SI Joint pain comes from trauma or inflammation (arthritis) between the two large bones in the back of the pelvis.  These bones flex against one another to a very small degree. Like many other joints in the body, these joints can “wear out”, leading to arthritis and chronic pain in the lower back and upper buttock. This pain is usually one-sided, and has an aching, deep quality to it in many cases. This cause for this pain is often overlooked or mis-diagnosed. Although physical therapy and/or steroid injections can sometimes cure the pain, occasionally the injury or inflammation in this area results in permanent low back pain.

Like the other causes of low back pain, as above, the diagnosis is made in 3 steps – talking about your history of pain and the symptoms involved. A physical examination is most helpful in localizing the potential source of the pain. Finally, a local anesthetic block may be recommended. If the pain is reduced by more than 50%, the patient may be a candidate for more permanent treatment with surgery.

All joints have sensory nerves that innervate the joint capsule to sense pain. Sometimes these nerves are injured or become chronically inflamed, and just never turn off. When this happens, these nerves are doing more harm than good. Because they are only sensory nerves in non-crucial areas, they are essentially disposable. Meaning, the nerve can be excised, and normal function is not compromised. This denervation technique can be utilized for some types of chronic SI joint pain syndromes. The nerves that are evaluated and blocked are the Superior and Medial Cluneal nerves.

One popular treatment for SI joint inflammation pain is to “fuse” the joint. Through small incisions, surgeons place pins between the two bones to prevent them from moving. This eliminates the pain in most cases. Although the technique is not new, new materials for the pins have been invented which increase the likelihood of success, while decreasing risks of complications.

“Failed Back Surgery”

Several possibilities exist for new or persistent pain following lower (lumbar) spinal surgery.

One potential cause follows spinal fusion. When the bones of the spine are fused together, the forces of twisting and bending motions are increased in other areas. The spinal bones above and below the fused level(s) (see section above regarding facet joints) as well as the bones of the pelvis (the SI joints – also see above) can bear the brunt of these forces instead and cause them to wear out sooner. It is also possible that these joints already contributed to the pain, which is not fixed with the spinal fusion surgery. These additional pain sources can be investigated and treated.

Another cause is scarring and injury to the small sensory nerves (Superior Cluneal Nerves – see section above) during the spinal surgery. Spine surgery, especially fusion, is a big operation. Getting access to the bones of the spine and putting in rods, cages and screws is no small undertaking! In doing so, several of the small nerves going to the skin can be damaged or caught up in scar tissue afterwards. Doctors at Neuropax Clinic are experts in locating sources of pain following all types of surgery – especially low back pain!

Diagnosis and treatment of low back pain after spine surgery:
The cause of the pain and recommended treatments are described in the sections above. This is usually straightforward, and the solutions can be dramatic and long-lasting