CHRONIC SACRO-ILEITIS

WHAT IS THE SACRO-ILIAC JOINT?

The Sacro-Iliac joint is the bridge between the pelvis and spine. This joint connects to the ilium (upper part of the pelvis) on its outer side and the sacrum (lower spine) by its inner side. It transmits weight from the upper body to the legs, and is bound by very strong ligaments. It has a very limited range of motion. It relaxes during pregnancy, to ease childbirth. Its degeneration is one of the leading causes of lumbosacral pain.
Sacro-iliac joint

 

SYMPTOMS OF PROBLEMS IN THE SACRO-ILIAC JOINT

  • Severe pain on one side of the pelvis above the hip.

  • Inability to sit due to pain or sit sideways because of the pain on the other side.
  • Recurrent pain in lower lumbar region or pelvis after a lumbar fusion surgery.

The symptoms of sacro-iliac joint pain can easily be confused with lumbar spine problems. This is a problem because treatment is different.

The pain from sacro-iliac joint may be dull, constant, severe, chronic and debilitating and may radiate to the entire lower lumbar region. It is often difficult to diagnose given the nonspecific symptoms. These symptoms may include local discomfort, pain in the lower lumbar region and / or buttock. This pain is usually most severe in the early morning getting out of bed and after being sat for a while.

CAUSES OF AN INJURY IN THE SACRO-ILIAC JOINT

  • A trauma or fall.

  • During pregnancy, although this type usually resolves spontaneously after delivery.
  • In patients who have undergone previous surgery in the lumbar spine, as some interventions such as lumbar fusions may cause deterioration in the sacro-iliac joint.

It is estimated that the pain of sacro-iliac joint affects up to 30% of patients with low back pain.


DIAGNOSIS

Infiltration of the sacro-iliac joint
Besides the clinical symptoms and physical examination, it is confirmed by an infiltration of the sacroiliac joint.
Infiltration of the sacro-iliac joint
 

TREATMENT

In some cases the pain disappears after a few months with conservative treatment (bed rest, anti-inflammatory drugs…). In others, the pain becomes chronic (lasting more than six months) and may require more aggressive treatments. In these rebel cases radiofrequency denervation of the sacroiliac joint is an alternative. If denervation is not effective, another option is the surgical fusion.

The surgical fusion can be performed open or through percutaneous techniques. In the second case, it noticeably reduces the size of the surgical wound and thus the pain after surgery and speeds the recovery after surgery.

Bilateral fusion of sacroiliac joint with titanium cylinders
Skin incisions for bilateral arthrodesis of the sacroiliac joint with titanium cylinders
Bilateral fusion of sacro-iliac joint with titanium cylinders
Skin incisions for bilateral arthrodesis of the sacro-iliac joint with titanium cylinders

Arthrodesis of the left sacroiliac joint with titanium screws
Skin incision for percutaneous arthrodesis of the left sacroiliac joint with titanium screws
Arthrodesis of the left sacro-iliac joint with titanium screws
Skin incision for percutaneous arthrodesis of the left sacro-iliac joint with titanium screws

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