Sacroiliac Joint TreatmentsAugust 18, 2017
Treatment for sacroiliac joint pain should not include spinal fusion.
This is what a paper published in the July 2017 edition of Neurosurgery clinics of North America suggests:
“Pain related to joint dysfunction can be treated with joint fusion; this is a long-standing principle of musculoskeletal surgery. However, pain arising from the sacroiliac joint is difficult to diagnose. Several implant devices are available that promote fusion by simply crossing the joint space. Evidence establishing outcomes is misleading because of vague diagnostic criteria, flawed methodology, bias, and limited follow-up. Because of non-standardized indications and historically inferior reconstruction techniques, sacroiliac joint fusion should be considered unproven. The indications and procedure in their present form are unlikely to stand up to scrutiny or weather the test of time.”1
If you suffer from unresolved sacroiliac joint pain, Prolotherapy Platelet Rich Plasma Therapy, and Stem Cell Therapy may be the answer.
Researchers writing in the medical journal Pain Physician examined various treatment recommendations for patients suffering from sacroiliac joint pain to confirm what many of our patients now. Traditional treatments do not work.
The researchers found the following:
“The evidence for cooled radiofrequency neurotomy in managing sacroiliac joint pain is fair.
The evidence for effectiveness of intraarticular steroid injections is poor.
The evidence for periarticular injections of local anesthetic and steroid or botulinum toxin is poor.
The evidence for effectiveness of conventional radiofrequency neurotomy is poor.
The evidence for pulsed radiofrequency is poor.” 2
Sacroiliac Joint Pain Treatment
Most patients that seek non-surgical treatment of their lower back pain come to us as a last chance effort. They have tried nearly every other treatment and have exhausted all possibilities – chiropractic, acupuncture, epidural steroid injections, physical therapy, massage, and a litany of medications such as anti-inflammatories, Lyrica, Neurontin, anti-depressants, muscle relaxers, and others.
As pointed out, some patients have also had surgeries on their back – fusions, laser spine surgery, discectomy, and decompression. Unfortunately, most patients who have chronic lower back pain sometimes give up and are told to “deal with it”, or end up on large amounts of opiates like Oxy Contin.
So why would non-surgical treatments such as prolotherapy, stem cells, and PRP work so well for this large subset of patients?
A report in the Journal of Alternative and Complementary Medicine says: “Intra-articular Prolotherapy provided significant relief of sacroiliac joint pain, and its effects lasted longer than those of steroid injections.3
A separate study also reported in the Journal of Alternative and Complementary Medicine says: “Ninety-one percent (91.0%) of (Prolotherapy) patients reported a reduction in the level of pain; 84.8% of patients reported improvement in activities of daily living, and 84.3% reported an improvement in the ability to work.”4
Prolotherapy worked because all the ligament and tendon structures that hold this joint together can become stressed, strained, or torn but may appear normal on MRI (which is not very accurate at diagnosing sacroiliac pain). Research published in the medical journal Spine, states “ligament laxity in the sacroiliac joint is the number one reason for sciatica, or pain radiating down the side of the leg, and is one of the most common reasons for chronic low back pain.” 5
Not only has research shown Prolotherapy to be effective but PRP as well. In a new study from July 2017 in the journal Pain Practice, doctors suggest that “Despite widespread use of steroids to treat sacroiliac joint pain, their duration of pain reduction is short. Platelet-rich plasma (PRP) can potentially enhance tissue healing and may have a longer-lasting effect on pain.” In fact, this research showed clear superiority in the PRP treatment over steroid injection in significantly reducing the intensity of pain.”6
Additionally, most back pain patients have a functional leg length discrepancy / tilted pelvis which further exacerbates sacroiliac joint pain.
As pointed out, epidurals, steroids, or surgery cannot repair the damage that causes sacroiliac pain, prolotherapy and platelet rich plasma (PRP) injections can.
If you have the opportunity to examine and study the anatomy of the lower back and pelvis, look at the ligament structure. The ligaments that insert into the L4 and L5 vertebrae (which are the most common to herniate in the lower back), are contiguous structures with the sacroiliac joint, coccyx, and insert into the ischium (sit bones). Therefore, dysfunction in any part of this ligament structure can impact what happens with the L4 and L5 disc and vertebrae. Just a tilt in the pelvis completely disrupts the balance between the left and right sides of the back and contributes to back and pelvic pain.
Now if you are skeptical, and still think that prolotherapy and platelet-rich plasma injections to the lower back are without merit, realize not only has this treatment withstood the test of time, with doctors practicing prolotherapy dating back to the 1950s, but randomized medical studies have shown significant success (greater than 85%) in patients with chronic lower back pain. In fact, in my home town of Philadelphia, PA, the head orthopedic spine surgeon, Abraham Myers, MD realized that the back surgeries that he performed on his patients did not help, he decided instead to treat his patients with Prolotherapy. He practiced prolotherapy for back pain until he was in his 80s, and had a satisfying and successful career curing patients with chronic back pain.
At the Magaziner Center for Wellness, we take a comprehensive approach to all conditions and procedures. Our patients are fully examined and then provided with the appropriate treatment plans that are best suited.
1 Bina RW, Hurlbert RJ. Sacroiliac Fusion: Another “Magic Bullet” Destined for Disrepute. Neurosurgery Clinics of North America. 2017 Jul 31;28(3):313-20.
2. Hansen H, Manchikanti L, Simopoulos TT, et al. A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions. Pain Physician. 2012 May;15(3):E247-78.
3. Kim WM, Lee HG, Jeong CW, Kim CM, Yoon MH. A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain. J Altern Complement Med. 2010 Dec;16(12):1285-90.
4. Hooper RA, Ding M.Retrospective case series on patients with chronic spinal pain treated with dextrose prolotherapy.J Altern Complement Med. 2004 Aug;10(4):670-4.
5. Schwarzer AC, April CN, Bogduk N. The sacroiliac joint in chronic low back pain. Spine 1995;20:31-37
6. Singla V, Batra YK, Bharti N, Goni VG, Marwaha N. Steroid versus Platelet-Rich Plasma in Ultrasound-Guided Sacroiliac Joint Injection for Chronic Low Back Pain. Pain Pract. 2016 Sep 27. Pain Pract. 2017 Jul;17(6):782-791. doi: 10.1111/papr.12526. Epub 2016 Dec 1.