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. 2020 Dec 8:13:3337-3348.
doi: 10.2147/JPR.S279390. eCollection 2020.

A Review and Algorithm in the Diagnosis and Treatment of Sacroiliac Joint Pain

Steven Falowski  1 , Dawood Sayed  2 , Jason Pope  3 , Denis Patterson  4 , Michael Fishman  5 , Mayank Gupta  6 , Pankaj Mehta  7
Affiliations

A Review and Algorithm in the Diagnosis and Treatment of Sacroiliac Joint Pain

Steven Falowski et al. J Pain Res. .

Abstract

Introduction: The sacroiliac joint (SIJ) has been estimated to contribute to pain in as much as 38% of cases of lower back pain. There are no clear diagnostic or treatment pathways. This article seeks to establish a clearer pathway and algorithm for treating patients.

Methods: The literature was reviewed in order to review the biomechanics, as well as establish the various diagnostic and treatment options. Diagnostic factors addressed include etiology, history, physical exam, and imaging studies. Treatment options reviewed include conservative measures, as well as interventional and surgical options.

Results: Proposed criteria for diagnosis of sacroiliac joint dysfunction can include pain in the area of the sacroiliac joint, reproducible pain with provocative maneuvers, and pain relief with a local anesthetic injection into the SIJ. Conventional non-surgical therapies such as medications, physical therapy, radiofrequency denervation, and direct SI joint injections may have some limited durability in therapeutic benefit. Surgical fixation can be by a lateral or posterior/posterior oblique approach with the literature supporting minimally invasive options for improving pain and function and maintaining a low adverse event profile.

Conclusion: SIJ pain is felt to be an underdiagnosed and undertreated element of LBP. There is an emerging disconnect between the growing incidence of diagnosed SI pathology and underwhelming treatment efficacy of medical treatment. This has led to an increase in SI joint fixation. We have created a clearer diagnostic and treatment pathway to establish an algorithm for patients that can include conservative measures and interventional techniques once the diagnosis is identified.

Keywords: SIJ pain; sacroiliac joint; sacroiliac joint dysfunction; sacroiliac joint fusion; sacroiliitis.

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Conflict of interest statement

Steven Falowski consults for Abbott, Medtronic, Boston Scientific, Vertoss and Saluda; research is performed with Abbott, Boston Scientific, Medtronic, Biotronik, Saluda, Stimgenics and Vertiflex; Equity positions held in Saluda, CornerLoc, Painteq, Celeri, SPR Therapeutics, Thermaquil, Stimgenics, SpineThera, Neural Integrative Solutions, and AGR; and is the owner of Neural Integrative Solutions, outside the submitted work. Dawood Sayed reports personal fees from Flowonix, Medtronic, Merit, Nevro, Vertiflex and Vertos,and stock options in PainTeq, SPR, and Vertos.Jason Pope reports stock options for Painteq, outside the submitted work. Denis Patterson reports personal fees from CornerLoc, outside the submitted work. Michael Fishman reports personal fees from Foundation Fusion Solutions, outside the submitted work. Mayank Gupta reports personal fees from Nevro Corp., speakers bureau/consultant/investigator for Vertos, Inc., advisory/medical board/consultant/investigator for Avertias Pharma, consultant/investigator for US WorldMeds, Nalu Medical, and SPR Therapeutics, Inc., and consultant/medical board for Foundation Fusion Solutions, LLC (CornerLoc), during the conduct of the study. Pankaj Mehta reports consultant for ABBOTT, BOSTON SCIENTIFIC, SPR, CORNER LOC, and ETHOS LABS, outside the submitted work. The authors report no other potential conflicts of interest for this work.

Figures

Figure 1
Figure 1
Algorithmic approach to SI joint pain.
See this image and copyright information in PMC

References

    1. March L, Smith EUR, Hoy DG, et al. Burden of disability due to musculoskeletal (MSK) disorders. Best Pract Res Clin Rheumatol. 2014;28(3):353–366. doi:10.1016/j.berh.2014.08.002 - DOI - PubMed
    1. Deyo RA, Dworkin SF, Amtmann D, et al. Report of the NIH task force on research standards for chronic low back pain. J Pain. 2014;15(6):569–585. doi:10.1016/j.jpain.2014.03.005 - DOI - PMC - PubMed
    1. Tsoi C, Griffith JF, Lee RKL, Wong PCH, Tam LS. Imaging of sacroiliitis: current status, limitations and pitfalls. Quant Imaging Med Surg. 2019;9(2):318–335. doi:10.21037/qims.2018.11.10 - DOI - PMC - PubMed
    1. Yoshihara H. Sacroiliac joint pain after lumbar/lumbosacral fusion: current knowledge. Eur Spine J. 2012;21(9):1788–1796. doi:10.1007/s00586-012-2350-8 - DOI - PMC - PubMed
    1. Guentchev M, Preuss C, Rink R, Peter L, Wocker E-L, Tuettenberg J. Technical note: treatment of sacroiliac joint pain with peripheral nerve stimulation. Neuromodulation. 2015;18(5):392–396. doi:10.1111/ner.12255 - DOI - PubMed