Back pain is experienced by about 90% of all people at some point during life. Fortunately, most individuals have relief of pain and do not require treatment beyond physical therapy and/or chiropractic care. Some individuals, when nerve pain is present, require epidural steroid injections. There are however, cases in which pain constitutes and ultimately affects a person’s daily life including work and recreation. Countless are the times this type of patient with low back pain will feel his or her situation is hopeless. The proverbial “Holy Grail” of pain relief can appear out of reach because “nothing seems to work.”
There are many reasons why some of these patients fail to achieve relief. Often, there is simply no treatment that will reliably provide relief without creating excessive risk. Unfortunately, these are areas of medical science that continue to require improvement. There are also cases which involve a missed or inappropriate diagnosis. These are areas that readily hold opportunity to improve outcomes and increase hope for the patient with disabling pain. After all, it is hard to treat a problem if you either do not know what caused it or if you have picked the wrong cause.
Sacro-iliac (SI) joint dysfunction is a very common cause of back pain. Medical literature has reported it as the cause in 25% or more of cases, however, it is not commonly diagnosed by many physicians. SI joint pain can present as low back pain and/or pain radiating down the back of the leg. Therefore, it is often misdiagnosed as degenerative disc disease, sciatica, failed back syndrome or categorized as a soft tissue disorder of unknown origin. These missed diagnoses lead to a multitude of failed treatments including surgeries that leave the patient no better, and sometimes worse than before the procedure. That is why it is important to seek treatment from a spine specialist who is thorough and has a broad knowledge of diseases and ailments of the spine.
Any evaluation should include a thorough history and physical exam by the medical team and include direct oversight by the physician. The diagnosis of SI Joint pain or dysfunction is typically made after physical exam and can be confirmed by an injection. These injections are done with xray guidance and will typically anesthetize (numb up) the joint and well as use steroid to reduce inflammation. If the SI Joint is the problem, the injection should relieve 70% or more of the patient’s pain. Once properly diagnosed, an appropriate rehabilitation program can be started to help the patient on to recovery. Sometimes, the injections have to be repeated.
Unfortunately, the rehab and injections do not always provide lasting or complete relief. At that time, more invasive treatments can be used.
Traditionally, surgery and interventional pain management were used to treat these patients. The surgery was a large procedure and was rarely recommended, so most patients would receive procedures from pain specialists such as nerve root ablations. Many of these procedures would only work several months to a year and would have to be repeated over the life of the patient to maintain relief. Currently, there are minimally invasive surgical procedures that have been developed to provide a permanent solution for pain relief. Procedures such as SImmetry, from Zyga Technologies Inc. allow surgeons to provide a surgical option to truly fuse the joint and obtain permanent pain relief. The procedure also uses a technique that avoids most of the risk and recovery downside to the previous large operations. These procedures can be safely done in an outpatient surgical setting and provide almost immediate pain relief. Patients are able to walk immediately and perform minor tasks with limited difficulty. This allows people to return to work and recreation more quickly and with less long term pain management needs.
Back pain is unfortunately an ailment that affects most of us at some point in our lives, but there is increasing hope for those who suffer from chronic pain. Pills and activity restrictions are not the only answers, and medical literature would also argue against chronic medication usage for pain. Chronic back pain does not have to be a nightmare. With new technologies and a careful and thoughtful diagnosis, there is hope for pain relief for greater numbers of patients every day.
Richard A. Kube II, MD, FACSS
