Fusion of the lumbar spine is commonly performed for low back and leg pain. Pain relief varies from minor to moderate. Unfortunately fusion of the lumbar spine can result in complications or the development of a new type of pain.
EB is a case in point. EB is a 50y/o patient who underwent two level fusion for severe lower back and leg pain which was refractory to conservative therapy. While her leg pain improved her lower back pain remained unchanged and she developed new buttock pain which was constant in duration, progressive in nature, localized deep in her buttock with radiations into the posterior thigh. Physical examination was significant for tenderness over the PSIS and a positive Patrick’s test. EB had developed sacroiliac joint dysfunction as a result of her lumbar fusion.
The sacroiliac Joint (SI) is the joint in the bony pelvis between the sacrum and the ilium. It functions as a major shock absorpter for the spine. Removal of some of the shock absorbers of the spine puts additional forces and strain on the SI jont leading to pain and dysfunction.
The SI joint, its anatomy, physiology and clinical significance is well documented.
Symptoms: Unilateral pain which if severe enought can refer into hip, groin and down the posterior thigh.
Engineeers have demonstrated increased stresses and motion in SI joint following lumbar fusion.
Katz demonstrated that SI joint dysfunction was a cause of pain in 32% of patients with low back pain after lumbar fusion.
At the Centeno-Schultz Clinic EB underwent x-ray guided injections of the prolotherapy into the joint and supporting ligaments with greater than 75% benefit. Patients unresponsive to prolotherapy have undergone SI injections with Regenexx SCP, Regenexx SD and Regenexx PL with good success.