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Sacroiliac joint dysfunction: pathophysiology, diagnosis, and treatment

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Abstract

Purpose

To review the anatomy and function of the sacroiliac joint (SIJ), as well as the pathophysiology, clinical presentation, diagnostic criteria, and treatment options for SIJ dysfunction.

Methods

The SIJ serves an extremely crucial function in mobility, stability, and resistance against shear forces. Joint mobility becomes increasingly limited with age-related cartilaginous changes that begin in puberty and continue throughout life. Pain can also be localized to the SIJ itself, known as SIJ dysfunction. A literature review was performed on the anatomy, etiology, risk factors, diagnostic modalities, and treatment options for SIJ dysfunction.

Results

SIJ dysfunction is an under-recognized source of low back pain. Dysfunction can result from various clinical conditions, as well as abnormal motion or malalignment of the joint. Diagnosis and evaluation of SIJ dysfunction are difficult, with use of physical maneuvers and image-guided anesthetic injection. Non-operative treatment options are considered first-line due to high surgical complication rates. Such options include conservative management, radiofrequency treatment, nerve blocks, and articular injections. Surgical management involves open and percutaneous approaches.

Conclusion

With the aging nature of the population, SIJ dysfunction has emerged as an extremely prevalent issue. Current research into the pathophysiology and risk factors of SIJ dysfunction is extremely important for planning preventative and therapeutic strategies. Various treatment options exist including conservative management, radiofrequency, nerve blocks, intra-articular or peri-articular injections, and surgical fixation. Improved diagnostic methods in clinical practice are thus critical to properly identify patients suffering from SIJ dysfunction, plan early intervention, and hasten return to function.

Level of Evidence I

Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Albert Einstein College of Medicine/ Montefiore Medical Center, 3400 Bainbridge Ave, 6th Floor, Bronx, NY, 10467, USA

    Ariella Gartenberg, Adam Nessim & Woojin Cho

Authors
  1. Ariella Gartenberg
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  2. Adam Nessim
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  3. Woojin Cho
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by AA, AN, and WC. The first draft of the manuscript was written by AA and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Woojin Cho.

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Gartenberg, A., Nessim, A. & Cho, W. Sacroiliac joint dysfunction: pathophysiology, diagnosis, and treatment. Eur Spine J 30, 2936–2943 (2021). https://doi.org/10.1007/s00586-021-06927-9

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  • DOI: https://doi.org/10.1007/s00586-021-06927-9

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