A fairly common problem, especially for women, is sacroilitis or sacroiliac joint syndrome. This is pain that arises from the sacroiliac joint (SIJ). The SIJ is the joint between the pelvis and the sacrum. It is commonly those little dimple area that people see on their backside. These joints generally fuse early in life and there is significant debate as to whether the pain is from the joints or the tissue overlying them.
The pain associated with SIJ disease is usually located over the buttock area but it can radiate. In fact, there have been many cases where people had fusion surgeries for possible pinched nerves only to find out later that the problem was SIJ related. Thus, the pain can be local or radiate all the way down the leg. As stated previously, women are more affected than men and this is probably due to the wider pelvis in women and childbirth which stretches out the pelvic tissues.
In my experience, the most common cause of the SIJ pain is due to torn ligaments over the SIJ and not the joint itself. A lot of the tissues connect to the bone at this point and these tissues get torn with time and lead to a tendonitis type of picture. Usually the pain is localized but as stated before can radiate. This syndrome can cause women much distress and pain.
What to do about it? For years injections were utilized to temporarily treat the pain in the joints. Surgeons have used fusions to treat this issue with a six inch incision and long recovery times. I wrote the first paper on an endoscopic approach to treating this problem with a 60% cure rate and a one inch incision.
Of interest, a new procedure has been developed which involves a large bore needle and the insertion of “cement” into the joint area to fuse the joint. The study was done on cadavers but it revealed that the procedure reduced SIJ motion by 50% in patients with SIJ fractures (usually after auto accidents). The question is whether this approach would be viable for regular SIJ pain not associated with fractures. If it is then it would represent an even more minimally invasive approach to treating this problem. It is possible that the insertion of the cement would even destroy some of the ligaments that are torn and causing pain. Currently, there are kits available for doing this procedure. The kits are made for spinal fractures but could be utilized for SIJ issues. It is especially useful for those who cannot undergo the SIJ surgery I devised or a SIJ fusion, such as in old or frail individuals. There is more information on SIJ problems on our website: www.emeraldcoastpain.com
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