Sacroiliac joint syndrome: aetiology, clinical presentation, diagnosis and management

Cover Page

Abstract

Sacroiliac joint (SIJ) syndrome is a relevant disorder to study because of the high prevalence of back pain conditions in people of working age. SIJ syndrome is a cause of pain in 15–30% of people with chronic pain in the lower lumbar spine. This review describes the anatomical structure of the SIJ and the aetiological factors that can lead to its dysfunction. Pathogenetic links in the development of this condition are identified separately. The issue of differential diagnosis with other vertebrogenic pain syndromes is considered in detail, and diagnostic tests are presented. The main current approaches to treating SIJ syndrome are described. Interventional methods for treating SIJ dysfunction are described in detail, including radiofrequency neuroablation as an alternative to conservative management.

About the authors

Anton V. Yarikov

City Clinical Hospital No. 39

Author for correspondence.
Email: anton-yarikov@mail.ru
Russian Federation, Nizhny Novgorod

Anton V. Morev

Privolzhsky Research Medical University

Email: anton-yarikov@mail.ru
Russian Federation, Nizhny Novgorod

Мaxim V. Shpagin

City Clinical Hospital No. 39

Email: anton-yarikov@mail.ru
Russian Federation, Nizhny Novgorod

Aleksandr P. Fryerman

City Clinical Hospital No. 39; Privolzhsky Research Medical University

Email: anton-yarikov@mail.ru
Russian Federation, Nizhny Novgorod

References

  1. Konovalov N.A., Proshutinskiy S.D., Nazarenko A.G., Korolishin V.A. [Radiofrequency denervation of intervertebral joints in the treatment of facet pain syndrome]. Voprosy neyrokhirurgii im. N.N. Burdenko 2011; 75: 51–55. (In Russ.)
  2. Nikitin A.S., Asratyan S.A., Kamchatnov P.R. [Stenosis of the vertebral canal in the lower spine]. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova 2015; 115: 130–140. (In Russ.)
  3. Kravets L.Ya., Istrelov A.K., Bokov A.E. [Minimally invasive technologies in the treatment of vertebral pain syndromes of various etiologies]. Nizhegorodskie vedomosti meditsiny 200; (8): 17–21. (In Russ.)
  4. Tyulikov K.V., Manukovskiy V.A., Litvinenko I.V. et al. [Minimally invasive methods of treating pain and radicular syndromes caused by degenerative-dystrophic diseases of the lumbar spine]. Vestnik Rossiyskoy voenno-medicinskoy akademii 2013; (1): 69–75. (In Russ.)
  5. Evzikov G.Yu., Egorov O.E., Rozen A.I. [Radiofrequency denervation in the treatment of pain syndrome in the pathology of the sacroiliac joint]. Neyrokhirurgiya 2015; (2): 80–85. (In Russ.)
  6. Pizova N.V. [Modern approaches to the treatment of sacroiliac arthropathy in patients with chronic back pain]. Meditsinskiy sovet 2014; (11): 62–65. (In Russ.)
  7. Prodan A.I., Sirenko A.A., Kolesnichenko V.A. [Denervation of the spinal joints: pro et contra]. Khirurgiya pozvonochnika 2005; (3): 78–86. (In Russ.)
  8. Dejung B. Iliosacralgelenks blockirungen. Eine Verlaufstudie. Manuelle Medizin 1985; 23: 109–115.
  9. Ignatova A.V. [Experience of using the drug Chondrogard in the composition of medical-medical blockades in the treatment of facet syndrome and dysfunction of the sacroiliac joint in the outpatient setting]. RMZh 2013; 21: 524–26. (In Russ.)
