Treating Sacroiliac Joint Pain

Lower back pain is a common complaint among adults and it can have several causes. Interestingly, up to 30% of all lower back pain symptoms actually originate in the sacroiliac joint which connects the base of the spine (sacrum) to the hips. This type of pain is most frequently experienced in the lower back and buttocks. Below, we’ll take a closer look at what causes sacroiliac joint pain and what types of procedures and therapies can help relieve this kind of lower back discomfort.

What is the sacroiliac joint?

The sacroiliac (SI) joints are formed by the connection of the sacrum and the right and left iliac bones. The sacrum is the triangular-shaped bone in the lower portion of the spine, centrally located below the lumbar spine. While most of the bones (vertebrae) of the spine are mobile, the sacrum is made up of five vertebrae that are fused together and do not move.

How can the sacroiliac joint become damaged?

As with most other joints in the body, the sacroiliac joints have a cartilage layer covering the bone. When the cartilage is worn away, the bones begin to rub on each other. This can happen through injury, pregnancy or normal wear and tear over time. When such damage happens, it can cause significant discomfort from the lower back down to the lower buttock region and the upper leg. This discomfort can lead to debilitation and can impact the quality of life greatly. Sacroiliac joint pain is often experienced on just one side of the body but can occur on both sides. The pain sensation can be either dull or sharp and tends to radiate from the joint itself moving through the groin, thighs, buttocks or upper back.

How do you treat sacroiliac joint pain?

As a neurosurgeon, I often treat patients with sacroiliac pain surgically, and I have performed minimally invasive sacroiliac joint fusion procedures for many years. The traditional surgical method involves fusing the sacrum and the ilium to minimize or eliminate movement in the sacroiliac joint.

In 2019, I performed Ochsner Medical Center’s first sacroiliac joint fusion surgery using the iFuse Implant System®. This is a procedure that is designed to offer a minimally invasive solution for patients who are no longer responding to conservative care and traditional open surgery is not desirable.

The procedure takes about an hour and involves three small titanium implants inserted surgically across the joint. The entire process is done through a small incision, with no soft tissue stripping and minimal tendon irritation. Patients typically leave the hospital the next day after surgery and depending on how well they are healing, can usually resume normal activities within six weeks.

Sacroiliac joint dysfunction pain can also be caused by a lack of stability of the joint due to muscle weakness, deconditioning or prior injury. Conservative measures such as physical therapy and bracing are usually recommended as the first line of treatment. A sacroiliac block done under x-rays is necessary to confirm the diagnosis of SI joint dysfunction. When conservative management fails to provide long term relief, minimally invasive sacroiliac joint fusion can be indicated as a more sustainable pain relief treatment.