Surgical Treatment for the Painful, Stable Sacroiliac Joint: What Does the Literature Tell Us?

Low back pain (LBP) represents the second most common cause of visits to primary care physicians with the loss of productivity, income, and associated medical expenses resulting in a $60 billion expenditure in the USA on an annual basis [ 1 ]. The sacroiliac joint (SIJ) has been identifi ed as one of the causes of LBP 15–30 % of the time at the initial offi ce visit [ 1 ]. The SIJ is a true synovial joint that primarily handles forces between the spine and pelvis [ 2 , 3 ]. In its normal state, the SIJ gains all of its stability from numerous associated ligamentous structures and its undulating oblique structure allows it to withstand signifi cant loads under normal physiologic conditions [ 3 ]. The painful, stable SIJ has recently been designated as a dysfunctional SIJ [ 4 ]. Although this is a recent defi nition, procedures to treat this joint have been in existence for nearly a century. The fi rst publication offering evidence in support of this condition with a primary diagnosis of traumatic arthritis was published in 1926 [ 5 ]. Consideration for the SIJ’s potential to cause pain temporarily slipped into obscurity when Mixter and Barr published their work on the injured herniated lumbar disc in 1934 [ 6 ]. Interest in the SIJ as a treatable pain generator has resurfaced, especially during the last decade. This is partially due to the emergence of pain clinics and the increasing number of diagnostic and potentially therapeutic SIJ injections being performed. In addition, with the increased utilization of instrumented lumbar or lumbosacral fusions to treat various spinal pathologies, the awareness of adjacent level degeneration affecting the SIJ and resulting in the painful, stable SIJ has surfaced [ 7 – 9 ]. Common causes for painful, stable SIJs include infl ammatory arthritis, postpartum syndrome, adjacent osteoporosis, Paget’s disease, direct or indirect trauma, and adjacent segmental degeneration secondary to a previous lumbosacral fusion [ 10 , 11 ]. When patients suffering from painful, dysfunctional SIJs have failed conservative treatment measures and their symptoms result in signifi cant inhibition of function, arthrodesis and/or stabilization of the joint may be considered. Again, along with an increase in diagnosis, there has been a resurgence of operations to fuse and/or stabilize the stable, painful SIJ during the past decade. Despite evidence of the existence of the painful, stable SIJ in the general population, the knowledge base for surgically treating the painful, stable SIJ remains limited. S. V. Eden , M.D. (*) Department of Neurological Surgery , Borgess Brain and Spine Institute, Western Michigan University Medical School , Kalamazoo , MI , USA e-mail: [email protected] 2 Surgical Treatment for the Painful, Stable Sacroiliac Joint: What Does the Literature Tell Us?