SIMMETRY AND SI JOINT DYSFUNCTION

FREQUENTLY ASKED QUESTIONS

Read below to find answers to some of the most frequently asked questions about low back pain causes,
SI joint dysfunction and much more.

WHAT IS SI JOINT DYSFUNCTION?

SI joint pain is one of the causes of low back pain. Often times it is misdiagnosed as lumbar pain or pain from either degenerative disks or degenerative joints of the lumbar spine. The SI joint is a joint where the lumbar spine meets the pelvis, it is a very complex joint that is held together by a lot of ligaments.

Often times these ligaments can become inflamed or lax resulting in SI dysfunction, which can result in SI pain or sacroiliac pain.

Often times patients will come in saying that they have low back pain that’s off to one side. Sometimes this can mimic sciatica where the pain radiates down a portion of the leg and into the groin.

A lot of times even us as clinicians misdiagnose SI pain as coming from a different part of the spine such as a herniated disk or a degenerative arthropathy of the lower back. Traditionally our misdiagnosis of low back pain that’s really coming from the SI joint has led to us treating low back pain with modalities such as lumbar fusions and interventional pain injections of the lumbar spine that really haven’t improved our patient’s symptoms.

As our knowledge of what really may be causing upwards of 30% of low back pain improved and as clinicians as we started to look at the SI joint as a pain generator and low back pain, our ability to treat these symptoms improved and we’ve been able to help upwards of a third of our patients.

WHAT CAN BE DONE ABOUT SI JOINT PAIN?

There are a spectrum of treatment options for treating sacroiliac joint dysfunction, or sacroiliitis. The most conservative treatment option would be non-steroidal, anti-inflammatory drugs, or NSAIDs. These are over the counter drugs like Motrin or Advil, and often times this will have a very beneficial effect on SI Joint Dysfunction.

If this is not successful or does not work well enough to the patient’s liking, the next option would be physical therapy or chiropractic care.

If the conservative care such as physical therapy is not effective, the next treatment option would involve a sacroiliac joint injection. This is usually done in an outpatient setting, with X-Ray guidance. This is a very quick procedure.

If the SI Joint injection does not work, the next step is usually surgery. When we look at surgery, there are generally two options for surgery. There is the traditional open approach, in which the patient is in the hospital for about 4-5 days, or there is a minimally invasive approach, which involves an incision about 2 centimeters, with minimal damage to tissue. This is a procedure that can be done with minimal blood loss and leads to minimal post-operative pain.

WHAT HAPPENS DURING SI JOINT FUSION SURGERY?

The SImmetry procedure is done through a small incision. It is performed with minimal damage to surrounding tissues and it is done through an incision, which allows minimal blood loss. Immediately after the surgery you should be able to experience some relief from your back pain and there will be minimal pain from the actual incision itself. This allows you to start your rehabilitation process shortly after your surgery, sometimes in as little as two weeks after the surgery. It is done with you completely asleep so you should experience no pain whatsoever during the procedure. When you wake up you may experience a little pain around the incision but its usually very limited. This allows you to begin your recovery and rehabilitation process fairly quickly after the surgery.

Rx Only. Caution: Federal law restricts this device to sale by or on the order of a physician. For SImmetry indications, contraindications, warnings and precautions, refer to the product Instructions for Use.

WHAT SHOULD I EXPECT AFTER SI JOINT FUSION SURGERY?

Most people who have this procedure don’t have a lot of incision pain after the surgery because the incision turns out to be relatively small. There’s some discomfort, but people are on pain medicine for a few days to a few weeks typically. Sometime patients are asked to use crutches for up to 6 weeks.

That’s not uncommon. Some doctors are forgoing the crutches, so I would check with your doctor about that. After about 3 months from surgery your fusion is coming along well, it’s starting to mature. People can become much more active after 3 to 4 months from surgery. People typically get back to golf and tennis, they can get back to hiking, biking, swimming, performing pretty much any activity that they feel good enough to do even the more aggressive ones after 6 months.

