Presentation, patient education02102011
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Presentation, patient education02102011 Presentation, patient education02102011 Presentation Transcript

  • Lower Back Pain Sacroiliac Joint, A Common Cause That is Often Overlooked
  • Agenda
    • Introduction
    • Anatomy of the Spine
    • Understanding Lower Back Pain
    • Symptoms
    • Treatment Options
    • Summary and Q&A
    Minimally Invasive Sacroiliac Joint Surgery 2
  • Epidemiology
    • Up to 85% of all people have lower back pain (LBP) at some point in life
    • 2 nd only to common cold in office visits
    • 15 million office visits annually
    • 5 th ranked cause of hospital admission
    • Annual direct and indirect costs have reach $86 Billion
    Minimally Invasive Sacroiliac Joint Surgery 3
  • Anatomy - Spine
    • 24 vertebrae
      • Base of Skull to Pelvis
      • Building blocks
    • Discs between vertebrae
      • Cushions between bones
    • Protects Spine Cord
    • Nerves exit spinal cord
    Minimally Invasive Sacroiliac Joint Surgery 4
  • Anatomy – Ligaments
    • Strong ligaments encase each joint
    • Allow for about 2-4 millimeters of movement
    • If damaged, may have excessive motion
    • Excessive motion may inflame and disrupt the joint and surrounding nerves
    Minimally Invasive Sacroiliac Joint Surgery 5
  • Anatomy – Nerve Supply of Pelvis
    • Nerves exit Lumbar Spine & Sacrum
    • Provide sensation to legs
    Minimally Invasive Sacroiliac Joint Surgery 6
  • Sacroiliac Joint Problems
    • Common causes:
    • Degenerative disease
    • History of trauma
    • Pregnancy/childbirth
    • Lumbar Fusion
    • other unknown reasons.
    • Disruption due to:
    • Injury, traumatic event or repetitive trauma
    • or may suffer from sacroiliitis (swelling)
    Minimally Invasive Sacroiliac Joint Surgery 7
  • Symptoms
    • Back pain - low back pain
    • Buttock pain
    • Thigh pain
    • Sciatic-like pain
    • Difficulty sitting in one place for too long due to pain
    Minimally Invasive Sacroiliac Joint Surgery 8
  • Diagnosing
    • SI Joint – being “rediscovered”
    • Not usually part of LBP work-up
    • Often misdiagnosed or not evaluated
    • Physicians are not trained to look for it
    • Proper Diagnosis important
      • Pain can mimic discogenic or radicular low back pain
      • potentially leading misdiagnosis and lumbar surgery
    Minimally Invasive Sacroiliac Joint Surgery 9
  • Diagnosing - Imaging
    • Plain film, CT scan, & MRI maybe order
      • Often misleading
      • One study, CT scans were negative in 42% of symptomatic SI joints 1
      • MRI has not been proven to have positive correlation
    Minimally Invasive Sacroiliac Joint Surgery 10 1. Elgafy H, Semaan HB, Ebraheim NA, et al. Computed tomography findings in patients with sacroiliac pain.  Clin Orthop Relat Res . Jan 2001;112
  • Diagnosing - Imaging
      • International Association for the Study of Pain (IASP) criteria for diagnosis of SI joint pain: 1
      • Pain is present in the region of the SI joint.
      • Stressing the SI joint by performing clinical tests that are selective for the joint reproduces the patient’s pain.
      • Selectively infiltrating the putatively symptomatic joint with local anesthetic completely relieves the patient of pain.
    Minimally Invasive Sacroiliac Joint Surgery 11 1. Merskey H, Bogduk N. Classification of chronic pain. In: Merskey H, Bogduk N.  Descriptions of Chronic Pain Syndromes and Definition of Pain Terms . 2 nd ed.8
  • Diagnosing – Physical Therapy
    • Distraction Test
    • The sacroiliac joint is stressed by the examiner, attempting to pull the joint apart
    • Compression Test
    • The two sides of the joint are forced together. Pain may indicate that the sacroiliac joint is involved.
    • Gaenslen's Test
    • lay on a table, one leg drops over the edge and the supported leg is flexed. In this position, sacroiliac joint problems will cause pain because of stress to the joint.
    • Patrick's Test
    • The leg is brought up to the knee, and the knee is pressed on to test for hip mobility.
    Minimally Invasive Sacroiliac Joint Surgery 12
  • Diagnosis – SI Injections
    • SI Joint Injections:
    • Gold standard
    • Confirm or deny SI Joint is source of pain
    • 20-30 minutes after the procedure, you will move your back to try to provoke your usual pain.
    Minimally Invasive Sacroiliac Joint Surgery 13
  • Conservative Treatment
    • Non Steroid Anti-Imflamatory Drugs (NSAIDS)
    • Chiropractic Manipulation
    • Physical Therapy
      • Loosen/Stretch for hypomobility
      • Strengthen for hypermobility
    • Pelvic Belt
    • Steroid injections
    • Others: RF ablation, etc.
    Minimally Invasive Sacroiliac Joint Surgery 14
  • Conservative Treatment – SI Belts
    • SI Belts:
    • Wraps around the hips
    • Hold the sacroiliac joint tightly together
    • Reduce motion to reduce pain
    • Goal: Decrease joint mobility
    Minimally Invasive Sacroiliac Joint Surgery 15
  • Conservative Treatment
    • Physical Therapy
    • Lumbar stabilization program: strengthening abdominals and buttock muscles
    • Improve flexibility in lower extremity musculature
    • Lower back stretches
    • Goal: Decrease mobility
    Minimally Invasive Sacroiliac Joint Surgery 16
  • Conservative Treatment – SI Injections
    • Treatment:
    • Same procedure as diagnosis
    • Includes Corticosteroid in injection
      • Reduce your inflammation
      • May provide months of relief
    • Treats symptoms, not joint mobility
    Minimally Invasive Sacroiliac Joint Surgery 17
  • Treatment – Radiofrequency Ablation
    • “ Burns” small nerves that provide sensation to SI joint
    • In theory, this treatment:
      • Destroys any sensation
      • Makes joint essentially numb
    • Not always successful
      • Temporary, nerves regenerate.
    • Treats symptoms, not joint mobility
    Minimally Invasive Sacroiliac Joint Surgery 18
  • Surgical Treatment – iFuse Implant
    • Decrease mobility of SIJ
      • Same rationale as SI Belt
    • Minimally Invasive
      • Small incision
    • Doesn’t require bone for fusion
    • Potential for less OR time
    • Restore Quality of Life
    Minimally Invasive Sacroiliac Joint Surgery 19
  • Surgical Treatment – iFuse Implant
    • 3 or 4 pins a cross SIJ
    • High success rate: 90%
    Minimally Invasive Sacroiliac Joint Surgery 20
  • Conclusion
    • SIJ is underdiagnosed
    • Have your physician examine SI Joint, diagnosis to confirm or rule out
    • If SI Joint is diagnosed, treatment goals:
      • Reduce symptoms
      • Decrease mobility of SIJ joint
    Minimally Invasive Sacroiliac Joint Surgery 21