Surgical Treatment Options at the Sacroiliac Joint

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.