Sacroiliitis refers to inflammation of one or both sacroiliac (SI) joints—the joints that connect the sacrum (the triangular bone at the base of your spine) with the iliac bones (part of the pelvis). These joints help transfer weight between your upper body and legs and play a crucial role in stability and movement. Inflammation in these joints can cause significant discomfort and interfere with daily activities.
Symptoms of Sacroiliitis
The most common symptom of sacroiliitis is lower back pain, but the pain can present in a variety of ways depending on the severity and underlying cause:
- Pain on one or both sides of the lower back, often radiating to the buttocks or thighs.
- Discomfort can spread upwards into the paraspinal muscles.
- In some cases, it may mimic a slipped disc, with pain radiating down the leg, often accompanied by numbness or tingling.
- Pain tends to worsen with physical activities such as prolonged standing, stair climbing, running, or sleeping on the affected side.
- Stiffness, especially in the morning or after rest.
Common Causes of Sacroiliitis
Sacroiliitis can result from a wide range of conditions, including trauma, degenerative changes, autoimmune disorders, and infections:
1. Trauma
- A direct injury or fall on the pelvis or hip can inflame the SI joint.
- Fractures involving the sacrum or ilium that extend through the SI joint can lead to inflammation and, if not healed properly, can result in chronic arthritis.
2. Degenerative and Inflammatory Arthritis
- Osteoarthritis: Age-related wear and tear of the SI joint can cause chronic degeneration.
- Inflammatory arthritis: Autoimmune diseases like:
- Ankylosing Spondylitis
- Psoriatic Arthritis
- Reiter’s Syndrome (Reactive Arthritis)
- Systemic Lupus Erythematosus (SLE)
These conditions often target the SI joints early in their course.
3. Pregnancy and Childbirth
- Hormonal changes during pregnancy cause ligament laxity, allowing the pelvis to widen for childbirth, which may strain or destabilize the SI joints.
- Vaginal delivery, especially difficult or prolonged labor, can further stress the SI joints.
4. Infections
- Bacterial or tubercular infections can invade the SI joints, especially in immunocompromised individuals, causing severe inflammation and joint destruction.
5. Lumbosacral Fusion Surgeries
- Patients who have undergone lumbar or lumbosacral spine fusion often develop sacroiliitis due to altered biomechanics and increased stress on the SI joints.
Diagnosis of Sacroiliitis
Sacroiliitis can be tricky to diagnose as its symptoms often mimic other spinal problems like herniated discs or sciatica. A detailed clinical evaluation is crucial.
1. Clinical Examination
- Direct tenderness over the SI joint region.
- Provocative physical tests like FABER (Patrick’s test) or Gaenslen’s test can reproduce pain, suggesting SI joint involvement.
2. Imaging Studies
- X-rays: May show joint space narrowing, sclerosis, or erosion in advanced cases.
- MRI: Best tool to detect early inflammation, fluid accumulation, or infection in the joint.
- CT Scan: Helpful in visualizing irregular joint surfaces, subtle fractures, or early arthritis.
3. Laboratory Investigations
- ESR (Erythrocyte Sedimentation Rate) and CRP (C-reactive Protein) are elevated in inflammatory or infectious sacroiliitis.
- HLA-B27 blood test may be positive in patients with Ankylosing Spondylitis.
4. Diagnostic Injection
- A local anesthetic injection into the SI joint under fluoroscopy or CT guidance can help confirm the diagnosis. Relief of pain following the injection is a strong indicator that the SI joint is the source of pain.
Treatment Options for Sacroiliitis
Treatment depends on the cause and severity of sacroiliitis. Most patients respond well to conservative management, while a few may require interventional or surgical treatment.
1. Conservative Treatment
- Rest and activity modification: Avoid movements that worsen pain.
- Physical therapy: To strengthen core and pelvic muscles and improve posture.
- Heat or cold therapy: To reduce inflammation and relieve stiffness.
- NSAIDs or pain-relieving medications: For controlling inflammation and discomfort.
- For patients with degenerative or autoimmune-related sacroiliitis, an injection of corticosteroids mixed with a local anesthetic directly into the SI joint can reduce inflammation and offer long-lasting pain relief.
3. Biopsy
- In cases of suspected infective sacroiliitis, a CT or fluoroscopy-guided biopsy may be required to identify the causative organism for targeted antibiotic therapy.
4. Radiofrequency Ablation (RFA)
- A minimally invasive procedure where the tiny nerves carrying pain signals from the SI joint are ablated (burnt) using radiofrequency energy.
- This technique provides significant pain relief for patients with chronic sacroiliitis not responding to injections.
5. Surgical Treatment
Surgery is considered only in severe cases where conservative and interventional treatments have failed:
- Sacroiliac Joint Fusion:
- The joint is cleaned (debrided), and bone grafting is performed to promote fusion.
- Internal fixation devices (such as screws or cages) may be used to stabilize the joint and allow it to fuse solidly over time.
- Indications for surgery include:
- Persistent, disabling pain
- Fractures involving the SI joint
- Infections not responding to antibiotics or when a biopsy is required
Conclusion
Sacroiliitis is a complex yet treatable condition. At Neo Spine Clinic, we emphasize a thorough clinical and diagnostic approach to accurately identify sacroiliitis and differentiate it from other spine-related conditions. With the right mix of medical management, physiotherapy, and interventional techniques, most patients experience significant relief.
If you’re struggling with chronic lower back or buttock pain that isn’t improving with usual care, sacroiliitis might be the reason.
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