Sacroiliac joint dysfunction in patients with imaging-proven lumbar disc herniation

Abstract

IntroductionDisc herniation leading to nerve root displacement with compression and causing radicular symptoms is only one of a variety of possible causes of lumbar and ischiadic pain. Pain radiating into the leg is not necessarily caused by irritation of the root [18,19]; Norman and May [25] identified the sacroiliac joint (SIJ) as one of the possible starting points of such complaints via injection of local anaesthetic. Disc herniations were detected on CT and MR scans in a high percentage of asymptomatic patients [5,16,17,31,32]. Likewise it has been shown that the size of herniations does not correlate with displayed clinical symptoms [6,8, 34]. If, despite the lack of sensory or motor losses, the incidental finding of pathologic disc morphology is concluded to be the source of pain, the wrong therapy may be initiated, e.g. nucleotomy, leading to unsatisfactory postoperative results [7,[28][29][30]. This has to be considered when a choice between surgical and non-surgical treatment is made.The lack of consideration of alternatives to disc-triggered pain is encouraged by the fact that some alternative diagnoses are undetectable by imaging procedures. Functional disorders in general, and dysfunction of the SIJ in specific, cannot be detected by CT or MRI. Reversible Abstract A dysfunction of a joint is defined as a reversible functional restriction of motion presenting with hypomobility according to manual medicine terminology. The aim of our study was to evaluate the frequency and significance of sacroiliac joint (SIJ) dysfunction in patients with low back pain and sciatica and imaging-proven disc herniation. We examined the SIJs of 150 patients with low back pain and sciatica; all of these patients had herniated lumbar disks, but none of them had sensory or motor losses. Forty-six patients, hereinafter referred to as group A, were diagnosed with dysfunction of the SIJ. The remaining 104 patients, hereinafter referred to as group B, had no SIJ dysfunction. Dysfunctions were resolved with mobilizing and manipulative techniques of manual medicine. Regardless of SIJ findings, all patients received intensive physiotherapy throughout a 3-week hospitalisation. At the 3 weeks follow-up, 34 patients of group A (73.9%) reported an improvement of lumbar and ischiadic pain, 5 patients were pain free. Improvement was recorded in 57 of the group B patients (54.8%); however, nobody in group B was free of symptoms. We conclude that in the presence of lumbar and ischiadic symptoms our presented data suggest consideration of SIJ dysfunction, requiring manual medicine examination and, in the presence of SIJ dysfunction, appropriate therapy, regardless of intervertebral disc pathomorphology. This could avoid wrong indications for nucleotomy.

The effect of two manipulative therapy techniques and their outcome in patients with sacroiliac joint syndrome

“…Also, by using Wilcoxon signed-rank test, we observed significant improvements in VAS and ODI within two groups throughout the trial. The positive finding in our study is in accord with findings of previous studies (Osterbauer et al, 1993;Galm et al, 1998;Shearar et al, 2005;Cleland et al, 2009), although, to the author's knowledge, there is no similar study comparing two manual manipulative therapy techniques for patients with SIJ syndrome; this correlate with our study. Also, significant differences in ODQ score were obtained in favor of the thrust manipulation group as compared to mobilization group.…”

“…Osterbauer et al (1993) applied mechanical forced manipulation (in contrast with our study that compare two manual manipulative therapy techniques) in patients with SIJ syndrome, and a decrease in pain, disability and pain pressure threshold was obtained after one year of follow up. Galm et al, (1998) reported a significant improvement after manual therapy treatment on SIJ in patients with imaging proven lumbar disc herniation that had SIJ dysfunction. If dysfunctions of the SIJ were present the patients were treated by manual therapy accordingly.…”

Health-Related Quality of Life in Sacroiliac Syndrome: A Comparison to Lumbosacral Radiculopathy

“…However, the different pathophysiologies of low-back pain do not occur in isolation, and more than one pathophysiology commonly occurs in any individual patient. 24,25 All patients in the present study carried radiographic evidence of some other degenerative process. The 2 groups differed with respect to the concomitant presence of facet arthropathy (greater in patients with SI syndrome) and spondylosis (greater in patients with lumbar radiculopathy).…”

Sciatica-like symptoms and the sacroiliac joint: clinical features and differential diagnosis

“…We therefore advocate to perform at least an MRI of the spine before a definitive diagnosis of SIJ-related leg pain is made. Moreover, as described by Galm et al [10] SIJ dysfunction can occur in patients with low back pain and sciatica and imaging-proven disk herniation. When therapy is focused on the presence of SIJ dysfunction nucleotomy can be prevented in these patients [10].…”

“…Moreover, as described by Galm et al [10] SIJ dysfunction can occur in patients with low back pain and sciatica and imaging-proven disk herniation. When therapy is focused on the presence of SIJ dysfunction nucleotomy can be prevented in these patients [10]. Can factors from the medical history or clinical examination be used to differentiate between SIJ-related pain, leg pain due to disk herniation or a combination of both?…”