Management of Sacroiliac Joint Pain

Abstract

Sacroiliac joint (SIJ)-based pain can be difficult to diagnose definitively through physical examination and conventional radiography. A fluoroscopically guided injection into the SIJ can be both diagnostic and therapeutic. The initial phase of treatment involves nonsurgical modalities such as activity modification, use of a sacroiliac (SI) belt, NSAIDs, and physical therapy. Prolotherapy and radiofrequency ablation may offer a potential benefit as therapeutic modalities, although limited data support their use as a primary treatment modality. Surgical treatment is indicated for patients with a positive response to an SI injection with >75% relief, failure of nonsurgical treatment, and continued or recurrent SIJ pain. Percutaneous SI arthrodesis may be recommended as a first-line surgical treatment because of its improved safety profile compared with open arthrodesis; however, in the case of revision surgery, nonunion, and aberrant anatomy, open arthrodesis should be performed.

Sacroiliac Joint Fusion – Impact of a New Image-Guidance Protocol on Safety and Complications

“…Previous estimates of up to 30% of chronic back pain being referable to the SI joint have been published by numerous authors. [3][4][5][6][7] Recognition of this pathology has been limited in the past by a lack of clear diagnostic criteria. With increasing focus on this clinical entity, there is starting to be more consensus on appropriate means of diagnosing SI joint dysfunction.…”

“…1,3 While the traditional focus of healthcare providers has been on lumbosacral pathology, sacroiliac joint dysfunction is an underappreciated and underdiagnosed cause of low back pain. Previous studies [3][4][5][6][7][8] have suggested that 15-30% of chronic low back pain is due to pathology located in the sacroiliac joint. Historically, recognition of this pathology was difficult, limited by lack of standardized diagnostic criteria and disease-specific outcome measures.…”

Diagnosis and interventional pain management options for sacroiliac joint pain

“…The rationale for SI joint fusion is to relieve pain created by the movement of a joint through the removal of movement by arthrodesis of the joint space [39]. Only few comparative studies of percutaneous SI joint fusion and denervation have been reported, and they had limited clinical evidence [4041].…”

Effectiveness of kinesiotaping in pregnant women with sacroiliac joint pain: A randomised controlled study

“…These factors particularly put stress on the SIJ, thereby contributing to SIJ pain 4 . Anti‐inflammatory drugs and physical therapy are commonly used for treatment of SIJ pain 5 . However, anti‐inflammatory drugs can enter the fetal circulation through the placenta and show toxic effects in various tissues and organs.…”