06/08/2021
What Are The Symptoms of Sacroiliac Dysfunction?
Pain associated with sacroiliac dysfunction is usually located in the low back, just to the side of the midline, and may be felt on one or both sides. The pain often radiates down to the knee and into the groin. Another commonly-reported symptom is discomfort when lying down.
How Is Sacroiliac Dysfunction Diagnosed?
Accurately diagnosing sacroiliac joint dysfunction can be difficult, and must be done by clinical exam. During the exam, the doctor may try to determine if the sacroiliac joint is the cause of pain by moving the joint. If the movement recreates the patient’s pain, and no other cause of pain has been found (such as a disc herniation on an MRI scan), the sacroiliac joint may be the cause of the pain.
A sacroiliac joint injection is another diagnostic tool that may be used. In this test, a physician uses fluoroscopic guidance (x-ray) and inserts a needle into the sacroiliac joint to inject lidocaine (a numbing solution). If the injection relieves the patient’s pain, it can be inferred that the sacroiliac joint is the source of the pain. A steroid solution also may be injected to decrease inflammation in the sacroiliac joint and decrease pain.
How Is Sacroiliac Dysfunction Treated?
Sacroiliac joint pain can become severe and disabling if not treated. If diagnosed early, the majority of patients with sacroiliac dysfunction and/or piriformis syndrome will improve with conservative treatment, which may include manipulation, physical therapy and anesthetic/steroid injections. It can be managed with some opioids medications. More recently, BOTOX® injections have been used to relax the piriformis muscle.
For those who do not respond to conservative measures, spine surgery is the appropriate next step, which involves stabilizing the sacroiliac joint through fixation and fusion. Sometimes the piriformis muscle also may need to be treated surgically to relieve pressure on the sciatic nerve.
The benefits of spine surgery, however, must be weighed against the risks. Your surgeon will be able to discuss the risks and benefits of surgery with you, and the likely results of operative versus non-operative treatment.
