Back pain can be very difficult to treat. Successful treatment depends on early and accurate diagnosis.
The first step for many patients are over-the-counter medications and some simple stretching exercises. If this fails, an MRI can be obtained to look at the condition of the discs and spinal facet joints.
Unfortunately, many patients still suffer from back pain with an essentially normal MRI. Clinicians and patients alike can be very frustrated by this diagnostic dilemma. Recommendations for pain medications and non-specific injections will lead to unsatisfying results and continued pain.
One diagnosis commonly overlooked is pain originating from the Sacroiliac (SI) joint. The Sacroiliac joint is a large joint that connects the sacrum (spine) to the ilium (pelvis). It is this joint that loosens for pregnant women to allow a child to go through the birthing canal.
Unfortunately, this joint can be a pain generator as well. Patients with a direct injury, such as a work injury, car accident, fall or previous lumbar fusion, are especially at risk. Many clinicians overlook or ignore this diagnosis as there is no imaging study that confirms the SI joint as the pain generator.
The diagnosis is only made by listening to the patient and having a high index of suspicion that the SI joint may be the cause of the patient’s pain. A diagnostic block with an injection of numbing medication directly into the joint under Xray guidance will confirm the diagnosis and should provide nearly complete relief of the patient’s pain for a short period of time. Unfortunately, there are many clinicians that do not even consider this a diagnosis and the patient is left to feel that the pain is all in his or her head.
Once the diagnosis has been made, a minimally invasive SI joint fusion can be performed on an outpatient basis. A small 1 inch incision is made and three implants are passed across the SI joint to provide stabilization as the joints fuses. The procedure takes approximately 45 minutes and requires crutches for the first few weeks. There is no significant loss of clinical motion noticed by the patient and the pain relief is typically noticed within the first two weeks. I have recently submitted my outpatient data to spine meetings on SI fusion. This represents the largest study of patients receiving this this procedure on an outpatient basis.
After 16 years in practice, listening to your patients and considering all of the possible pain generators for back pain will maximize the chances of unlocking the mystery of back pain.
Dr. Nitin Khanna, www.nkspine.com, is a recognized international leader in Minimally Invasive Spine and Outpatient Surgery and serves as associate editor for SPINE and the International Journal of Spine Surgery. He has been in practice in Munster for the past 16 years at Orthopedic Specialists of Northwest Indiana after completing his spine fellowship at RUSH in 2003.
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