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Algorithm for the Diagnosis and Treatment of the Dysfunctional Sacroiliac Joint

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Surgery for the Painful, Dysfunctional Sacroiliac Joint

Abstract

This chapter looks in depth at an organized methodical approach for diagnosing and treating the dysfunctional SIJ. The Borgess Brain and Spine Institute (BBSI) created it based on years of diagnosing and treating patients with this condition (Dall et al., http://www.borgess.com/files/bbsi/pdf/si_joint_white.pdf, 2010). Since that time, further editing of this algorithm has occurred with input from Arnold Graham Smith, MD, Jacksonville, Florida, and Michael Rahl, DPT, trained at the University of Connecticut. This algorithm is meant to be a general guide for the clinician, providing a simple, reliable path through the process of diagnosing and treating the painful, stable SIJ. It is not meant to be an exhaustive review of all the literature that has contributed to its creation. Although this algorithm has worked well for our patients at the BBSI, it is only one concept as to how clinicians might proceed. As time passes some of the steps in this algorithm are expected to change due to increasing knowledge and experience.

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References

  1. Dall BE, Eden SV, Brumblay H. Algorithm for the diagnosis and treatment of the dysfunctional sacroiliac joint. 2010. http://www.borgess.com/files/bbsi/pdf/si_joint_white.pdf

  2. Zelle BA, Gruen GS, Brown S, George S. Sacroiliac joint dysfunction: evaluation and management. Clin J Pain. 2005;21:446–55.

    Article  PubMed  Google Scholar 

  3. Bernard TN, Kirkaldy-Willis WH. Recognizing specific characteristics of non-specific low back pain. Clin Orthop. 1987;217:266–80.

    PubMed  Google Scholar 

  4. Schwarzer AC, Aprill CN, Bogduk N. The sacroiliac joint in low back pain. Spine. 1995;20:31–7.

    Article  CAS  PubMed  Google Scholar 

  5. Maigne JY, Aivaliklis A, Pfefer F. Results of the sacroiliac joint double block and value of sacroiliac provocation tests in 54 patients with low back pain. Spine. 1996;21:1889–92.

    Article  CAS  PubMed  Google Scholar 

  6. Schuit D, McPoil TG, Mulesa P. Incidence of sacroiliac joint malalignments in leg length discrepancies. J Am Podiatr Med Assoc. 1989;79:380–3.

    Article  CAS  PubMed  Google Scholar 

  7. Herzog W, Conway PJ. Gait analysis of sacroiliac joint patients. J Manipulative Physiol Ther. 1994;17:124–7.

    CAS  PubMed  Google Scholar 

  8. Schoenberger M, Hellmich K. Sacroiliac dislocation and scoliosis. Hippokrates. 1964;35:476–9.

    CAS  PubMed  Google Scholar 

  9. Katz V, Schofferman J, Reynolds J. “The sacroiliac joint” a potential cause of pain after lumbar fusion to the sacrum. J Spinal Disord Tech. 2003;16:96–9.

    Article  PubMed  Google Scholar 

  10. Ebraheim NA, Elgafy H, Semaan HB. Computed tomographic findings in patients with persistent sacroiliac pain after posterior iliac graft harvesting. Spine. 2000;25:2047–51.

    Article  CAS  PubMed  Google Scholar 

  11. Albert H, Godskesen M, Westergaard J. Prognosis in four syndromes of pregnancy-related pelvic pain. Acta Obstet Gynecol Scand. 2001;80:505–10.

    Article  CAS  PubMed  Google Scholar 

  12. Berg G, Hammar M, Moller-Nielsen J. Low back pain during pregnancy. Obstet Gynecol. 1988;71:71–5.

    CAS  PubMed  Google Scholar 

  13. Daly JM, Frame PS, Rapoza PA. Sacroiliac subluxations: a common treatable cause of low back pain in pregnancy. Fam Pract Res J. 1991;11:149–59.

