Archives of Orthopaedic and Trauma Surgery

, Volume 127, Issue 10, pp 885–888 | Cite as

The role of sacroiliac joint dysfunction in the genesis of low back pain: the obvious is not always right

  • Natan WekslerEmail author
  • Gad J. Velan
  • Michael Semionov
  • Boris Gurevitch
  • Moti Klein
  • Vsevolod Rozentsveig
  • Tzvia Rudich
Orthopaedic Surgery


Background context

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.


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.


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.


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.


Sacroiliac joint dysfunction should be considered strongly in the differential diagnosis of low back pain in this group of patients.


Low back pain Sacroiliac joint Fluoroscopic guided infiltration 


  1. 1.
    AHCPR Clinical Guidelines (1994) Acute low back pain problems in adults: assessment and treatment. Quick reference guide for clinicians. Clinical practice guidelines #14: US Agency for Health Care Policy and ResearchGoogle Scholar
  2. 2.
    Atlihan D, Tekdemir I, Ates Y, Elhan A (2000) Anatomy of the anterior sacroiliac joint with reference to lumbosacral nerves. Clin Orthop 376:236–241PubMedCrossRefGoogle Scholar
  3. 3.
    Bernard TN, Cassidy JD (1991) The sacroiliac joint syndrome: pathophysiology, diagnosis and management. In: Frymoyer JW (ed) The adult spine: principle and practice. Raven Press, New York, pp 2111–2112Google Scholar
  4. 4.
    Broadhurst NA, Bond MJ (1998) Pain provocation tests for the assessment of sacroiliac joint dysfunction. J Spinal Disord 11:341–345PubMedCrossRefGoogle Scholar
  5. 5.
    Chen YC, Fredericson M, Smuck M (2002) Sacroiliac joint pain syndrome in active patients. A look behind the back. Phys Pain Med 30:30–37Google Scholar
  6. 6.
    Chou LH, Slipman CW, Bhagia SM, Tsaur L, Bhat AL, Isaac Z, Gilchrist R, El Abd OH, Lenrow DA (2004) Inciting events initiating injection-proven sacroiliac joint syndrome. Pain Med 5:26–32PubMedCrossRefGoogle Scholar
  7. 7.
    Cibulka MT (1992) The treatment of the sacroiliac joint component to low back pain: a case report. Phys Ther 72:917–922PubMedGoogle Scholar
  8. 8.
    Deyo RA, Cherkin D, Conrad D, Volinn E (1991) Cost, controversy, crisis: low back pain and the health of the public. Annu Rev Public Health 12:141–156PubMedCrossRefGoogle Scholar
  9. 9.
    Drezner JA, Herring SA (2001) Managing low-back pain. Steps to optimize function and hasten return to activity.Phys Sportsmed 29:37–43PubMedGoogle Scholar
  10. 10.
    Ebraheim NA, Lu J, Biyani A, Huntoon M, Yeasting RA (1997) The relationship of lumbosacral plexus to the sacrum and the sacroiliac joint. Am J Orthop 26:105–110PubMedGoogle Scholar
  11. 11.
    Fortin JD, Dwyer AP, West S, Pier J (1994) Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part I: Asymptomatic volunteers. Spine 19:1475–1482PubMedGoogle Scholar
  12. 12.
    Fortin JD, Washington WJ, Falco FJ (1999) Three pathways between the sacroiliac joint and neural structures. AJNR Am J Neuroradiol 20:1429–1434PubMedGoogle Scholar
  13. 13.
    Frymoyer JW (1988) Back pain and sciatica. N Engl J Med 318:291–300PubMedCrossRefGoogle Scholar
  14. 14.
    Gevargez A, Groenemeyer D, Schirp S, Braun M (2002) CT-guided percutaneous radiofrequency denervation of the sacroiliac joint. Eur Radiol 12:1360PubMedCrossRefGoogle Scholar
  15. 15.
    Greenman PE (1992) Sacroiliac dysfunction in the failed low back pain syndrome. In: Proceedings of First interdisciplinary world congress on low back pain and its relation to the sacroiliac joint, San Diego, pp 329–352Google Scholar
  16. 16.
    Helbig T, Lee CK (1988) The lumbar facet syndrome. Spine 13:61–64PubMedCrossRefGoogle Scholar
