When Back Pain May Not Be Back Pain

April 05, 2017


Many patients come to an orthopaedic specialist for back pain only to find out, in some cases, the source of discomfort is not the spine or its mechanics.

Located inside the pelvis lives the SI (sacroiliac) Joint, which serves as the point of movement connecting the ilium bones (pelvis) to the sacrum (the lowest part of the spine above the tailbone). This joint is an essential component for shock absorption to prevent impact forces from reaching the spine. As with any other joint in the body, the SI Joint can be injured (through trauma or giving birth) and/or become degenerative. When this happens, individuals can feel pain in the buttock and sometimes in the lower back, which mimics disc or lower back pain.

Oftentimes listening well to what the patient is experiencing and when, can point the right direction. If back pain is indeed caused by the SI Joint, an X-ray guided injection can be a key tool for diagnosis. If an injection into the SI joint relieves the pain that has been radiating through the back and down the leg, it’s a clear clue that the issue has been identified. An MRI may be used to confirm diagnosis and rule out any other underlying spine issue.

As for treatment, orthopaedists may start with nonsteroidal anti-inflammatory drugs and therapy. Continued injections every few months after diagnosis may keep the pain controlled. For more serious cases, where chronic pain inhibits daily life despite treatment, a minimally invasive surgical procedure can be performed. Three small titanium implants are placed surgically across the SI joint to stabilize and fuse the joint. Done through a small incision, the procedure takes about one hour.

Patients undergoing surgery spend one night in the hospital and are told to avoid putting weight on the impacted side for a few weeks—go light and easy giving the body time to restore itself. Discharge from the hospital is allowed once the patient can safely toe touch and bear weight on the hip. Most patients feel relief immediately after the procedure. Typical recovery takes three to six weeks for proper healing.

In some cases, the SI Joint condition can co-exist with spine or hip conditions. It’s important if someone is experiencing spine-related pain that is interfering with daily activity and enjoyment of living, to ask for a referral to an orthopaedic specialist who can look at them more closely and help alleviate the pain.

- Matthew Eager, MD, SUN Orthopaedics of Evangelical, specializes in the diagnosis and treatment of the spine. He is certified by the American Board of Orthopaedic Surgery. For more information on SUN Orthopaedic services and locations, visit www.evanhospital.com or call 1-800-598-5096.

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