If you or someone you care about has low back pain, don’t resign yourself to lumbar spine surgery just yet. There’s a good chance the problem isn’t a disc, or even in the spine itself—it may be someplace else that’s easier to handle.
The SI Situation
Doctors today estimate that up to 25 percent of all low back pain actually originates in the sacroiliac (SI) joint, which is located in the pelvis just behind the hip. The SI joint bears and transfers weight and movement from your upper body to your legs, and over the years it can become arthritic and the ligaments can wear out. When that happens, low back complaints are usually the result. If you have trouble lying or sleeping comfortably in certain positions or feel lower back pain when lifting, running or walking, the SI joint may be the source.
“The SI joint is a significant cause of low back complaints, including pain and disability, which can mimic disc pain without actually originating from the lumbar spine,” said Ralph Rashbaum, M.D., a board-certified orthopedic surgeon. “All spine surgeons should include the SI joint as one of the first places to evaluate in patients presenting with low back problems.”
One common way for a doctor to identify SI joint dysfunction is to inject Lidocaine, a local anesthetic, into the joint. If it relieves the pain temporarily, the joint is the likely source of the problem. There are multiple treatment options—physical therapy, chiropractic manipulations, oral medications and steroid injection therapy—and all can be helpful. Some people also find relief from wearing a pelvic belt, which can provide support part of the time.
However, if these alternatives improve the symptoms only temporarily or not at all, surgery may be required. Traditional open surgery involves repairing and/or resurfacing the malfunctioning SI joint, but there’s also a new high-tech procedure using small titanium implants to stabilize the joint. This minimally invasive system, called iFuse, involves a much smaller incision and much less soft-tissue damage, so it is likely to heal more quickly and comfortably than traditional open surgery.
Diagnosing your low back pain is the first step toward getting it fixed. And new technology is helping patients achieve that more quickly.