New Development Improves Surgical Treatment of Sacroiliac Joint Dysfunction

Gregory Gullung, MD

Disorder Common among Women after Multiple Pregnancies

Look in a medical textbook for an illustration of the pelvis, near the tailbone, and along each side you'll find a complex-looking structure of connecting bones and joints.

Near the center there's a connection between the sacrum and iliac bones known (not surprisingly) as the sacroiliac (SI) joint. It's a familiar term because it's such a frequent source of problems. One recent study shows that nearly one-third of patients' hip pain is SI-related.

Fortunately, SI treatment has come a long way since the days when metal plates were attached to limit motion. Gregory Gullung, MD of Grandview Medical Center is streamlining one new development that uses a surgical tool known as SICure.

"SICure is a screw that, when you put it through the joint, harvests some of the bone as it goes," Gullung says. "It has a hollow center, and teeth that cut some of the bone and pull it across the joint so the joint will fuse. There have been different devices over time, such as little pegs and regular-looking screws, but this is a new design of screw that we can utilize.

"This is much less invasive. The width of the screw head is about half a centimeter, so an incision that size is all it takes."

Both men and women suffer from SI joint dysfunction. The causes for men are often trauma, falling, or arthritis of the lower back. The disorder is more common in women, however, and one of the most frequent causes is pregnancy, especially multiple births.

"When you're having a baby, your body releases hormones that relax the joints, and sometimes the joints don't stiffen back up like they should and end up as a permanent issue," Gullung says. "SI dysfunction is a little more common among women who have had one or more children through vaginal delivery, but it can also occur through C-section.

"Some hip pain after delivery is normal, but by six to 10 weeks the pain should be getting better. If it's not, there may be some sort of dysfunction occurring."

SI dysfunction can be easy to misdiagnose. There are more than a dozen possible tests. "It's very frustrating," Gullung says. "Tests can point to it, but the symptoms can be caused by other issues as well, so each test's ability to predict is about 60 percent. If three of the tests are positive, that's a generally accepted answer for pointing to SI dysfunction.

"But the most accepted test is to inject the joint and numb it up. If the patient really feels better, anywhere from a 50 percent to 75 percent reduction in pain, one can reasonably confirm the SI joint as the source of pain. We recently had a patient, a lady we injected, and she had no pain after the procedure. We did the fusion on her and she felt fantastic. That's obviously the best-case scenario."

Another tool of the surgery in addition to the connecting screw is a triangular, porous plasma-coated implant that is bored into a hole, so that the bone will grow across the implant and fuse to it.

"In any procedure without a self-harvesting option, you have to put some bone graft in somewhere to help it heal," Gullung says. "That can be from the patient, synthetic, a cadaver, whatever. It's more a fixation than a true fusion, and there are different ways you can help that bone growth. The whole purpose is to stop motion in that joint.

"Stopping the motion doesn't interfere with activity because there's not a lot of motion in that joint to begin with. It's not meant to be a very mobile joint. It's the increased mobility where the dysfunction can occur, and when it does become hypermobile, it's a problem.

"Fortunately once the joint is fused you really wouldn't notice any limitation in your ability to stand, bend, or twist. In fact, once most people are fused they say that can move with more freedom because it doesn't hurt."

"Non-surgical treatment, such as physical therapy, can help in the short term but unfortunately the long-term data shows that people continue to have increased pain with the conservative treatment. Surgical fixation is the only treatment that's been shown to really cut down on pain, which can also help get people off narcotics, and as we see from the current news, getting them off opiates is a good thing."

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Dr. Gregory Gullung, Grandview Medical Center, sacroiliac joint, sacroiliac dysfunction, SICure, self-harvesting screw, fusion, fi


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