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Sacroiliac Joint Injection for low back pain

Sacroiliac pain is something that many orthopaedic or neurosurgical spinal surgeons are not looking for, and have little experience in treating.
Some patients who have this problem have been told that they have sciatica or low back pain from osteoarthritis.

It is a painful arthritic process in the large joints of the pelvis where the sacrum of the spine joins the pelvis.
The ligaments should be hard and rigid here, but in some people they allow a micro-movement or abnormal movement which causes wear and pain over time.

It is more common in women who have had children, as the pelvic ligaments soften in the third trimester.

The other common group of patients with sacroiliac pain are those with long spinal fusions or deformity constructs fixed to the pelvis.
In this instance adjacent level wear is occurring at the only joint left below the construct, i.e the sacroiliac joint.
This occurs due to the long lever arm of the rigid spinal segment acting on a stress riser.
I also see it occasionally in patients with bilateral total hip replacements.

The final common group who get sacroiliac pain are those with rheumatoid arthritis or other inflammatory conditions.
These underlying problems will need treatment also from a rheumatologist.

The injection itself takes only a couple of minutes aided by X-ray guidance.
A very thin (0.7mm) diameter needle is used under local anaesthesia.
Steroid and long acting local anaesthetic are injected to soothe the joint.
Feedback shows that people tolerate this very well, and it is very effective at relieving symptoms.

Very few of my patients require further treatment in the form of a percutaneous sacroiliac joint fusion.