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      Diagnosis and interventional pain management options for sacroiliac joint pain

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          Abstract

          The sacroiliac (SI) joint is among the most common sources of chronic low back pain, accounting for 15%–30% of patients presenting chronic low back pain. The complex anatomic structures, nerve innervation, and functional biomechanisms of the SI region make it challenging to diagnose and treat the SI joint as a pain source. In addition to physical therapy and medication for treating SI joint pain, multiple interventional measures including steroid injection, radiofrequency ablation, prolotherapy, and SI joint fusion have been proposed with various efficacies. This article describes the etiology, risk factors, and diagnostic methods as well as the different treatment modalities, focusing on interventional pain management options for patients suffering from SI joint pain.

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          Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment.

          Steven Cohen (2005)
          Sacroiliac (SI) joint pain is a challenging condition affecting 15% to 25% of patients with axial low back pain, for which there is no standard long-term treatment. Recent studies have demonstrated that historical and physical examination findings and radiological imaging are insufficient to diagnose SI joint pain. The most commonly used method to diagnose the SI joint as a pain generator is with small-volume local anesthetic blocks, although the validity of this practice remains unproven. In the present review I provide a comprehensive review of the anatomy, function, and mechanisms of injury of the SI joint, along with a systematic assessment of its diagnosis and treatment.
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            Randomized placebo-controlled study evaluating lateral branch radiofrequency denervation for sacroiliac joint pain.

            Joshua Cohen, Robert W Hurley, Chester C Buckenmaier … (2008)
            Sacroiliac joint pain is a challenging condition accounting for approximately 20% of cases of chronic low back pain. Currently, there are no effective long-term treatment options for sacroiliac joint pain. A randomized placebo-controlled study was conducted in 28 patients with injection-diagnosed sacroiliac joint pain. Fourteen patients received L4-L5 primary dorsal rami and S1-S3 lateral branch radiofrequency denervation using cooling-probe technology after a local anesthetic block, and 14 patients received the local anesthetic block followed by placebo denervation. Patients who did not respond to placebo injections crossed over and were treated with radiofrequency denervation using conventional technology. One, 3, and 6 months after the procedure, 11 (79%), 9 (64%), and 8 (57%) radiofrequency-treated patients experienced pain relief of 50% or greater and significant functional improvement. In contrast, only 2 patients (14%) in the placebo group experienced significant improvement at their 1-month follow-up, and none experienced benefit 3 months after the procedure. In the crossover group (n = 11), 7 (64%), 6 (55%), and 4 (36%) experienced improvement 1, 3, and 6 months after the procedure. One year after treatment, only 2 patients (14%) in the treatment group continued to demonstrate persistent pain relief. These results provide preliminary evidence that L4 and L5 primary dorsal rami and S1-S3 lateral branch radiofrequency denervation may provide intermediate-term pain relief and functional benefit in selected patients with suspected sacroiliac joint pain. Larger studies are needed to confirm these results and to determine the optimal candidates and treatment parameters for this poorly understood disorder.
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              Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality.

              O Friberg (1983)
              A simple and reliable low dose radiologic method developed by the author was used to measure leg length inequality of 798 patients with chronic and therapy resistant low-back and/or unilateral hip symptoms and 359 symptom free subjects. Statistically highly significant correlations of the symptoms and leg length inequality were observed. In the majority (79 and 89%), the chronic or recurrent sciatic pain and unilateral hip symptoms occurred on the side of the longer lower extremity. When correcting the leg length inequality simply with an adequate shoe lift, a permanent and mostly complete alleviation of symptoms was achieved in the majority of the cases. The unilateral symptoms associated with mostly unrecognized leg length inequality of 5 to 25 mm were, at least in part, due to the biomechanical responses, like bending and rotational forces, needed for compensation of the lateral imbalance caused by leg length inequality.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ci Ji Yi Xue Za Zhi
                Journal ID (iso-abbrev): Ci Ji Yi Xue Za Zhi
                Journal ID (publisher-id): TCMJ
                Title: Tzu-Chi Medical Journal
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 1016-3190
                ISSN (Electronic): 2223-8956
                Publication date Collection: Oct-Dec 2019
                Publication date (Electronic): 16 September 2019
                Volume: 31
                Issue: 4
                Pages: 207-210
                Affiliations
                [a ]Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
                [b ]School of Medicine, Tzu Chi University, Hualien, Taiwan
                Author notes
                [* ] Address for correspondence: Dr. Ming-Chang Kao, Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289, Jianguo Road, Xindian District, New Taipei, Taiwan. E-mail: dr_mck@ 123456yahoo.com.tw
                Article
                Publisher ID: TCMJ-31-207
                DOI: 10.4103/tcmj.tcmj_54_19
                PMC ID: 6905244
                SO-VID: 67ab50c0-9667-4e32-b007-240b4ddea88a
                Copyright © Copyright: © 2019 Tzu Chi Medical Journal
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 01 March 2019
                Date revision received : 15 April 2019
                Date accepted : 02 May 2019
                Categories
                Subject: Review Article

                Keywords: diagnostic block,low back pain,radiofrequency,sacroiliac joint injection,sacroiliac joint pain
                Data availability:
                Keywords: diagnostic block, low back pain, radiofrequency, sacroiliac joint injection, sacroiliac joint pain

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