I've struggled with sacroiliac joint pain all my adult life. Having three children made my life wonderful but wreaked havoc on my low back and SI joint. Is there anything new out there in the way of surgery that might help me?Multiple pregnancies can be a factor in the development (or worsening) of a sacroiliac joint (SIJ) problem. A previous spinal fusion and unequal leg lengths are two additional risk factors. Other factors that can increase the risk of sacroiliac joint problems include , scoliosis (curvature of the spine), polio, and hip arthritis. Having more than one of these factors can compound the problem and must be dealt with as best as possible. SIJ as a cause of pain is a challenge to treat but not impossible. In fact, we've come a long way in our understanding that the sacroiliac joint can cause painful symptoms and in finding ways to solve the problem. There was a time when the SIJ wasn't believed to move or develop movement impairments. Fusion of the joint is really a last resort effort and only used when all other approaches have failed. Surgery to fuse the joint is not guaranteed to end the painful symptoms. So, nonoperative (conservative) care is really the order of the day. Conservative (nonoperative) care is the first step. The patient will be seeing a physical therapist who will assess pain, posture, alignment, core stability, and biomechanics before setting up a patient-specific treatment program. Joint mobilization to correct joint alignment, stabilization exercises, and supportive sacral belts are newer additions to our treatment arsenal that can make a difference. Failure of the patient to improve after at least six months of nonoperative care is required before fusion surgery is even considered. There are several different ways to fuse the sacroiliac joint -- none of them are easy or guaranteed to be successful. The surgeon may use pins, screws, or plasma-coated implants along with bone graft to hold the sacrum and pelvic bones together and prevent motion at the sacroiliac joint. After surgery, the patient may be in a cast from the waist down to the toes. In some cases a removable splint is used instead of a full cast. Weight-bearing (standing and walking) are limited for up to eight weeks after surgery. The specific guidelines depend on the surgeon's recommendation.Patients with chronic sacroiliac joint dysfunction are also counseled to lose weight, quit using tobacco products, and consider behavior therapy for pain that does not go away even with conservative care. Until better ways are found to surgically correct the problem, fusion is the end-choice for this diagnosis.
References:Jonathan N. Sembrano, MD, et al. Diagnosis and Treatment of Sacroiliac Pain. In Current Orthopaedic Practice. July/August 2011. Vol. 22. No. 4. Pp. 344-350.
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