Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment

Abstract

Sacroiliac joint (SIJ) pain is an underappreciated source of mechanical low back pain, affecting between 15 and 30% of individuals with chronic, nonradicular pain. Predisposing factors for SIJ pain include true and apparent leg length discrepancy, older age, inflammatory arthritis, previous spine surgery, pregnancy and trauma. Compared with facet-mediated and discogenic low back pain, individuals with SIJ pain are more likely to report a specific inciting event, and experience unilateral pain below L5. Owing in part to its size and heterogeneity, the pain referral patterns of the SIJ are extremely variable. Although no single physical examination or historical feature can reliably identify a painful SIJ, studies suggest that a battery of three or more provocation tests can predict response to diagnostic blocks. Evidence supports both intra- and extra-articular causes for SIJ pain, with clinical studies demonstrating intermediate-term benefit for both intra- and extra-articular steroid injections. In those who fail to experience sustained relief from SIJ injections, radiofrequency denervation may provide significant relief lasting up to 1 year. This review covers all aspects of SIJ pain, with the treatment section being primarily focused on procedural interventions.

Діагностика Синдрому Крижово-Клубових Суглобів

“…Диагноз синдрома крестцово-подвздошного суста-ва устанавливают на основании жалоб, анамнеза, ди-агностических тестов, диагностической блокады, а также исключения другой патологии поясничного от-дела позвоночника или тазобедренного сустава [7]. Выводы 1.…”

Non-inflammatory sacroiliac joint disorders

“…Radiofrequency neurolysis may also provide significant relief lasting for up to a year if posterior complex origin of pain was confirmed by nerve blocks. 38 …”

Local approaches to sacro-iliac joint pathologies: several unanswered questions

“…Local approaches for SIJ are necessary as well as other local approaches commonly used for other joints, even if physiopathology and anatomy of this peculiar joint makes local approaches more difficult than those used in other joints. There are several reports in the literature of patients affected by an isolated SIJ inflammation, mono-or bilateral, or post-traumatic/surgical or degenerative SIJ involvement not associated to other systemic manifestations, thus making local approaches more effective in the balance of costs and risks related to systemic therapies 5 . The local approach to SIJ isolated involvement has been proposed previously in literature for patients affected by monoarthritis of SIJ or for patients whose clinical condition was to ascribe only to SIJ.…”