Sacroiliac Dysfunction/Piriformis Syndrome
What Is Sacroiliac Dysfunction?
The typical patient is often a woman in her 30s or 40s who has had children. It is thought that the relaxation of the sacroiliac ligaments necessary for childbirth does not fully reverse, and that a subsequent minor trauma may sublux (partially dislocate) the joint and cause pain. Younger women may develop sacroiliac problems as a result of sport or other injuries. The condition also occurs in men, but less frequently and usually from more severe injuries, often involving lifting while the trunk is in torsion.
Sacroiliac dysfunction also may be associated with piriformis syndrome. The piriformis is a small muscle in the buttock that stabilizes the sacroiliac joint. When irritated, it causes pain in the buttock. The piriformis muscle happens to overlap the sciatic nerve and can also cause sciatic pain down the leg all the way to the foot. This is often mistaken for sciatica, caused by a pinched nerve root in the spine.
What Are The Symptoms of Sacroiliac Dysfunction?
How Is Sacroiliac Dysfunction Diagnosed?
A sacroiliac joint injection is another diagnostic tool that may be used. In this test, a physician uses fluoroscopic guidance (x-ray) and inserts a needle into the sacroiliac joint to inject lidocaine (a numbing solution). If the injection relieves the patient’s pain, it can be inferred that the sacroiliac joint is the source of the pain. A steroid solution also may be injected to decrease inflammation in the sacroiliac joint and decrease pain.
How Is Sacroiliac Dysfunction Treated?
For those who do not respond to conservative measures, spine surgery is the appropriate next step, which involves stabilizing the sacroiliac joint through fixation and fusion. Sometimes the piriformis muscle also may need to be treated surgically to relieve pressure on the sciatic nerve.
The benefits of spine surgery, however, must be weighed against the risks. Your surgeon will be able to discuss the risks and benefits of surgery with you, and the likely results of operative versus non-operative treatment.
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