  17. 17.
    Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS (1994) Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 331:69–73PubMedCrossRefGoogle Scholar
  18. 18.
    Laslett M, Young SB, Aprill CN, McDonald B (2003) Diagnosing painful sacroilic joints: a validity study of a McKenzie evaluation and sacroiliac provocation tests. Aust J Physiother 11:118–125Google Scholar
  19. 19.
    Laslett M, McDonald B, Tropp H, Aprill CN, Oberg B (2005) Agreement between diagnoses reached by clinical examination and available reference standards: a prospective study of 216 patients with lumbopelvic pain. BMC Musculoskelet Disord 6:28. doi:10.1186/1471-2474-6-28PubMedCrossRefGoogle Scholar
  20. 20.
    LeBlanc KE (1992) Sacroiliac sprain: an overlooked cause of back pain. Am Fam Physician 46:1459–1463PubMedGoogle Scholar
  21. 21.
    Maigne JY, Aivaliklis A, Pfefer F (1996) Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine 21:1889–1892PubMedCrossRefGoogle Scholar
  22. 22.
    McCormick A, Fleming D, Charlton J (1995) Morbidity statistics from general practice. Fourth national study 1991–1992. HMSO, Office of Population Censuses and Surveys (Series MB5 No 3), LondonGoogle Scholar
  23. 23.
    Mierau DR, Cassidy JD, Hamin T, Milne RA (1984) Sacroiliac joint dysfunction and low back pain in school aged children. J Manipulative Physiol Ther 7:81–84PubMedGoogle Scholar
  24. 24.
    Patel AT, Ogle AA (2000) Diagnosis and management of acute low back pain. Am Fam Physician 61:1779–1786, 1789–1790PubMedGoogle Scholar
  25. 25.
    Potter NA, Rothstein JM (1985) Intertester reliability for selected clinical tests of the sacroiliac joint. Phys Ther 65:1671–1675PubMedGoogle Scholar
  26. 26.
    Schwarzer AC, Aprill CN, Bogduk N (1995) The sacroiliac joint in chronic low back pain. Spine 20:31–37PubMedCrossRefGoogle Scholar
  27. 27.
    Slipman CW, Sterenfeld EB, Chou LH, Herzog R, Vresilovic E (1996) The value of radionuclide imaging in the diagnosis of sacroiliac joint syndrome. Spine 21:2251–2254PubMedCrossRefGoogle Scholar
  28. 28.
    Slipman CW, Jackson HB, Lipetz JS, Chan KT, Lenrow D, Vresilovic EJ (2000) Sacroiliac joint pain referral zones. Arch Phys Med Rehabil 81:334–338PubMedCrossRefGoogle Scholar
  29. 29.
    Smith AG (1999) The diagnosis and treatment of the sacro-iliac joints as a cause of low back pain. The management of pain in the butt. Jacksonv Med 50:152–154Google Scholar
  30. 30.
    Waddell G, McCulloch JA, Kummel E, Venner RM (1980) Nonorganic physical signs in low back pain. Spine 5:117–125PubMedCrossRefGoogle Scholar
  31. 31.
    Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P, Fam AG, Farber SJ, Fiechtner JJ, Franklin CM, Gatter RA, Hamaty D, Lessard J, Lichtbroun AS, Masi AT, McCain GA (1990) The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 33:160–172PubMedCrossRefGoogle Scholar
  32. 32.
    Solonen KA (1957) The sacroiliac joint in light of anatomical, roentgenological, and clinical studies. Acta Orthop Scand 27:1–7Google Scholar
  33. 33.
    Zelle Ba, Gruen GS, Brown S, George S (2005) Sacroiliac joint dysfunction: evaluation and management. Clin J Pain 21:446–455PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Natan Weksler
    • 1
    Email author
  • Gad J. Velan
    • 2
  • Michael Semionov
    • 1
  • Boris Gurevitch
    • 1
  • Moti Klein
    • 1
  • Vsevolod Rozentsveig
    • 1
  • Tzvia Rudich
    • 1
  1. 1.Pain Service, Division of Anesthesiology and Critical Care, Soroka Medical Center, Faculty of Health SciencesBen Gurion University of the NegevBeer ShevaIsrael
  2. 2.Department of Orthopedics, Soroka Medical Center and Faculty of Health SciencesBen Gurion University of the NegevBeer ShevaIsrael

Personalised recommendations