  10. Roy I.V., Fishchenko Ya.V., Kudrin A.P. [Radiofrequency neuroablation of the sacroiliac joint as a method for the treatment of pain syndrome]. Travma 2017; 18: 95–99. (In Russ.)
  11. Fishchenko Ya.V., Kudrin A.P., Kravchuk L.D. [Radiofrequency neuroablation in the treatment of pain syndrome of the sacroiliac joint]. Bol'. Sustavy. Pozvonochnik 2018; 8: 80–84. (In Russ.)
  12. Sitel' A.B. [Manual therapy for spondylogenic diseases]. Moscow, 2008. (In Russ.)
  13. Kim D.H., Vaccaro A.R., Dickman C.A. et al. Surgical Anatomy and Techniques to the Spine. Philadelphia, 2013.
  14. Isaykin A.I., Davydov O.S., Kavelina A.V., Ivanova M.A. [The problem of spondyloarthrosis. The neurologist’s point of view]. Effektivnaya farmakoterapiya 2017; (38): 28–41. (In Russ.)
  15. Fishchenko Ya.V., Belaya I.I., Kudrin A.P. [Diagnosis of the syndromes of the sacroiliac joints]. Bol'. Sustavy. Pozvonochnik. 2016; (4): 18–23. (In Russ.)
  16. Fortin J.D., Kissling R.O., O'Connor B.L., Vilensky J.A. Sacroiliac joint innervation and pain. Am J Orthop (Belle Mead NJ) 1999; 28: 687–690. PMID: 10614759.
  17. Cohen S.P., Chen Y., Neufeld N. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert Rev Neurother 2013; 13: 99–116. doi: 10.1586/ern.12.148. PMID: 23253394.
  18. Chenskiy A.D., Slinyakov L.Yu., Cherepanov V.G., Ternovoy K.S. [Diagnosis and treatment of the syndrome of the sacroiliac joint]. Kafedra travmatologii i ortopedii 2015; (2): 12–16. (In Russ.)
  19. Isaykin A.I., Ivanova M.A., Kavelina A.V. et al. [Sacroiliac joint syndrome]. RMZh 2016; 24: 1583–1588. (In Russ.)
  20. Nazarenko G.I., Cherkashov A.M., Shevelev I.N. et al. [Effectiveness of one-stage microdiscectomy and radiofrequency denervation of intervertebral joints compared to microdiscectomy in patients with spinal disc herniation]. Voprosy neyrokhirurgii im. N.N. Burdenko 2014; 78: 4–8. (In Russ.)
  21. Kuznetsov A.V., Dreval' O.N., Rynkov I.P. et al. [Treatment of facet syndrome in patients undergoing microdiscectomy]. Voprosy neyrokhirurgii im. N.N. Burdenko 2011; 75: 56–61. (In Russ.)
  22. Slipman C.W, Jackson H.B., Lipetz J.S. et al. Sacroiliac joint pain referral zones. Arch Phys Med Rehabil 2000; 81: 334–338. PMID: 10724079.
  23. Isaykin A.I., Kuznetsov I.V., Kavelina A.V., Ivanova M.A. [Nonspecific lumbodynia: causes, clinic, diagnosis, treatment]. Nevrologiya, neyropsikhiatriya, psikhosomatika 2015; 7: 101–109. (In Russ.)
  24. Akhmetov B.Kh., Maksimov Yu.N. [The role of the pathology of the sacroiliac joint in the development of pain in the lower back]. Prakticheskaya meditsina 2013; (1): 27–30. (In Russ.)
  25. Kavelina A.V., Isaykin A.I., Ivanova M.A. [Treatment of nonspecific lumbodynia due to dysfunction of the sacroiliac joint by interventional medicine methods]. Nevrologiya, neyropsikhiatriya, psikhosomatika 2018; 10: 33–37. (In Russ.)
  26. Kavelina A.V., Isaykin A.I., Ivanova M.A. [Interventional treatments for dysfunction of the sacroiliac joint]. Rossiyskiy zhurnal boli 2018; (2): 227–228. (In Russ.)
  27. Eskander J.P., Ripoll J.G., Calixto F. et al. Value of examination under fluoroscopy for the assessment of sacroiliac joint dysfunction. Pain Physician 2015; 18: E781–E786. PMID: 26431131.
