Donald Corenman, MD, DC

First, you have really taken the bull by the horns to do research on this disorder and you should be commended. It is difficult to fend through all of the information on the internet as some of it is incorrect at best.

You are correct in that sacroiliac syndrome (SIJD) can be associated with multilevel lumbar fusion (greater than two levels). Iliac crest bone graft taken during spine surgery is highly correlated with SIJD. Thankfully, most patients no longer need that graft.

I disagree with leg length discrepancy as a cause as well as age as SIJD is much less common as we get older (the joint stiffens with age which reduces the chance of pain).

You have two significant risk factors for SIJD, multilevel lumbar fusion and especially prior iliac crest bone graft. Most SIJD cases I have seen are unilateral but there are occasional bilateral cases I have seen. Inflammatory disorders have to be ruled out in any patient with SIJD as cases of psoriatic arthritis, inflammatory bowel disease, ankylosing spondilitis, and Reiter’s syndrome can cause SIJD.

SIJD typically do not refer pain to the groin. Groin pain with SI pain leads me more toward hip disorders and radiculopathy. I am not stating that groin pain fully rules out SIJD but puts that diagnosis further down on the differential list. Also, SIJD pain typically will not wake you up but is mechanical in nature (pain with standing and walking as well as transition pain- pain with changing positions- sitting to standing).

Mechanical tests to diagnose SIJD are notoriously unreliable. That is, many different disorders will be aggravated by these maneuvers. The one most specific maneuver is the Gaenslen’s test and that is still a non-specific test.

I do believe that the best test to diagnose SIJD is the intra-articular injection (the joint is both fibrous and capsular). This is not a 100% test in that even patients with radiculopathy can have relief with this injection but that is a more unusual finding. This injection can be performed in the lateral decubitis position (lying on your side) but more standard is the prone position. Yes, a short term hypnotic (Versed) can be used for the injection but the relief of pain in the short term (three hours) is the most important information that needs to be collected (see pain diary). If you are too sedated and do not try to reproduce the symptoms during the first three hours, the diagnostic value is lost.

Treatment of SIJD has three potential therapies. One is prolotherapy. Injection of a sclerosing agent into the joint can cause fibrosis and pain relief. There are complications associated with this therapy. The second is rhizolysis. This therapy attempts to “kill” the nerves that supply the joint with pain fibers. The last therapy is surgical fusion of the joint. This is the “last resort” and in very good hands, has a 70% satisfaction rate.

Dr. Corenman

Your pain into the arms, left greater than right that is a dull ache with sharp pain components is consistent with radiculopathy (nerve root compression). This pain can be associated with a disc herniation at C6-7. Since you have had the pain for some time (three MRIs normally mean at least six months), you could be a candidate for a selective nerve root block (SNRB- see website).

The nerve block would be good for two purposes. One is that temporary relief for 2-3 hours would confirm that the herniation is the cause of your pain (see pain diary on the website). The second is that the steroid included in the injection can reduce pain and inflammation, sometimes for a long period of time.

Dr. Corenman

Lower back pain typically originates from degenerative disc or facet disease. Buttocks and posterior thigh pain typically originates from nerve root compression. Hip and groin pain can originate from the hip joint or from compression of higher nerves in the lumbar spine (L1-3).

You have isolated disc resorption at L5-S1 with foraminal stenosis (see website). This can cause generalized lower back pain and/or leg pain with standing and walking. The discs at L4-5 and L3-4 are slightly degenerative. These discs can cause mild-moderate lower back pain. Your L2-3 far lateral disc hernation on the right can compress the L2 nerve which can cause right sided hip and anterior thigh pain. The others above this level are not that important to your symptoms.

Dr. Corenman