HOW DO I KNOW IF I HAVE SI JOINT PAIN?

There are many causes of low back pain and SI joint pain or sacroiliitis pain is just one of them. There are certainly certain maneuvers that your doctor can do to examine you that may suggest that you have SI joint pain or SI joint dysfunction. Generally, if you have low back pain that is off to the side, just after the mid line or on both sides after the midline, that’s certainly suspicious for SI joint pain. It does not cause you symptoms like sciatica, it is usually just localized to that one spot in the back.

The gold standard would be to get a sacroiliac injection or SI joint injection, usually with x-ray guidance. There is not a perfect radiology test to let you know if you have SI joint dysfunction. You can certainly have a normal x-ray or a normal CAT scan or normal MRI but still have SI joint pain or SI joint dysfunction. If you think you have SI joint dysfunction, call your doctor and make an appointment.

WHAT ARE THE CAUSES OF LOW BACK PAIN ON ONE SIDE?

The SI joint is the joint where the lumbar spine meets the pelvis. It is a very complex joint that’s held together by a lot of ligaments and oftentimes these ligaments can become inflamed or lax resulting in SI dysfunction, which can result in SI pain or sacroiliac pain. Patients will often come in saying that they have pain in their lower lumbar spine, which is off to one side or the other. Sometimes the pain can radiate into a patients groin or into the back part of the leg or thigh. This type of pain that emanates from the SI joint can be replicated if a patient is sitting on a hard surface or chair. Also patients may have the ability to replicate their pain if they are laying on one side or the other. So if a patient is sleeping in bed they will come into clinics saying that they can’t sleep on their left side or right side because it hurts a lot. Sometimes patients will come in pointing to a very specific part of their lumbar spine off to one side which is over their SI joint which they character as buttock pain and this is actually pain originating from the SI joint which may be caused by SI joint dysfunction

WHAT IS THE DIFFERENCE BETWEEN SI JOINT DYSFUNCTION AND SI JOINT INFLAMMATION?

Patients will often ask what the difference is between SI inflammation and SI dysfunction. SI dysfunction is an umbrella term for an abnormality within the joint. Often times this includes inflammation. Typically, when we use it as clinicians, we are referring to either an abnormal motion or an abnormal position of the SI joint.

This abnormal position or abnormal motion is caused by ligament dyslaxity or loosening of the ligaments. When ligaments become loose they can become inflamed and this is typically what we refer to as a SI inflammation. Often SI inflammation and SI dysfunction go hand in hand but they are two separate entities.

CAN PREGNANCY CAUSE SI JOINT DYSFUNCTION?

Pregnancy can certainly cause sacroiliac joint pain, but thankfully the pregnancy induced sacroiliac pain usually gets better, without any significant intervention. It doesn’t always, but usually it does.

WHAT IS TRUE SI JOINT ARTHRODESIS?

The SImmetry system is a good system because it allows us to use time tested proven orthopedic principles. The first is that we are able to prep a joint exposing true bone marrow and bleeding cells into a space that needs to be fused. The second is we are able to introduce bone graft into the joint to act as a scaffold so the SI Joint can actually be fused as well. What the SImmetry system allows us to do is to use techniques that we know will result in bone growth across a joint to obtain a true fusion to treat SI dysfunction. One of the biggest advantages of this is that we don’t have to compromise principles that we know that work and we are able to use a minimally invasive technique to actually deliver true fusion for our patients.

Rx Only. Caution: Federal law restricts this device to sale by or on the order of a physician. For SImmetry indications, contraindications, warnings and precautions, refer to the product Instructions for Use.

The SImmetry® Sacroiliac Joint Fusion System is available by prescription only. Ask your doctor to provide details on the indications, contraindications, warnings and precautions.

Rx Only. Caution: Federal law restricts this device to sale by or on the order of a physician. For SImmetry indications, contraindications, warnings and precautions, refer to the product Instructions for Use.