140 - Sacroiliac Joint Pain

Abstract

The sacroiliac (SI) joint is a prevalent yet underrecognized source of low back, buttock, and radiating leg pain in patients presenting to a spine surgeon’s clinic. SI joint pain can mimic symptoms from the lumbar spine or hip. Further complicating diagnosis of SI joint pain is the lack of pathognomonic physical examination findings or hallmark radiographic features. SI joint pathology cannot be ruled out on the basis of normal imaging. The clinician must follow a distinct diagnostic pathway consisting of dedicated provocative physical examination maneuvers to screen for SI joint pain, followed by intraarticular injection to confirm the diagnosis. First-line treatment is nonoperative with physical therapy, medication, and injections. Level I evidence supports durable and superior outcomes for minimally invasive SI joint fusion surgery over ongoing nonoperative management in patients who fail initial conservative treatment. Failure to screen for and recognize SI joint pathology can result in ineffective treatment of pain or, in the worst case scenario, needless, ineffective operations on the lumbar spine. All spine surgeons must therefore be facile in the diagnosis and treatment of SI joint pain.