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Lower Back Pain Sacroiliac Joint, A Common Cause That is Often Overlooked
Agenda <ul><li>Introduction </li></ul><ul><li>Anatomy of the Spine </li></ul><ul><li>Understanding Lower Back Pain </li></...
Epidemiology <ul><li>Up to 85% of all people have lower back pain (LBP) at some point in life </li></ul><ul><li>2 nd  only...
Anatomy - Spine <ul><li>24 vertebrae </li></ul><ul><ul><li>Base of Skull to Pelvis </li></ul></ul><ul><ul><li>Building blo...
Anatomy – Ligaments <ul><li>Strong ligaments encase each joint </li></ul><ul><li>Allow for about 2-4 millimeters of moveme...
Anatomy – Nerve Supply of Pelvis <ul><li>Nerves exit Lumbar Spine & Sacrum </li></ul><ul><li>Provide sensation to legs </l...
Sacroiliac Joint Problems <ul><li>Common causes: </li></ul><ul><li>Degenerative disease </li></ul><ul><li>History of traum...
Symptoms <ul><li>Back pain - low back pain  </li></ul><ul><li>Buttock pain  </li></ul><ul><li>Thigh pain  </li></ul><ul><l...
Diagnosing <ul><li>SI Joint – being “rediscovered” </li></ul><ul><li>Not usually part of LBP work-up </li></ul><ul><li>Oft...
Diagnosing - Imaging <ul><li>Plain film, CT scan, & MRI maybe order </li></ul><ul><ul><li>Often misleading </li></ul></ul>...
Diagnosing - Imaging <ul><ul><li>International Association for the Study of Pain (IASP) criteria for diagnosis of SI joint...
Diagnosing – Physical Therapy <ul><li>Distraction Test </li></ul><ul><li>The sacroiliac joint is stressed by the examiner,...
Diagnosis – SI Injections <ul><li>SI Joint Injections: </li></ul><ul><li>Gold standard </li></ul><ul><li>Confirm or deny S...
Conservative Treatment <ul><li>Non Steroid Anti-Imflamatory Drugs (NSAIDS) </li></ul><ul><li>Chiropractic Manipulation </l...
Conservative Treatment – SI Belts <ul><li>SI Belts: </li></ul><ul><li>Wraps around the hips </li></ul><ul><li>Hold the sac...
Conservative Treatment <ul><li>Physical Therapy </li></ul><ul><li>Lumbar stabilization program: strengthening abdominals a...
Conservative Treatment – SI Injections <ul><li>Treatment: </li></ul><ul><li>Same procedure as diagnosis </li></ul><ul><li>...
Treatment – Radiofrequency Ablation <ul><li>“ Burns” small nerves that provide sensation to SI joint  </li></ul><ul><li>In...
Surgical Treatment – iFuse Implant <ul><li>Decrease mobility of SIJ </li></ul><ul><ul><li>Same rationale as SI Belt </li><...
Surgical Treatment – iFuse Implant <ul><li>3 or 4 pins a cross SIJ </li></ul><ul><li>High success rate: 90% </li></ul>Mini...
Conclusion <ul><li>SIJ is underdiagnosed </li></ul><ul><li>Have your physician examine SI Joint, diagnosis to confirm or r...
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Presentation, patient education02102011

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Transcript of "Presentation, patient education02102011"

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