gms | German Medical Science

Introduction: Low back pain prevalence ranges from 15-30% at a certain point of lifetime to 60-80 % in whole lifetime. It is one of the commonest health problems, and considered as the second cause of pain. Disc herniation/prolapse is a major source of low back pain. SIJ dysfunctions are common association with lumbar disc prolapse in about 2/3 of patients, especially females with recurrent pain and positive leg raising test. This concurrence is associated with more significant functional impairment [1], [2], [3].

Methods: In this study 86 Patients (57 females 29 males) with lumbar disc prolapse diagnosed by either MRI or CT were included. All of them aged > 18 years with no special condition for the duration of disc prolapse. All of them had clinical manifestations in the form of mechanical low back pain or sciatica or limited spine mobility. All participants had no or poor response to conservative treatment. Previous surgery, severe facet arthropathy, ankylosing spondylitis, sensory or motor deficit and wedge fracture were considered as exclusion criteria. Distraction, compression, thigh thrust, and sacral thrust were used to assess SIJ dysfunction only at baseline before injection. Fingertip to floor and Oswestry disability index (ODI) were used to assess mobility and function of the spine at baseline (before and after injection) and after 2 and 16 weeks. Visual Analogue Scale (VAS) was used for pain appraisal at the same intervals. Participants were randomly assigned into active and control group using 1:1 allocation. In the active group bilateral SIJ injection was performed under ultrasound US guidance. The patient was prone. The transducer was placed in axial position at the of sacral hiatus level. Then the sacral cornuae were detected. The transducer moved laterally to detect the lateral edge of the sacrum. The probe moved cephalad to detect the ileum. The cleft between sacrum and ilium is the sacroiliac joint [4]. The injection site was marked and 2 ml of were injected. Later, under US guidance a 22G spinal needle, where 1 mL 2 % lidocaine hydrochloride (xylocaine, AstraZeneca) mixed with triamcinolone 40 milligrams (Kenacort, Bristol Myers Squip) were injected in each SIJ [5].

Results: The mean age of the all participants was 44 years, with disease duration of around 42 months in both groups. The commonest symptom was mechanical low back pain, followed by sciatica and lastly limitation of spine mobility. SIJ involvement was detected in around 70% of the cases and 72% of the controls (Table 1). There was statistically significant improvement in all outcome measures at all follow-up time points in relation to baseline assessment. The highest was pain followed by mobility and finally ODI. The most surviving effect was mobility followed by ODI and finally pain (Table 2 [Tab. 1], Figure 1, Figure 2, Figure 3).

Conclusion: SIJ injection is effective in improving pain, mobility and function in lumbar disc prolapse patients. Disease duration and SIJ dysfunction was not related to amelioration. Age, caudality of the disc and number of prolapsed discs were negatively related to outcome measures.

Disclosures: none