Ever since early man came into an upright position, back pain has been a problem. Today, up to 84% of the adult population across the globe have some experience with lower back pain, and nearly a quarter of adults struggle with chronic lower back pain.
While there are many roads that lead to lower back pain, board-certified neurosurgeon Dr. Ali H. Mesiwala and our team want to focus on one, in particular, in this month’s blog post — sacroiliac (SI) joint dysfunction.
To better understand SI joint dysfunction, it’s helpful to review the structures that are involved. You have five vertebrae in your lumbar region (lower back) that connect to your sacrum. Your sacrum is a triangular piece of bone that’s connected to your iliac (hip) bones on either side by your SI joints.
Together, your sacrum, the SI joints, and your hip bones (as well as your coccyx) make up your pelvic girdle.
Your SI joints have no small task, as they’re responsible for absorbing the shock between your upper body and your lower body. These joints don’t enjoy a good deal of movement, but enough to allow shock absorption and to facilitate bending forward or backward.
With SI joint dysfunction, which accounts for between 15% and 30% of lower back pain in adults, the joints allow either too much or too little movement. If your SI joints are too loose, it can lead to pelvic instability. If they’re too stiff, it can cause muscle tension and mobility issues.
In addition to too much or too little movement in your SI joints, SI joint pain can also stem from inflammation in the joints, which is called sacroiliitis.
One of the problems with SI joint issues is that they mimic other common issues, such as a herniated disc. For example, if your SI joints are too stiff, you can experience pain on one side, and this pain can radiate down through your buttock and into your leg.
Another common sign of SI joint dysfunction is pain on one side of your buttocks, as well as discomfort in your upper back or side of your thigh. While symptoms of SI joint dysfunction typically develop only on one side, they can affect both.
SI joint pain can present as a dull ache or as sharp, stabbing pain. The pain can worsen when you add more pressure to the affected joint, such as concussive activities or when you lie down on the side of the problematic joint.
You may also experience stiffness in your pelvis that make getting in and out of chairs or climbing stairs more difficult.
If your SI joints are too loose, you may feel instability and the feeling that your pelvis is going to simply give out.
Prior fusion surgery on the lumbar spine also has a strong correlation to sacroiliac joint degeneration and sacroiliac joint degeneration can also be mistaken for hip pain or an atypical low back pain.
Diagnosis for SI joint dysfunction is a multi-modal approach. Typically begins with a comprehensive history and then a physical examination consisting of several maneuvers. Typically by the time patients get to our office they have exhausted other options for treatment like medications and physical therapy.
A review of pelvic CT scan and pelvic x-rays helps confirm the anatomical aspects and rule out any other conditions.
Based on this, we refer patients to a pain management specialist for a diagnostic SI joint injection.
Patients who derive meaningful relief are then candidates to undergo a minimally invasive SI joint fusion.
The first order of business is to come see Dr. Mesiwala and his team so that we can identify the source of your lower back pain. Dr. Mesiwala is one of the leading spine surgeons in the country to do this procedure and one of the earliest adopters of the technique. Additionally he is an innovator for SI joint implant development and has conducted in multiple research studies regarding the treatment of this phenomenon.
If we discover that your SI joints are responsible, we can discuss next steps for helping you find relief, which might include physical therapy, medications, or minimally invasive SI joint surgery.
Dr. Mesiwala regularly performs surgery on the SI joint after thoroughly evaluating patients. He is also faculty for the surgery and trains other surgeons on the techniques. The surgery itself is relatively straight forward. It is routinely performed in the outpatient setting and patients go home the same day after a 30-40 minute procedure. We allow our patients to ambulate immediately and most patients report a greater than 50% reduction in pain around 6 weeks after surgery.
To get to the bottom of your lower back pain, please contact one of our offices in Newport Beach, Marina del Rey, Rancho Cucamonga, or San Bernardino, California, to set up an appointment.