Sacroiliac Joint and Minimally Invasive Sacroiliac Joint Surgery Chicago, IL
The sacroiliac joint or SI joint (SIJ) is the joint that connects the sacrum and the pelvis on each side of the lower spine. The sacrum is a large wedge-shaped vertebra at the end of the spine while pelvis refers to the iliac bone that is part of the hip joint. The primary purpose of this joint is to allow the slight shifting of these bones relative to each other in a bid to increase the flexibility of the pelvis, particularly during childbirth.
According to the extensive review of scientific evidence published in the Journal of Anatomy, for many centuries scientists have shown an interest in the structure and functionality of the SIJ in relation to pain and movement. Throughout the history, various studies provided a multitude of useful facts about the sacroiliac joint, but there were many misconceptions too.
For example, a wide array of well-known physicians from Hippocrates to Vesalius and Pare assumed that SIJ is only mobile during pregnancy. In the early 18th century, studies demonstrated that this particular joint is mobile in both men and women. It was discovered that the SIJ has a synovial membrane which only confirmed its mobility. The late 19th century marked yet another discovery which showed that the sacral movement takes place around a transverse axis, located at the level of the second sacral vertebra. The iliac rotation relative to the sacrum or rotation that occurs primarily around a transverse axis was named nutation or forward nodding and counternutation or backward nodding.
The succeeding studies discovered that the generalized pivot of the sacroiliac joint must be localized at the level of the iliac tuberosity. The tuberosity refers to the bony structure situated dorsal to the auricular of the SIJ. The sacroiliac joint was also described as a real diarthrosis or a mobile joint with a joint cavity between two bony surfaces. Later researches led scientists to conclude that SIJ is, in fact, the diarthro-amphiarthrosis thus implying the joint has characteristics of both freely mobile joint and an ossified joint at the same time.
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Anatomy of the sacroiliac joint
The sacroiliac joints provide a stable support to the upper body. Both the specific architecture of SIJ and the tightness of the well-developed fibrous apparatus result in the quite limited mobility. Sacral movement directly impacts the discs, the higher lumbar joints, and involves the sacroiliac joint.
Along with the small internal pelvic motions of the sacroiliac joints and symphysis, the significant motion of the external pelvic platform takes place as well. The pelvic platform movement upon the hip joints relative to the femur such as extension and flexion as well as rotation and adduction massively contributes to the spine and lumbar movement.
Scientists suggest that the sacroiliac joints pose as stress relievers in the force-motion relationships between the lower limb and the trunk. These particular joints make sure that the pelvic girdle isn’t a solid ring of bone that would fracture easily under the greater pressure. The SIJs provide a sufficient level of flexibility for the intra-pelvic forces to be transferred to/from the lower extremities and lumbar spine.
Generally, the sacroiliac joint is formed within sacral segments (S1, S2, and S3). It is important to mention that inclusion of the entire S3 isn’t common for females. The fusion of the sacral vertebra starts early in the second decade. The bony anatomy differs in shape, size, and contour among different people. Also, the shape of the joint changes from infancy to adulthood. The iliac part is mainly convex while the sacral auricular part is primarily concave. That said, in intra-articular bony tubercle it is present ventrally.
The sacralization or assimilation of the 5th lumbar vertebrae into the body of the sacrum develops in 6% of American adults. The S1 and L5 vertebra can fuse either at one or more locations. Women with sacralization have a narrower sacral angulation than men. Additionally, they have a narrower sacrum and shorter posterior sagittal diameter of the pelvic outlet compared to men.
The sacroiliac joint has either L-shaped or C-shaped configuration. The joint has a longer caudal or short cranial limb. The lower part of the cranial and caudal limb are synovial in structure while the upper part of a cranial limb is fibrous. When you’re standing, the S1 portion of the joint is positioned vertically.
We can divide the surface of SIJ into three parts corresponding to the three sacral elements that participate in the auricular surface. Of these parts, S1 is the longest, S2 middle, and S3 shortest. They are indicated as the cranial, middle, and caudal respectively.
According to the limited scientific data, the surface area of SIJ is greater in adult men than in women. In both genders, the mobility of sacroiliac joint declines from birth to puberty. That said, mobility in women gradually increases to a peak at about 25 years. In men, the mobility of SIJ remains low, especially in middle and advanced age.
Ligaments supporting the SIJ are strong and numerous including the ventral, dorsal, and interosseous. Long and short dorsal sacroiliac ligaments complement the interosseous ones. Furthermore, the LDL or long dorsal ligament is the most dorsally and superficially located of all SIJ ligaments. The LDL originates from the posterior superior iliac spine.
Types of ligaments of the SIJ are the following:
- Anterior sacroiliac ligament – although scientists refer to it as ligament, it is more of a slight thickening of the anterior joint capsule
- Interosseous sacroiliac ligament – lies deep into the posterior ligament and comprises of a series of short, strong fibers connecting the tuberosities of the sacrum and ilium. It’s the strongest ligament in your body
- Posterior sacroiliac ligament – we can divide time into long (extrinsic) or short (intrinsic). The dorsal sacroiliac ligaments belong to this category
- Sacrotuberous ligament – located at the lower and back part of the pelvis. The ligament is flat and triangular in form; narrower in the middle than at the ends
- Sacrospinous ligament – thin, triangular ligament
Just like other joints in your body, SIJ can also induce pain that limits your mobility and affects the overall quality of life. Dysfunction in sacroiliac joint causes lower back and leg pain; the latter can be particularly difficult. Leg pain caused by SIJ dysfunction resembles that of sciatica or pain that occurs as a result of lumbar disc herniation.
