gms | German Medical Science

Objective: Pain due to a micro-instability and arthrosis of the sacroiliac joint (SIJ) is a frequently underestimated reason for deep sacral low back pain (LBP). As in our series of patients, it is often observed after prior surgical lumbar fusion.

Methods: The diagnosis of SIJ-arthosis was based on clinical symptoms, as well as on clinical and radiological findings. In addition, all patients underwent a SIJ-infiltration for diagnostic reasons and conservative treatment for at least 3 months. Since Nov. 2009, we have diagnosed and treated 27 patients with SIJ-syndrome according to this concept. Due to a failure of conservative treatment, 11 patients underwent operative treatment using the Diana-SIJ-cage (Signus) to achieve SIJ-arthrodesis. Preoperative examination and postoperative follow-up after 6 and 12 months to date included an assessment of the clinical outcome, the satisfaction of the patient and a pelvic CT-scan.

Results: 16 out of 27 patients responded at least temporarily to conservative treatment and remained therefore nonsurgical. All 11 patients who were operated described a good relief of their preoperative symptoms especially the sitting intolerance. However, in 3 patients, an only partially satisfactory result was achieved due to remaining mild to moderate persisting LBP.

Conclusions: SIJ-Arthrodesis using a novel technique seems to be a promising treatment option for patients with chronic SIJ-pain that does not respond to conservative therapy. However, our good single-center experience needs to be confirmed in a controlled, randomized well-designed study comparing the new technique to the alternatives of a continuous conservative treatment and other operative techniques introduced in the past.