The Significance of the SI Joint in Low Back Pain

The Significance of the SI Joint in Low Back Pain


While sacroiliac joint dysfuntion has been
well documented as a clinically significant source of low back pain, it remains one of
the under-diagnosed and under-treated areas in orhopedic practice. Noted orthopedic surgeon Dr. Steven Garfin
will review some important background about the SI Joint. The SI joint may be responsible for up to
25 or 30% of complaints related to low back pain. That number may be even higher in long fusions
that include the sacrum. Despite the fact the literature on the SI
joint goes back a long way it has truly been an under-appreciated, under-studied and under-diagnosed
joint. The SI joint was nothing we ever paid attention
to. You learn about it in anatomy but diagnostically
or therapeutically it just wasnÕt an issue. Recently there has been a summit meeting of
individuals who are familiar with the SI joint and academic spine surgeons and clinically
active spine surgeons such as me to talk about the SI joint. Meta analysis was done of available literature. The discussions were summarized and we were
able toÉ (deletion) Écome up with an agreement as to a consensus how to diagnose and potentially
treat SI joint related problems that fortunately has been accepted for publication. I realized É Éthat this is something I should listen to,
pay attention to, and try to diagnose and try to teach my residents and fellows. The algorithm lays out questions to ask for
the history and for the physical exam. It includes examining the hip and neurologics
exam for the spine, and then there are roughly five tests for the SI joint that stress the
SI joint. Three of them should be positive to lead or
strongly lead to the diagnosis of the SI joint as a cause of pain. These tests are not very complicated or too
sophisticated. Most health care providers no matter what
their specialty have learned them somewhere along their training. Unless you think about the SI joint you donÕt
do these tests. To add them in takes maybe five minutes maximum
and itÕs really sort of a thought process and a completeness of the exam and anybody
can do that. ItÕs critical for physicians and non-physicians,
surgeons and non-surgeons to pay attention to the joint as a possible diagnosis and etiology
related to low back pain.

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