Sacroiliac Joint Dysfunction (SJD) also known as Sacroiliitis, is a condition that directly affects the sacroiliac joints that reside in the lumbar region of the spine. These joints sit right where the spine and pelvis connect with several ligaments supporting them. Studies show that almost everyone will experience lower back pain at some point in their life, however, there are so many conditions that cause lower back pain, diagnosing the cause can sometimes be difficult. SJD can be difficult to diagnose because it is easily mistaken for alternative causes of lower back pain, however, it does fall under the umbrella of diseases that cause inflammatory arthritis of the spine. Although SJD can be harder to diagnose, SJD is found in approximately 15%-30% of patients with lower back pain.
The symptoms associated with SJD are:
- Lower back pain
- Pain in the buttocks
- Pain in one or both legs
- Sciatica-like pain
- Burning sensation
- Pain that is triggered by bending or twisting
- Recurring pain
- Pain with daily activities such as walking, climbing stairs, sitting, or standing
Causes of Sacroiliac Joint Dysfunction
SJD can be caused by a variety of factors. Of course, this can occur spontaneously as a result of a traumatic event. However, it may also be caused by:
- History of lumbar fusions
- Leg length discrepancies such as one leg being shorter than the other
- Sustained athletic activity
- Gait abnormalities
- Arthritis, specifically osteoarthritis
The first line of treatment for SJD would be nonoperative management. This would include any combination of physical therapy, manual manipulation therapy, and exercise programs. One effective form of treatment is the use of a sacroiliac belt. These small belts are worn across the lower back. Studies show that these sacroiliac belts improve health-related quality of life and contribute to decreasing SJD-related pain. These belts also help improve postural steadiness during movement. This is likely the most affordable and low-risk form of treatment.
Steroid injections are another minimally invasive treatment option. These injections are outpatient and usually do not take longer than 30 minutes. The physician will first administer a local anesthetic to numb the area. Then, an x-ray method called fluoroscopy or an ultrasound will be used to guide the needle to the best place within the joint or joint space, at which point, the steroid will be injected. These injections start working within 3-7 days and provide great, temporary pain relief.
Fusion surgery is another, more invasive form of treatment that has proven to be successful. Fusion surgery allows for a biomechanical stabilization of the sacroiliac joints. This stabilization does cause a decreased range of motion, however, a lessened range of motion also decreases the need for certain muscular and ligament support that the joints typically rely on. These fusions can be done two different ways. The dorsal approach includes inserting small titanium cages with grafts into the joint space. Alternatively, there is a lateral approach where hollow screw implants are filled with graft or titanium triangle-shaped plates are placed across the joint. One study of over 400 patients showed an improvement in pain with 81.4% of participants.