Sacroiliitis is an inflammation or malfunction of the sacroiliac joint, resulting in low back pain. In fact, it is estimated that between 15 and 20% of all low back pain diagnosed has its origin in this joint and not in the lumbar spine.
This is why it is essential to correctly identify that the problem is located in the sacroiliac joint, despite the fact that today there is no specific test that assures us that the problem is really located there.
The sacroiliac joint is the largest joint in the body. It joins the sacrum with the ilium of the pelvis. Its function is not movement, but to support the mechanical load of the upper body in the pelvis.
During the final phase of pregnancy, this joint opens, widening the pelvis to make room for the baby.
Causes of sacroiliitis
There are numerous causes of sacroiliitis. It should be mentioned that the pain is similar to a low back pain originating in the spine, so it is important to identify the onset of pain.
The most common causes are traumatic causes:
- Falling on the ass.
- Motorcycle accident in which there is an impact on the side of the hip.
- Car accident in which there is a lateral or posterior impact.
- Excessive weight bearing that is done repeatedly.
- Childbirth.
In the case of non-traumatic causes, the following stand out:
- Post-surgery of lumbar fusion.
- Alterations in body balance, such as scoliosis or leg dysmetry.
- Multiple pregnancy.
Symptoms of sacroiliitis
The diagnosis of this pathology is not simple, since its main symptoms are similar to those produced by low back pain whose origin is located in the spine. It may also be accompanied by false sciatica.
The most common signs are:
- Unilateral low back pain, that is, on one side of the body.
- Pain radiating to the hip and/or groin.
- The pain may extend down the lateral aspect of the leg to the ankle or foot.
It is also common for any or all of the following symptoms to be present:
- Night pain: the patient cannot sleep on the affected side.
- Pain when sitting.
- Pain when standing: the patient bears the weight of the body on the leg that does not hurt.
- Pain when climbing stairs.
How is sacroiliitis diagnosed?
The diagnosis of this pathology is made by means of a clinical history, examination and a diagnostic puncture, since there is no radiological test to indicate whether the sacroiliac is affected.
- Clinical history: history – traumatic or not – that raises the suspicion of possible sacroiliitis.
- Symptomatology.
- Physical examination:
- Positive Fortin’s point: it is a painful palpation of the joint.
- Positive stand leg test: pain is produced by weight bearing on the affected side.
- Maneuvers to provoke pain in the sacroiliac joint.
- Distraction.
- Compression
- Faber.
- Genslen.
- Trigh Trust.
If three or more of these maneuvers are positive, and the clinical history and examination suggest sacroiliitis, a diagnostic puncture will be performed. This is performed under local anesthesia and in the operating room, and is a puncture with anesthesia inside the joint.
If after the puncture the pain is reduced by 50% or more, then sacroiliitis is diagnosed.
How is sacroiliitis treated?
There are two ways to treat it, conservatively or by undergoing surgery.
In conservative treatment, the following is done:
- Physical therapy exercises to strengthen the pelvic muscles.
- Pelvic closure belt.
- Direct puncture of the joint.
- Radiofrequency treatment or rhizolysis.
In the event that conservative treatment does not achieve the desired results, the alternative is sacroiliac fusion surgery.
Sacroiliac joint fusion is a surgery that stabilizes, fixes, and over time fuses the iliac and sacral bones with titanium implants. Since the sacroiliac joint is a support joint, its fusion does not entail a loss of function or mobility for the patient.
What does sacroiliac joint fusion consist of?
Mainly, the procedure stabilizes and fuses the sacroiliac joint thanks to the implantation of three titanium pins that go through the circulation.
At the Clavel Institute we perform this procedure with the IFUSE system, which is currently the most proven technique and has the best success rate. In turn, at Instituto Clavel we use the O-AMR2 navigated assistance system for its successful placement.
The whole process is performed under general anesthesia, placing the patient face down. The incision is barely three centimeters in the lateral part of the buttock on the affected side, and in a minimally invasive way the bone is perforated through the sacroiliac joint until reaching the sacrum bone, and once there, the titanium implants are placed. These, which are triangular in shape, are placed in a specific position for each patient in order to provide greater stability to the joint.
The surgery lasts approximately one hour, and the hospital stay should not exceed 48 hours.
For more information, consult an expert in Neurosurgery.