Sacroiliitis

Description

The sacroiliac joints (SI joints) connect the spine to the pelvis and lower skeleton. These joints provide minimal movement; approximately two to four millimeters with weight bearing activity, unlike that of the hip or knee. The SI joint's main function is to provide shock absorption for the spine through a gliding-type motion. Sacroiliitis (inflammation of the SI joint) is commonly caused by degenerative arthritis, traumatic injury, motor vehicle accident, or blow to the buttock or pelvic region. Women are at risk for developing sacroiliitis from childbirth, as the female pelvis must stretch enough to allow birth. The ligaments around the joint, which connect one bone to another, may become inflamed or torn. Tearing of these ligaments can lead to too much motion in the joint, causing degenerative changes and chronic pain.

Symptoms

In most cases of sacroiliitis, there is a diffuse pattern of back and pelvic pain that mimic each other. Patients with SI inflammation will generally complain of low back, buttock, and thigh pain. This pain typically becomes worse when sitting for any prolonged period of time. Sacroiliitis is commonly confused with sciatica.

Treatment

In most cases rest, anti-inflammatory medication, and physical therapy alleviate symptomology. Physical therapy should focus on mobilization (exercise and manipulation by the therapist), and stabilization (muscle strengthening). For pain relief, fluoroscopic guided injections into the joint may be warranted. The SI joint is located deep in the buttock region and is covered by thick muscle. The fluoroscope uses X-rays to help visualize the SI joint. This visualization allows the physician to see on screen the exact placement of the needle into the joint. Cortisone is typically injected into the joint to calm the inflammation and reduce pain.

Procedures

Spinal Injections

Spinal injections are used to diagnose and treat spinal conditions. With most spinal injections, a local anesthetic (numbing medication) is injected into a specific area of the spine. The anesthetic is fast-acting, but the effects wear off within about two hours. A strong anti-inflammatory steroid medication, such as cortisone, is usually injected with the anesthetic to reduce inflammation in the affected area. Cortisone is long lasting and can be slow releasing in order to give the best possible benefit of pain relief. Cortisone may take several days to start working, but the effects may last for months.

Several of the injections given at our office under fluoroscopic guidance include:

Epidural Steroid Injections - Good for reducing radicular pain caused by nerve root irritation from herniated discs and spinal stenosis. The patient may require a series of several epidural injections over a period of a few weeks.

Transforaminal Injections - Selective injection around a specific nerve root and into the spinal canal. This is more effective for nerve compression with sciatica.

Facet Joint Injections - Used to localize and relieve low back and neck pain caused by arthritic facet joints.

Sacroiliac Joint Injections - Used for pain from an inflamed sacroiliac joint.