The pain occurs as a result of SIJ inflammation and multiple factors can contribute to it. For instance, the joint can get hurt during sports activity or during falls. SIJ dysfunction also occurs from an activity that gives the area a regular pounding e.g. jogging.
Arthritis is yet another factor that contributes to dysfunction of sacroiliac joint and pain, particularly the type of arthritis called ankylosing spondylitis. Age-related cartilage wear and tear also causes pain associated with SIJ dysfunction.
Lower back and leg pain linked to SIJ dysfunction occur in pregnant women too. The reason this happens is due to the fact the body releases hormones that loosen the joints and make them move more, thus changing the way the joints usually move.
Sacroiliac joint pain usually affects young and middle-aged women and is indicated by the following symptoms:
- Buttock/pelvis pain
- Groin/hip pain
- Impaired sitting patterns i.e. inability to sit for long periods, sitting on one side
- Lack of sleep due to pain
- Leg instability i.e. buckling, giving way
- Numbness, pain, tingling, weakness, in lower extremities
- Pain going from sitting to standing
- Pain in lower back area (below L5)
Sacroiliac joint dysfunction diagnosis
In order to make a precise and correct diagnosis, the doctor needs to know all symptoms that patient experiences. Based on the provided information including any history of injury, the location of pain, and problems standing and sleeping, the doctor is able to determine the diagnosis, but to be 100% certain, some tests might be necessary. They are:
Diagnostic injections of the SI joint
X-ray, CT, MRI
How is SIJ dysfunction treated?
Fortunately, it is entirely possible to manage pain and improve mobility. After establishing the diagnosis, doctors usually recommend adequate treatment options such as:
- Chiropractic treatment
- Discontinuing strenuous activities for a certain period of time
- Injections – patient may get an injection of cortisone to reduce inflammation
- Nerve treatment – using a needle doctor permanently damages the nerve that sends pain signals from the sacroiliac joint to the brain
- Physical therapy – exercises aimed to improve strength and flexibility
While in most cases these “traditional” treatments are effective for management of pain linked with SIJ dysfunction, other patients don’t find relief. If the pain and discomfort don’t improve, the doctor usually recommends a surgical procedure. Fortunately, with the progress of technology, science, and medicine, problems with sacroiliac joints are managed through minimally invasive surgery.
Minimally invasive surgery for the sacroiliac joint in Chicago, Illinois
Surgical procedures for sacroiliac joints aren’t often and, as mentioned above, they’re performed only when other forms of treatment don’t work. SIJ stabilization or joint fusion is an operation that helps you cope with the pain and other symptoms of SIJ dysfunction.
Minimally invasive surgery has a wide array of advantages over open, invasive procedures which are associated with many risks including greater blood loss, increased risk of infections, higher costs, and so on. It is needless to mention that minimally invasive surgeries for sacroiliac joint dysfunction leads to a faster recovery, shorter hospital stay, and lower intensity of pain. For this purpose, patented iFuse Implant System is widely used. The system is primarily intended for sacroiliac fusion for SIJ pain and discomfort caused by sacroiliac joint disruption and degenerative sacroiliitis.
Contrary to the popular belief, noninvasive procedures aren’t less effective than open surgeries. For instance, a study whose findings were published in the Advances in Orthopedics showed that minimally invasive surgery for SIJ fusion using the iFuse Implant System is a safe and effective treatment option. Moreover, a systematic review of minimally invasive SIJ surgeries, published in the International Journal of Spine Surgery showed that these procedures are successful in improving SIJ pain, disability, and overall quality of life.
The procedure is performed under general or spinal anesthesia. The surgeon utilizes a specially designed system to guide the instruments that prepare the bone and insert the implants. Due to the fact it’s a noninvasive operation, it requires a small incision that is about 2-3cm long, along with the side of the buttock. Throughout the procedure, the surgeon uses fluoroscopy to get the live imaging for maximum precision and adequate placement of implants.
The average length of noninvasive surgery for sacroiliac joint is about an hour. Based on the postsurgical status of a patient, the doctor determines when he/she can return home.
Before the patient gets to go home, doctor arranges follow-up visits to assess the progress, health status, etc. Doctor also provides useful info about recovery, when to resume with daily activity, go back to work, physical therapy, and so on. The patient will most likely need crutches for about three weeks. The great news is; if the SIJ pain affects just one side, recovery time is quicker.
Benefits of minimally invasive surgery for sacroiliac joint
As mentioned above, noninvasive procedures have a multitude of benefits compared to open surgeries. The most important advantages include the following:
- Reduced blood loss
- Smaller incision
- Shorter hospital stay and faster recovery
- Triangular implant profile provided by iFusion system minimizes rotation and an interference fit minimizes micromotion
- No need for bone grafting
- Minimal tendon irritation
- Less postoperative pain
- Less damage to the surrounding tissues
Despite the fact that sacroiliac joint isn’t as mobile and flexible as other joints e.g. in knees, they’re still prone to damage and injuries. These unfortunate scenarios lead to pain and discomfort that affect mobility and quality of life. Patients who’re experiencing symptoms mentioned above should consult their healthcare providers to receive an accurate diagnosis and adequate treatment. In cases when standard therapies prove to be ineffective, surgery is an ideal solution. Nowadays, minimally invasive surgeries are largely performed using iFusion patented system whose benefits and efficacy are well-documented.