The truth about the Sacroiliac Joint

July 15, 2018

For the last 5 years I have been confronted with a new procedure thats been available to some doctors known as the SI Fusion or Sacroiliac Joint Fusion.

The Sacroiliac joint in a non-moveable joint attaching the Iliac bone to the sacrum on both sides. It essentially does not move. It is not a diarthroidial joint like the hip or the knee or the shoulder. It has little or no motion or innervation as far as causing pain.

I have seen SI Joint problems with people dropping a motorcycle at 60 MPH having a fracture. A fracture causes instability where the ligaments are damaged. Other then that it is not a problem.

The SI Joint has been marketed as a solution to the pain problem of the buttock and the back. The bottom line is the SI Joint does not move. There are 30 or 40 articles pushed forward by manufacturers that market this procedure. None of these articles stated anything about a differential diagnosis of Sacroiliac Joint Pain.

Sacroiliac Joint Pain can be one of many things.

• It can be a Facet Arthropathy at L4-L5 or L5-S1.
• It could be a degenerative disc at L4-L5
• A Gluteus Medius muscle spasm
• An Iliotibial band and biceps femoral muscle spasm can also be tight causing accentuated problems.

All of these symptoms can be aggravated by a stiff lumbar spine or a fused lumbar spine. A pain injection can be used in the Sacro Iliac Joint in order to facilitate some improvement, however this can also diminish the innervation and pain fibers of the gluteus medius area and the referred pain from L4-L5.

The point is it doesn’t exist!

One of the interesting thoughts are, if the SI Joint is being fused what a “miraculous” target for an industry. Think about it.

You have a joint that doesn’t move.

A joint that is under the skin.

A joint that has no nerves next to it.

A joint that is easily accessible to anyone including NEUROSURGEONS who are not experts in fusing anything.

And you can charge for it!

So it’s an industry developing an economy based on a body part.

I think until a differential diagnosis of all I mentioned is eliminated, a surgeon has no business operating on a Sacroiliac joint unless major trauma has occurred.

I find it to be reprehensible that this procedure is being pushed forward and it is sad that the Integrity of many doctors have not generated a stop or a halt to this without some intellectualization as to the reasons of why they are doing it.

I talk about this in an abundance of caution to move ahead with any type of surgery along these lines.

What is a differential diagnosis?

If you have arm pain or leg pain? What causes it? Pain is a symptom not a diagnosis. One has to find where the pain is coming from. If you can put pressure on a facet or a joint in the lower back, you give it a pain injection and the pain goes away, that proves where the pain is coming from.

By the same token other parts of the body can cause pain, but until you can delineate where it is coming from, one can not appreciate it. The SI Joint is an easy target diagnosis. But referred pain to that area, from tight muscles or somewhere in the spine; all those can be confusing.

If a doctor is not academically correct to where the pain originates from. The differential diagnosis has to be eliminated before surgery can take place.