  28. Volkov I.V., Karabaev I.Sh., Ptashnikov D.A. et al. [Influence of spinopelvic parameters on the development of sacroiliac joint pain syndrome and efficacy of its treatment]. Vestnik travmatologii and orthopedii im. N.N. Priorova 2018; (2): 13–20. (In Russ.)
  29. Volkov I.V., Karabaev I.Sh., Ptashnikov D.A. et al. [Cold Plasma Nucleoplasty Versus Radiofrequency Annuloplasty for Discogenic Pain Syndrome: Comparative Analysis of Efficacy]. Travmatologiya and orthopediya Rossii 2018; 24: 49–58. (In Russ.)
  30. Fortin J.D., Aprill C.N., Ponthieux B., Pier J. Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part II: Clinical evaluation. Spine (Phila Pa 1976) 1994; 19: 1483–1489. PMID: 7939979.
  31. Fortin J.D., Dwyer A.P., West S., Pier J. Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part I: Asymptomatic volunteers. Spine (Phila Pa 1976) 1994; 19: 1475–1482. PMID: 7939978.
  32. Cohen S.P., Hurley R.W, Buckenmaier C.C. 3rd et al. Randomized placebo-controlled study evaluating lateral branch radiofrequency denervation for sacroiliac joint pain. Anesthesiology 2008; 109: 279–288. doi: 10.1097/ALN.0b013e31817f4c7c. PMID: 18648237.
  33. Chamokova B.B. [Magnetic resonance imaging in the early diagnosis of sacroiliitis]. Radiologiya — praktika 2009; (1): 25–33. (In Russ.)
  34. Volkov I.V., Karabaev I.Sh., Ptashnikov D.A. et al. [Diagnosis and interventional treatment of pain syndromes after surgery for degenerative lumbar spine diseases]. Voprosy neyrokhirurgii im. N.N. Burdenko 2018; 82: 55–61. (In Russ.)
  35. Volkov I.V., Karabaev I.Sh., Aleksanin S.S. [Biological and radiation safety for patients during interventional and minimally invasive procedures for spine traumas and diseases: Experience of neurosurgical department of the Nikiforov Russian Center of Emergency and Radiation Medicine, EMERCOM of Russia]. Mediko-biologicheskie i sotsial'no-psikhologicheskie problemy bezopasnosti v chrezvychaynykh situatsiyakh 2017; (3): 38–46. (In Russ.)
  36. Manchikanti L., Abdi S., Atluri S. et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician 2013; 16: S49–S283. PMID: 23615883.
  37. Kennedy D.J., Engel A., Kreiner D.S. et al. Fluoroscopically guided diagnostic and therapeutic intra-articular sacroiliac joint injections: a systematic review. Pain Med 2015; 16: 1500–1518. doi: 10.1111/pme.12833. PMID: 26178855.
  38. Roy I.V., Fishchenko Ya.V., Belaya I.I., Kudrin A.P. [The effectiveness of intra-articular injections of hormonal drugs in the treatment of pain on the background of dysfunction of the sacroiliac joint]. Visnyk ortopediyi, travmatolohiyi ta protezuvannya 2016; (3): 26–32. (In Ukranian)
  39. Bollow M., Braun J., Taupitz M. et al. CT-guided intraarticular corticosteroid injection into the sacroiliac joints in patients with spondyloarthropathy: indication and follow up with contrast-enhanced MRI. J Comput Assist Tomogr 1996; 20: 512–521. PMID: 8708047.
  40. Braun J., Bollow M., Seyrekbasan F. et al. Computed tomography guided corticosteroid injection of the sacroiliac joint in patients with spondyloarthropathy with sacroiliitis: clinical outcome and followup by dynamic magnetic resonance imaging. J Rheumatol 1996; 23: 659–664. PMID: 8730123.
  41. Fischer T., Biedermann T., Hermann K.G. et al. Sacroiliitis in children with spondyloarthropathy: therapeutic effect of CT guided intra-articular corticosteroid injection. Rofo 2003; 175: 814–821. doi: 10.1055/s-2003-39925. PMID: 12811695.