    CAS  PubMed  Google Scholar 

  14. Bollow M, Braun J, Hamm B. Sacroiliitis: the key symptom of spondyloarthropathies. 1. The clinical aspects (German). Rofo. 1997;166:95–100.

    Article  CAS  PubMed  Google Scholar 

  15. Cush JJ, Lipsky PE. Reiter’s syndrome and reactive arthritis. In: Koopman WJ, editor. Arthritis and allied conditions: a textbook of rheumatology, vol. 1. 14th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001. p. 1324–44.

    Google Scholar 

  16. Wise CL, Dall BE. Minimally invasive sacroiliac arthrodesis: outcomes of a new technique. J Spinal Disord Tech. 2008;8:579–84.

    Article  Google Scholar 

  17. Dreyfuss P, Michaelsen M, Pauza K, McLarty J. The value of the medical history and physical examination in diagnosing sacroiliac joint pain. Spine. 1996;21:2594–602.

    Article  CAS  PubMed  Google Scholar 

  18. Fortin JD, Dwyer AP, West S. Sacroiliac joint pain referral maps upon applying a new injection/arthrography technique, part I. Spine. 1994;19:1475–82.

    Article  CAS  PubMed  Google Scholar 

  19. Fortin JD, Aprill CN, Ponthieux B. Sacroiliac joint pain referral maps upon applying a new injection/arthrography technique, part I. Spine. 1994;19:1483–9.

    Article  CAS  PubMed  Google Scholar 

  20. Dreyfuss P, Dreyer S, Cole A, Mayo K. Sacroiliac joint pain. J Am Acad Orthop Surg. 2004;12:255–65.

    PubMed  Google Scholar 

  21. Prather H. Sacroiliac joint pain: practical management. Clin J Sport Med. 2003;13:252–5.

    Article  PubMed  Google Scholar 

  22. Bernard TN, Cassidy JD. The sacroiliac joint syndrome: pathophysiology, diagnosis, and management. In: Frymoyer JW, editor. The adult spine: principles and practice. New York: Raven; 1991. p. 2107–30.

    Google Scholar 

  23. Maugars Y, Mathis C, Berthelot JM, Charlier C, Prost A. Assessment of the efficacy of sacroiliac corticosteroid injections in spondyloarthropathies: a double-blind study. Br J Rheumatol. 1996;35:767–70.

    Article  CAS  PubMed  Google Scholar 

  24. Braun J, Bollow M, Seyrekbasan F. Computed tomography guided corticosteroid injection of the sacroiliac joint in patients with spondyloarthropathy with sacroiliitis: clinical outcome and follow-up by dynamic magnetic resonance imaging. J Rheumatol. 1996;23:659–64.

    CAS  PubMed  Google Scholar 

  25. Luukkainen R, Nissila M, Asikainen E. Periarticular corticosteroid treatment of the sacroiliac joint in patients with seronegative spondyloarthropathy. Clin Exp Rheumatol. 1999;17:88–90.

    CAS  PubMed  Google Scholar 

  26. Luukkainen R, Wennerstrand PV, Kautiainen HH. Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondyloarthropathic patients with chronic low back pain in the region of the sacroiliac joint. Clin Exp Rheumatol. 2002;20:52–4.

    CAS  PubMed  Google Scholar 

  27. Belanger TA, Dall BE. Sacroiliac arthrodesis using a posterior midline fascial splitting approach and pedicle screw instrumentation: a new technique. J Spinal Disord. 2001;2:118–24.

    Article  Google Scholar 

  28. Borowsky CD, Fagen G. Sources of sacroiliac region pain: insights gained from study comparing standard intra- and peri-articular injection. Arch Phys Med Rehabil. 2008;89:2048–56.

    Article  PubMed  Google Scholar 

  29. Klein RG, Edk BC, Delong WB, Mooney V. A randomized double blind trial of dextrose-glycerine-phenol injections for chronic low back pain. J Spinal Disord. 1993;6:23–33.

