How Often Is Low Back Pain Not Coming From the Back?

Sembrano, Jonathan N.; Polly, David W.

doi:10.1097/brs.0b013e31818b8882

Cited by 330 publications

(245 citation statements)

References 41 publications

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“…19, 89, 249, 266, 318 It has been suggested that altered movements of the hip and spine may contribute to the development of low back pain, as it may alter the loads placed on the lumbar facets and posterior spinal ligaments. 1, 190 Several authors have described restricted hip mobility in patients with low back pain as an indicator of positive response to interventions targeting the hip.…”

Section: Clinical Guidelines: Interventionsmentioning

confidence: 99%

Low Back Pain

Delitto¹,

George²,

Dillen³

et al. 2012

Journal of Orthopaedic & Sports Physical Therapy

802

352

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Section: Clinical Guidelines: Interventionsmentioning

confidence: 99%

Low Back Pain

Delitto¹,

George²,

Dillen³

et al. 2012

Journal of Orthopaedic & Sports Physical Therapy

802

352

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“…Since treatment of disc pathology does not always result in LBP relief, interest has resurfaced in the SIJ as potential source of LBP. Recently several reports estimate that 15-30 % of LBP is caused by the SIJ [5,6]. The SIJ The members of iMIA Study Investigators/study coordinators are listed in ''Appendix' '. may be an even more common pain source after lumbar fusion [7,8].…”

Section: Introductionmentioning

confidence: 99%

Six-month outcomes from a randomized controlled trial of minimally invasive SI joint fusion with triangular titanium implants vs conservative management

et al. 2016

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Purpose To compare the safety and effectiveness of minimally invasive sacroiliac joint fusion (SIJF) using triangular titanium implants vs conservative management (CM) in patients with chronic sacroiliac joint (SIJ) pain. Methods 103 adults with chronic SIJ pain at nine sites in four European countries were randomly assigned to and underwent either minimally invasive SIJF using triangular titanium implants (N = 52) or CM (N = 51). CM was performed according to the European guidelines for the diagnosis and management of pelvic girdle pain and consisted of optimization of medical therapy, individualized physical therapy (PT) and adequate information and reassurance as part of a multifactorial treatment. The primary outcome was the difference in change in self-rated low back pain (LBP) at 6 months. Additional endpoints included quality of life using EQ-5D-3L, disability using Oswestry Disability Index (ODI), SIJ function using active straight leg raise (ASLR) test and adverse events. NCT01741025. Results At 6 months, mean LBP improved by 43.3 points in the SIJF group and 5.7 points in the CM group (difference of 38.1 points, p \ 0.0001). Mean ODI improved by 26 points in the SIJF group and 6 points in the CM group (p \ 0.0001). ASLR, EQ-5D-3L, walking distance and satisfaction were statistically superior in the SIJF group. The frequency of adverse events did not differ between groups. One case of postoperative nerve impingement occurred in the surgical group. Conclusions In patients with chronic SIJ pain, minimally invasive SIJF using triangular titanium implants was safe and more effective than CM in relieving pain, reducing disability, improving patient function and quality of life.

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“…Some patients may have lumbar fusion for misdiagnosed SIJ syndrome or some may have only lumbar fusion for lumbar pathology and SIJ syndrome. Sembrano and Polly [36] reported that up to 14.5 % of patients presenting to a spine surgeon's clinic for low back pain had SIJ pathology. In another study, Weksler et al [37] found that patients with low back pain and disc herniation who responded positively to pain provocation tests for SIJ dysfunction exhibited significant improvement in visual analogue scale (VAS) pain scores after SIJ injection.…”

Section: Pathophysiologymentioning

confidence: 99%

Sacroiliac joint pain after lumbar/lumbosacral fusion: current knowledge

Yoshihara

2012

Eur Spine J

109

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Recently, the sacroiliac joint (SIJ) has gained increased attention as a source of persistent or new pain after lumbar/lumbosacral fusion. The underlying pathophysiology of SIJ pain may be increased mechanical load, iliac crest bone grafting, or a misdiagnosis of SIJ syndrome. Imaging studies show more frequent degeneration of the SIJ in patients with lumbar/lumbosacral fusion than in patients without such fusion. Using injection tests, it has been shown that SIJ pain is the cause of persistent symptoms in a considerable number of patients after fusion surgery. Recent articles reporting on surgical outcomes of SIJ fusion include a high percentage of patients who had lumbar/lumbosacral fusion or surgery before, although well-controlled clinical studies are necessary to assess the efficacy of surgical treatment. Taking these findings into consideration, the possibility that the SIJ is the source of pain should be considered in patients with failed back surgery syndrome after lumbar/lumbosacral fusion.

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How Often Is Low Back Pain Not Coming From the Back?

Cited by 330 publications

References 41 publications

Low Back Pain

Low Back Pain

Six-month outcomes from a randomized controlled trial of minimally invasive SI joint fusion with triangular titanium implants vs conservative management

Sacroiliac joint pain after lumbar/lumbosacral fusion: current knowledge

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