treated by interventional pain physicians at one of the eight different pain management centers. All patients underwent posterior SIJ fusion via the LinQ TM sacroiliac fusion procedure. Demographical data were collected, in addition to patient-reported pain relief. Results A total of 111 patients were included in the study and underwent posterior SIJ fusion for refractory SIJ-related pain following the use of spinal cord stimulation (SCS), interspinous spacer (ISS), intrathecal drug delivery (IDDS), and/or minimally invasive lumbar decompression (MILD). Overall, the mean patient reported pain relief following posterior SIJ fusion was 67.6%. In patients with a history of failed back surgery syndrome, the mean patient reported pain relief was 76.5%. Conclusion In this retrospective case series of patients with continued intolerable pain following SCS, ISS, IDDS, or MILD, a novel posterior SIJ fusion device provided significant pain relief in a salvage manner. These early results suggest that this intervention may be a therapeutic option to consider in these patients.

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Section: Introductionmentioning

confidence: 99%

Pain Relief Salvage with a Novel Minimally Invasive Posterior Sacroiliac Joint Fusion Device in Patients with Previously Implanted Pain Devices and Therapies

Deer¹,

Rupp²,

Budwany³

et al. 2021

JPR

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“…The largest true synovial joint in the body, the sacroiliac joint (SIJ), is one of the most common sources of chronic lower back pain (LBP), as it is a highly specialized joint that is innervated by spinal nerves and grants stability, limited flexibility, and support of the upper body [1][2][3]. Sacroiliitis is defined as the inflammation of the SIJ that can present in both rheumatic and non-rheumatic disorders and can be caused by both traumatic and atraumatic etiologies [2,4]. Consequently, the SIJ has been estimated to account for 15%-30% of chronic low back pain in the general population.…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, the SIJ has been estimated to account for 15%-30% of chronic low back pain in the general population. Risk factors include obesity, low-grade trauma such as jogging, pregnancy, lumbar fusion, scoliosis, leg length discrepancy, and gait abnormalities [ 2 , 3 ]. The pain can be attributed to the posterior extra-articular elements, such as ligamentous or muscular injuries, enthesopathy, or intra-articular elements [ 2 , 3 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…These gender dimorphisms include a narrower sacral angulation, a shorter posterior sagittal diameter of the pelvic outlet, and a narrower sacrum, as well as an iliac bone groove that usually develops in the second decade of life [ 1 ]. While pregnancy alone is considered to be an extra-articular pathological cause of SIJ pain, the asymmetry of laxity has been correlated to the presence of pain and clinical symptoms [ 1 , 2 ]. Another cause of pregnancy-related SIJ pain, although rare, is septic sacroiliitis, which is approximated to be 15% of all septic sacroiliitis cases [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although there are no specific historic features, provocation tests, or radiological findings that conclude a definite diagnosis of SIJ pain, the diagnostic algorithm is conducted through a proper medical history followed by physical examination, imaging study, and sometimes diagnostic SIJ blocks [ 2 , 3 ]. There is a wide array of non-surgical treatments including pain medication, steroid injections, physical therapy, individualized pelvic stabilizing exercises, and radiofrequency ablation of the sacral nerves [ 3 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Sacroiliac Joint and Pelvic Dysfunction Due to Symphysiolysis in Postpartum Women

Sekhon

Doan

Bowers

et al. 2021

Cureus

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Pregnancy-related pain in the sacroiliac joint (SIJ), lumbosacral region, pubic symphysis, or in any combination of these joints has been coined as pelvic girdle pain (PGP) and has been estimated to affect almost half of all pregnant women. SIJ dysfunction in pregnancy is due to multiple biomechanical mechanisms, such as increased weight, change in posture, increased abdominal and intrauterine pressure, and laxity of the spine and pelvic structures. Moreover, when compared to men, women have increased SIJ mobility due to increased pubic angle and decreased SIJ curvature. These differences may assist in parturition where hormones, such as relaxin and estrogen, cause symphysiolysis. A retrospective review of the literature was conducted in the PubMed database using the search term "pregnancy-related sacroiliac joint pain." All peer-reviewed studies were included. Around 8%-10% of women with PGP continue to have pain for one to two years postpartum. Patients that were treated with SIJ fusion show statistically significant improvement in pain scores when compared to patients that had non-operative treatment. Although we have a number of studies following patients after sacroiliac (SI) joint fusion for pelvic pain with SI joint dysfunction, further research is needed to study sacroiliac fusion for SI joint dysfunction in postpartum women to better tailor and optimize surgical outcomes for this patient population.

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Sacroiliac joint pain in adolescents: Diagnostic and treatment challenges

Cucchiaro

Francis

Householder

et al. 2022

Paediatric and Neonatal Pain

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The aim of this review was to assess diagnostic and treatment challenges of adolescents with SI joint pain. We diagnosed 13 of the patients who were referred to our chronic pain clinic because of low back pain (30%) with SI joint pain based on provocative tests response. We performed SI joint steroid infiltration. Six patients (46%) felt better immediately after the procedure and 1 (8%) patient had a one‐side only pain relief after a bilateral block. Four of these patients (31%) did not experience any further episode of pain during the follow‐up and three patients reported recurring pain on average 2 months after the initial procedure. The 2nd procedure was successful in two patients and the third one experienced pain again 12 months later, requiring a third successful infiltration. Six patients (46%) experienced pain again within a few hours or days after the infiltration and their pain score were unchanged compared with what they had reported prior to the procedure. We were unable to place the needle within the joint under fluoroscopy in 1 patient; however, we were successful repeating the procedure under CT guidance. One patient experienced a motor and sensory block in the distribution of the sciatic nerve immediately after the procedure, which resolved within 24 and 48 hours, respectively. SI joint pain is a distinctive pathology that can be present in children and adolescents and is often overlooked by practitioners. Its diagnosis and management are challenging in this population as it is in adults. SI joint steroids injections may play a role in the management of these patients.

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Diagnosis and interventional pain management options for sacroiliac joint pain

Cited by 28 publications

References 42 publications

Pain Relief Salvage with a Novel Minimally Invasive Posterior Sacroiliac Joint Fusion Device in Patients with Previously Implanted Pain Devices and Therapies

Pain Relief Salvage with a Novel Minimally Invasive Posterior Sacroiliac Joint Fusion Device in Patients with Previously Implanted Pain Devices and Therapies

Sacroiliac Joint and Pelvic Dysfunction Due to Symphysiolysis in Postpartum Women

Sacroiliac joint pain in adolescents: Diagnostic and treatment challenges

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