The role of sacroiliac joint dysfunction in the genesis of low back pain: the obvious is not always right.
BACKGROUND
It is a common practice to the link low back pain with protruding disc even when neurological signs are absent. Because pain caused by sacroiliac joint dysfunction can mimic discogenic or radicular low back pain, we assumed that the diagnosis of sacroiliac joint dysfunction is frequently overlooked.


OBJECTIVE
To assess the incidence of sacroiliac joint dysfunction in patients with low back pain and positive disc findings on CT scan or MRI, but without claudication or objective neurological deficits.


METHODS
Fifty patients with low back pain and disc herniation, without claudication or neurological abnormalities such as decreased motor strength, sensory alterations or sphincter incontinence and with positive pain provocation tests for sacroiliac joint dysfunction were submitted to fluoroscopic diagnostic sacroiliac joint infiltration.


RESULTS
The mean baseline VAS pain score was 7.8 +/- 1.77 (range 5-10). Thirty minutes after infiltration, the mean VAS score was 1.3 +/- 1.76 (median 0.000E+00 with an average deviation from median = 1.30) (P = 0.0002). Forty-six patients had a VAS score ranging from 0 to 3, 8 weeks after the fluoroscopic guided infiltration. There were no serious complications after treatment. An unanticipated motor block that required hospitalization was seen in four patients, lasting from 12 to 36 h.


CONCLUSIONS
Sacroiliac joint dysfunction should be considered strongly in the differential diagnosis of low back pain in this group of patients.
Weksler
Natan
N
Pain Service, Division of Anesthesiology and Critical Care, Soroka Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel. weksler@bgumail.bgu.ac.il
Velan
Gad J
GJ
Semionov
Michael
M
Gurevitch
Boris
B
Klein
Moti
M
Rozentsveig
Vsevolod
V
Rudich
Tzvia
T
D000779:Anesthetics, Local / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001623:Betamethasone / Q000031:analogs & derivatives / Q000627:therapeutic use; D002045:Bupivacaine / Q000627:therapeutic use; D005260:Female; D005471:Fluoroscopy; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000503:physiopathology; D007592:Joint Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D017116:Low Back Pain / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D015641:Radiography, Interventional; D012446:Sacroiliac Joint / Q000473:pathology / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed