Abstract
Pregnancy-related pain in the sacroiliac joint (SIJ), lumbosacral region, pubic symphysis, or in any combination of these joints has been coined as pelvic girdle pain (PGP) and has been estimated to affect almost half of all pregnant women. SIJ dysfunction in pregnancy is due to multiple biomechanical mechanisms, such as increased weight, change in posture, increased abdominal and intrauterine pressure, and laxity of the spine and pelvic structures. Moreover, when compared to men, women have increased SIJ mobility due to increased pubic angle and decreased SIJ curvature. These differences may assist in parturition where hormones, such as relaxin and estrogen, cause symphysiolysis. A retrospective review of the literature was conducted in the PubMed database using the search term “pregnancy-related sacroiliac joint pain.” All peer-reviewed studies were included. Around 8%-10% of women with PGP continue to have pain for one to two years postpartum. Patients that were treated with SIJ fusion show statistically significant improvement in pain scores when compared to patients that had non-operative treatment. Although we have a number of studies following patients after sacroiliac (SI) joint fusion for pelvic pain with SI joint dysfunction, further research is needed to study sacroiliac fusion for SI joint dysfunction in postpartum women to better tailor and optimize surgical outcomes for this patient population.
Highlights
The largest true synovial joint in the body, the sacroiliac joint (SIJ), is one of the most common sources of chronic lower back pain (LBP), as it is a highly specialized joint that is innervated by spinal nerves and grants stability, limited flexibility, and support of the upper body [1,2,3]
Pregnancy-related pain in the SIJ, lumbosacral region, pubic symphysis, or in any combination of these joints has been coined as pelvic girdle pain (PGP) and has been estimated to affect almost half of all pregnant women [6]
In the majority of women, the pain resolves within four months after giving birth but persists in approximately 20% of women; PGP that begins during pregnancy without resolving or that develops immediately after pregnancy is termed as postpartum pelvic girdle pain (PPGP) [7]
Summary
The largest true synovial joint in the body, the sacroiliac joint (SIJ), is one of the most common sources of chronic lower back pain (LBP), as it is a highly specialized joint that is innervated by spinal nerves and grants stability, limited flexibility, and support of the upper body [1,2,3]. Women who used crutches in pregnancy, experienced pain in three pelvic girdle locations compared to one or two, underwent an instrumental birth instead of an unassisted vaginal birth, received cesarean section, had a co-morbidity index of two to three or four or more, had a BMI of 30 or more, presented with a history of low back pain, occasional smoking, menarche onset of 10 or younger, and experienced emotional distress at one point during pregnancy were more likely to have persistent and severe PGS at six months postpartum [34] Factors such as prolonged labor, a high level of pain provocation tests, a lower mobility index score, and early gestational pain are correlated with long-term PGP. We have a number of studies following patients after SI joint fusion for pelvic pain with SI joint dysfunction, further research is needed to study sacroiliac fusion for SI joint dysfunction in postpartum women to better tailor and optimize surgical outcomes for this patient population
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