    Article  CAS  PubMed  Google Scholar 

  30. Calvillo O, Esses SI, Ponder C, D’Agostino C, Tanhui E. Neuroaugmentation in the management of sacroiliac joint pain: a report of two cases. Spine. 1998;23:1069–72.

    Article  CAS  PubMed  Google Scholar 

  31. Yin W, Willard F, Carreiro J, Dreyfuss P. Sensory stimulation-guided sacroiliac joint radiofrequency neurotomy: technique based on neuroanatomy of the dorsal sacral plexus. Spine. 2003;28:2419–25.

    Article  PubMed  Google Scholar 

  32. Buijs EJ, Kamphuis ET, Groen GJ. Radiofrequency treatment of sacroiliac joint-related pain aimed at the first three sacral dorsal rami: a minimal approach. Pain Clin. 2004;16:139–46.

    Article  Google Scholar 

  33. Ferrante FM, King LF, Roche EA. Radiofrequency sacroiliac joint denervation for sacroiliac syndrome. Reg Anesth Pain Med. 2001;26:137–42.

    Article  CAS  PubMed  Google Scholar 

  34. Gevargez A, Groenemeyer D, Schirp S, Braun M. CT-guided percutaneous radiofrequency denervation of the sacroiliac joint. Eur Radiol. 2002;12:1360–5.

    Article  CAS  PubMed  Google Scholar 

  35. Srejic U, Calvillo O, Kabakibou K. Viscosupplementation: a new concept in the treatment of sacroiliac joint syndrome: a preliminary report of four cases. Reg Anesth Pain Med. 1999;24:84–8.

    CAS  PubMed  Google Scholar 

  36. Ackerman SJ, Polly DW, Knight T, Schneider K, Holt T, Cummings J. Comparison of the costs of non-operative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States Medicare population: potential economic implications of a new minimally-invasive technology. Clinicoecon Outcomes Res. 2013;5:575–87.

    Article  PubMed Central  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Neurosurgery of Kalamazoo, Borgess Brain and Spine Institute, Orthopedic Spine Division, Western Michigan University Medical School, Kalamazoo, MI, USA

    Bruce E. Dall M.D.

  2. Department of Neurological Surgery, Borgess Brain and Spine Institute, Western Michigan University Medical School, Kalamazoo, MI, USA

    Sonia V. Eden M.D.

  3. Full Potential Physical Therapy, 286 Hoover Boulevard, Holland, MI, 49423, USA

    Michael D. Rahl P.T., D.P.T., O.C.S., C.S.C.S.

  4. Orthopaedic surgery, Baptist Medical Center – South, 9191 R.G. Skinner Pkwy #103, Jacksonville, FL, 32256, USA

    Arnold Graham Smith M.D., P.A.

Authors
  1. Bruce E. Dall M.D.
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  2. Sonia V. Eden M.D.
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  3. Michael D. Rahl P.T., D.P.T., O.C.S., C.S.C.S.
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  4. Arnold Graham Smith M.D., P.A.
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Corresponding author

Correspondence to Bruce E. Dall M.D. .

Editor information

Editors and Affiliations

  1. Borgess Brain and Spine Institute Western Michigan University School of Medicine, Kalamazoo, Michigan, USA

    Bruce E. Dall

  2. Borgess Brain and Spine Institute Western Michigan University School of Medicine, Kalamazoo, Michigan, USA

    Sonia V. Eden

  3. Full Potenial Physical Therapy, Holland, Michigan, USA

    Michael D. Rahl

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Dall, B.E., Eden, S.V., Rahl, M.D., Smith, A.G. (2015). Algorithm for the Diagnosis and Treatment of the Dysfunctional Sacroiliac Joint. In: Dall, B., Eden, S., Rahl, M. (eds) Surgery for the Painful, Dysfunctional Sacroiliac Joint. Springer, Cham. https://doi.org/10.1007/978-3-319-10726-4_6

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  • DOI: https://doi.org/10.1007/978-3-319-10726-4_6

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-10725-7

  • Online ISBN: 978-3-319-10726-4

  • eBook Packages: MedicineMedicine (R0)

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