Salman A Jaffery.
Sacroiliac Joint Syndrome in the Differential Diagnosis of Low Back Pain and Sciatica.
Med Forum Jan ;2(11):71-5.

Background: Sacroiliac Joint syndrome (SIJS) is an extraspinal cause of low-back and lower-extremity pain that can present in so many different ways. The constellation of symptoms attributed to SIJS includes pain referral to numerous anatomic regions. Specific pain referral zones reported include the Posterior superior Iliac Spine (PSIS),(1) lower Lumbar Region,(2,3,4,5,6,7) Buttock,(3,,4,7,13,14,21) Groin and Medial Thigh(13,21), Posterior Thigh(8,13,14,22) Lower Abdomen (9,14), Calf and foot. Objectives: To determine the origin of pain of the sacroiliac joint and to differentiate it from pain due to degenerated lumbar disc disease. Study Design: Long term, prospective study Place and Duration of Study: This study was conducted in the Department of Neurosurgery, Women Medical College, Abbottabad from August 2006 - July 2013 Materials and Methods: Fifty Three patients who satisfied clinical criteria and demonstrated a positive diagnostic response to sacroiliac joint injections were included in an attempt to solve the dilemma in neurosurgical patients when differentiation between discogenic pain and one origination from sacroiliac joint(Sacroiliac joint syndrome -SIJS) is difficult. Clinical and radiological differentiation were not so remarkable between two conditions and based on these the diagnosis can go either way. Each patients’ pre-injection pain description was used to determine areas of pain referral and then sacroiliac joint was blocked by injections to see whether patients are still experiencing the Discogenic pattem of LBP and sciatica. Outcome Measures: To block sacroiliac joint by injection and then Invoking patients’ pain by clinical tests to see the origin of pain. Results: Seventeen men (36.0%) and 36 women (64.0%) were included with a mean age of 42.5 years (range, 20 to 75 yrs) and a mean symptom duration of 18.2 months (range, l to 72 months). Twenty patients (37.73.0%) described buttock pain and 33 patients (62.26%) described lower lumbar pain. Groin pain was described in 7 patients (13.20.0%). Twenty-five patients (47.16%) described associated lower-extremity pain. Fourteen patients (26.41.0%) described pain distal to the knee, and 6 patients (11.32%) reported foot pain. A statistically significant relationship was identified between pain location and age with younger patients more likely to describe pain distal to the knee. It was possible to identify a patient population consisting 15 patients (28.30%) who were actually suffering from SIJS and their treatment streamlined accordingly. After treating the sacroiliac joint and restoring symmetrical hip rotation, these patients no longer complained of low back pain. Conclusion: Pain referral from the sacroiliac joint does not appear to be limited to the lumbar region and buttock. The variable patterns of pain referral observed may arise for several reasons, including the joint’s complex innervation , sclerotomal pain referral, irritation of adjacent structures, and varying locations of injury with the sacroliasjoint.

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