A history of SI Joint dysfunction:
Sacroiliac (SI) Joint dysfunction and the associated symptoms have been well known for over a century.
In fact, in the early 1900’s all symptoms which seemed to arise from the back were attributed
to the SI Joint, and all surgical cures were directed at that joint. However,
none of the operations for the SI Joint had greater than a 50% success rate, and frequently the
patient was worse off than before the surgery.
In 1934, a paper was published on the disc as a source of symptomology in the back.
As a result, disc treatment became the most common operation
for orthopedic surgeons, and the SI Joint was all but forgotten. Now, 70 years later,
orthopedic and spine surgeons have recognized that the disc is not the only source
of low back pain problems in the axial skeleton. According to published scientific
data, it’s common for pain from SI Joint dysfunction to mimic disc or low back pain. Many
patients go on to receive lumbar fusion instead of SI Joint fusion – so SI Joint dysfunction should be
strongly considered in diagnosis of low back pain.1
The role of the SI Joint in back and pelvic symptomology:
The SI Joint is located in the pelvis; it links the iliac bones (pelvis) to the sacrum (lowest part of the spine above the tailbone). Like any other joint in the body, the SI Joint can become arthritic or its support ligaments can become loose or injured. When this happens, people can feel problems in their buttock and sometimes even well above their buttock and higher on the axial skeleton. This is especially true with lifting, running, walking or even sleeping on the involved side. In all of these cases, the symptoms can be felt anywhere from the lower buttocks to the lower spine. It is important to note that on occasion, patients who have not had symptomatic relief from lumbar spine surgery may actually have had SI Joint dysfunctions to begin with.What can be done today?
The good news is that your surgeon can now distinguish between the low back pain symptoms arising from the lumbar portion of the spine and the SI Joint. There are several treatment options (see below) for SI Joint dysfunction. One choice for treatment of SI Joint dysfunction is the traditional open surgical approach. Even better news is the fact that, for the first time, a less invasive surgical system has been developed with titanium implants, which create a durable construct to stabilize the SI Joint, maximize post-surgical weight bearing capacity and minimize implant micromotion. SI-BONE is pleased to introduce the iFuse Implant SystemTM as a less invasive surgical alternative. The rest of this informational document describes how this is done.Diagnosis of SI Joint symptomology:
The first step is to establish a diagnosis of SI Joint symptomology. A variety of tests performed during physical examination may help reveal the SI Joint as the cause of your symptoms. In addition, X-rays, CT-scan or MRI can be helpful in the diagnosis of SI Joint-related problems. It is also important to remember that more than one condition (like a disc problem) can co-exist with SI Joint dysfunction.The most reliable method to accurately determine whether the SI Joint is the cause of your low back pain symptoms is to inject the SI Joint with Lidocaine, a local anesthetic. Your surgeon will deliver the injection with either fluoroscopic or CT guidance to verify accurate placement of the needle in the SI Joint. If your symptoms are decreased by a minimum of 75%, it can be concluded that the SI Joint is either the source, or a major contributor, to your low back pain. If the level of symptomology does not change after SI Joint injection, it is less likely that the SI Joint dysfunction is the cause of your low back pain.
Treatment options:
Once the SI Joint is confirmed as the cause of your symptoms, treatment can be provided. Some patients respond to physical therapy, chiropractic manipulations, use of oral medications, as well as injection therapy. Intermittent use of a pelvic belt may provide symptomatic relief as well. These treatments are performed repetitively and frequently symptom improvement using these therapies is temporary. At this point, your surgeon may consider other options, including surgery, for your SI Joint dysfunction.SI Joint Fusion with the iFuse Implant SystemTM:
SI Joint Fusion is a surgical procedure performed in an operating room, with either general or
spinal anesthesia. You will be lying face down while your surgeon uses a specially designed
system to guide the instruments that prepare the bone and insert the implants. Both the surgical
technique and the iFuse Implant SystemTM are designed to offer the maximum protection to your
surrounding tissues and minimize soft tissue exposure.
The entire procedure is performed through a small incision (approximately one inch long),
along the side of your buttock. During the procedure, fluoroscopy provides your surgeon with
live imaging during the procedure so exact placement of the implants is possible. Fluoroscopy is
an imaging technique commonly used by physicians to obtain real-time moving images of internal
structures using x-rays. Normally, two to four implants will be used, depending on your size.
The procedure takes about an hour. You may feel comfortable enough to return home the same
day of surgery or perhaps the morning after. Your surgeon will make this decision based on your
post-surgical status.