  42. Maugars Y., Mathis C., Berthelot J.M. et al. Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies: a double-blind study. Br J Rheumatol 1996; 35: 767–770. PMID: 8761190.
  43. Roy I.V., Fishchenko Ya.V., Belaya I.I., Kudrin A.P. [Radiofrequency neuroablation in the fight against pain in the sacroiliac joint]. Meditsina boli 2016; (4): 60–65. (In Russ.)
  44. Singla V., Batra Y.K., Bharti N. et al. Steroid vs. platelet-rich plasma in ultrasound guided sacroiliac joint injection for chronic low back pain. Pain Pract 2017; 17: 782–791. doi: 10.1111/papr.12526. PMID: 27677100.
  45. Kholodov S.A. [The transcutaneous prosthetics of joint synovial fluid at patients suffered from lumbar spondylarthrosis]. Neyrokhirurgiya 2014; (3): 50–54. (In Russ.)
  46. Cohen S.P., Strassels S.A., Kurihara C. et al. Outcome predictors for sacroiliac joint (lateral branch) radiofrequency denervation. Reg Anesth Pain Med 2009; 34: 206–214. doi: 10.1097/AAP.0b013e3181958f4b. PMID: 19587617.
  47. Gevargez A., Groenemeyer D., Schirp S., Braun M. CT-guided percutaneous radiofrequency denervation of the sacroiliac joint. Eur Radiol 2002; 12: 1360–1365. doi: 10.1007/s00330-001-1257-2. PMID: 12042940.
  48. Cohen S.P., Abdi S. Lateral branch blocks as a treatment for sacroiliac joint pain: a pilot study. Reg Anesth Pain Med 2003; 28: 113–119. doi: 10.1053/rapm.2003.50029. PMID: 12677621.
  49. Karaman H., Kavak G.O., Tüfek A. Cooled radiofrequency application for treatment of sacroiliac joint pain. Acta Neurochir (Wien) 2011; 153: 1461–1468. doi: 10.1007/s00701-011-1003-1008. PMID: 21479801.
  50. Gilligan C.J., Shih J.C., Cai V.L. et al. Puncture approach for simplicity 3 sacral plexus radiofrequency ablation: technical note. Pain Physician 2016; 19: E643–E648. PMID: 27228532.
  51. Hegarty D. Clinical outcome following radiofrequency denervation for refractory sacroiliac joint dysfunction using the simplicity III probe: a 12-month retrospective evaluation. Pain Physician 2016; 19: E129–E135. PMID: 26752481.
  52. Stelzer W., Aiglesberger M., Stelzer D., Stelzer V. Use of cooled radiofrequency lateral branch neurotomy for the treatment of sacroiliac joint-mediated low back pain: a large case series. Pain Med 2013; 14: 29–35. doi: 10.1111/pme.12014. PMID: 23279364.
  53. Rashbaum R.F., Ohnmeiss D.D., Lindley E.M. et al. Sacroiliac joint pain and its treatment. Clin Spine Surg 2016; 29: 42–48. doi: 10.1097/BSD.0000000000000359. PMID: 26889985.
  54. Polly D.W., Swofford J., Whang P.G. et al. Two-year outcomes from a randomized controlled trial of minimally invasive sacroiliac joint fusion vs. non-surgical management for sacroiliac joint dysfunction. Int J Spine Surg 2016; 10: 22. doi: 10.14444/3028. PMID: 27652199.
  55. Lingutla K.K., Pollock R., Ahuja S. Sacroiliac joint fusion for low back pain: a systematic review and meta-analysis. Eur Spine J 2016; 25: 1924–1931. doi: 10.1007/s00586-016-4490-8. PMID: 26957096.

Statistics

Views

Abstract: 1367

PDF (Russian): 1767

Article Metrics

Metrics Loading ...

Dimensions

PlumX


Copyright (c) 2019 Yarikov A.V., Morev A.V., Shpagin М.V., Fryerman A.P.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies