Sacro-iliac Joint Dysfunction
The sacro-iliac joint is the joint with the spine and the pelvis on either side. The sacrum is a segment of the spine between the lumbar spine and the tail bone (coccyx). It is a triangular piece of bone formed of fused vertebrae. The sacrum forms the joint with the iliac part of the pelvis and it is named as the sacro-iliac joint. The stability of the joint is aided by the way the two bones articulate and it is aided by strong ligaments which stabilise the joint along with several muscles which influence the stability of the joint itself.
The sacro-iliac joint has very minimal movement but it helps to transmit body weight from the spine onto the pelvis down to the lower limbs.
Sacro-iliac pain can present in isolation, i.e. leg/buttock pain but that is not always the case and the symptoms would be more part of the lower back pain complex which need specific assessment to assess and gauge if the pain is actually arising from the sacro-iliac joint and there are different clinical tests utilised to assess this.
From an investigation point of view, various investigations i.e. X-rays, MRI scan, CT scan or bone scan could be utilised but many of these could be negative without any specific abnormality on these investigations.
There are various conditions which can cause sacro-iliac joint pain but for most of the cases the cause usually is mechanical in nature. Although there could be injury to the sacro-iliac joint which causes sacro-iliac joint pain and dysfunction. It could also present following pregnancy and delivery, giving rise to pain which could be a part of the symphysis pubic dysfunction syndrome (SPD). It could also be caused due to arthritic conditions, e.g. osteo-arthritis, rheumatoid arthritis and rheumatoid arthritis like conditions, which can affect the joint leading to pain. One of the mechanical causes for sacro-iliac joint dysfunction could be following fusion/stabilisation of the lower lumbar segments which causes adjacent level problems affecting the sacaro-iliac joint due to mechanical issues.
An important aspect in management of sacro-iliac joint pain is the assessment and appropriate diagnosis.
Most sacro-iliac joint dysfunction could be treated with non-operative and conservative methods, i.e. physiotherapy, osteopathy or chiropractic manipulation, which help improve the symptoms as the majority of sacro-iliac joint dysfunction is usually mechanical in nature.
Sacro-iliac belts could be an option to help with the symptoms and this should be discussed with your practitioner, physiotherapist, osteopath or chiropractor, to the efficacy and the duration of usage.
If non-operative methods fail then you would need an assessment from a clinician who would possibly decide to proceed with selective injections, i.e. targeted injections to the sacro-iliac joint under X-ray or CT guidance using local anaesthetic and steroid.
If non-operative methods and injection therapy fail then surgery would be an option, i.e. stabilising the sacro-iliac joint and this is usually achieved via a percutaneous approach in most situations and this should be discussed further in detail with your clinician about the procedure, outcome, risks and complications, and the rehabilitation following the procedure. The procedure is usually successful in the majority of individuals and they undergo post-operative rehabilitation.
Sciatica can occur with or without back pain and is caused when a nerve root in the spine is compressed. Your symptoms will be dictated by the position along the spine of the compressed nerve root.