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Spine Surgery pp 123-127 | Cite as

Surgical Treatment Options at the Sacroiliac Joint

  • Simon Bayerl
  • Dimitri Tkatschenko
  • Julius Dengler
  • Peter VajkoczyEmail author
Chapter

Abstract

This case will address the possible treatment options of sacroiliac joint pain (SIP) including conservative treatment with intraarticular injections and radiofrequency denervation as well as operative fusion. SIP is a frequent cause for low back pain (LBP) with association of poor quality of life. Inflammation, pregnancy, trauma and especially previous spine surgeries are important triggers for SIP. Therefore Spine surgeons are frequently confronted with patients suffering from SIP. Making the diagnosis of SIJ dysfunction in the physical examination is difficult. It includes provocative maneuvers as FABER, distraction test, Oestgaard test, Gaenslen test and thigh thrust test. Even the diagnostic sensitivity of x-Ray, CT scans and MRI for SIP is low, but radiological diagnostics are essential to rule out other sources of LBP. Conservative treatment of LBP includes physical therapy, manual therapy and NSAID administration. Injections with steroids and local anesthetics or cryo and radiofrequency neurotomy may support the conservative treatment. However, in some cases the treatment of SIP is very difficult and even interventional approaches lead to a temporary pain relief only. In these cases fusion surgery of the SIJ can be offered. This case report describes a patient, who underwent all types of SIP treatment with physiotherapy, pain medication, intraarticular injections and radiofrequency neurotomy and finally minimally invasive fusion of the SIJ.

References

  1. 1.
    Aydin SM, Gharibo CG, Mehnert M, Stitik TP. The role of radiofrequency ablation for sacroiliac joint pain: a meta-analysis. PM R. 2010;2:842–51.  https://doi.org/10.1016/j.pmrj.2010.03.035.CrossRefPubMedGoogle Scholar
  2. 2.
    Buchowski JM, Kebaish KM, Sinkov V, et al. Functional and radiographic outcome of sacroiliac arthrodesis for the disorders of the sacroiliac joint. Spine J. 2005;5:520–8.  https://doi.org/10.1016/j.spinee.2005.02.022.CrossRefPubMedGoogle Scholar
  3. 3.
    Fuchs V, Ruhl B. Distraction arthrodesis of the sacroiliac joint: 2-year results of a descriptive prospective multi-center cohort study in 171 patients. Eur Spine J. 2018;27(1):194–204.CrossRefGoogle Scholar
  4. 4.
    Dengler JD, Kools D, Pflugmacher R, et al. 1-year results of a randomized controlled trial of conservative management vs. minimally invasive surgical treatment for sacroiliac joint pain. Pain Physician. 2017;20:537–50.PubMedGoogle Scholar
  5. 5.
    Polly DW, Swofford J, Whang PG, et al. Two-year outcomes from a randomized controlled trial of minimally invasive sacroiliac joint fusion vs. Non-surgical management for sacroiliac joint dysfunction. Int J Spine Surg. 2016;10:28.  https://doi.org/10.14444/3028.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Guentchev M, Preuss C, Rink R, et al. Long-term reduction of sacroiliac joint pain with peripheral nerve stimulation. Oper Neurosurg. 2017;13:634–8.  https://doi.org/10.1093/ons/opx017.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Simon Bayerl
    • 1
  • Dimitri Tkatschenko
    • 1
  • Julius Dengler
    • 1
  • Peter Vajkoczy
    • 1
    Email author
  1. 1.Department of NeurosurgeryCharitè – Universitätsmedizin BerlinBerlinGermany

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