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SI or facet joints?

SoFarAwaySSoFarAway Posts: 17
edited 06/11/2012 - 8:51 AM in Sacroiliac (SI) Joint Problems
I'm having a little trouble distinguishing symptoms between SI joint pain and facet joint pain. My MRI shows that I have the beginnings of facet joint hypertrophy due to a left paracentral disc herniation at L5-S1. Slight retrolisthesis as well due to the disc dying. I have pain on the left side, but it seems to be right around where my "joint" is back there. When I sit down, I can make the pain almost go away by wading up a blanket and putting it where the pain is on that left side. It's always like things are uneven back there, which I guess would make sense because my pelvis is crooked.

I've read many posts, many articles, and I can't seem to figure out how to tell the difference between SI and facet joint pain. The symptoms seem so similar. My orthopedic surgeon and pain management doctor both want me to try facet joint injections, which I'll probably eventually do. Sometimes I wonder about the SI joint, though.


  • Hi When I got facet joint injections I also got bilateral SI joint injections at the same time so hopefully you're Dr. will be doing that also for you. I got some relief after the injections and hope when you go for yours it will help. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • When you have an issue with the lower spine, esp. L5-S1, its almost always going to create a secondary SI issue.
    I think the best way to separate facet pain from SI pain is to have "diagnostic" injections of local anesthesia alone (no steroid) done separately. The immediate relief of local anesthesia should be in an amount small enough to not spread to the SI joint. I would probably see if your doc can do a "diagnostic" facet injection; followed by a steroid injection into the SI with local.
    Another option is some PT's who specialize in spine can do manipulations in attempt to distinguish the two, but those guys are rare. Many SI issues can be fixed by PT alone, but to reduce the facet pain you need to address its cause - which is probably that disc herniation.
  • SoFarAway,
    If you really want to learn the anatomy of the spine and pelvis, invest in a small (but good) model and a good anatomy text. A picture is worth a thousand words and a three dimensional model is worth a million. You speak of three separate and distinct entities: the sacroiliac joint, the zygapophysial (or more commonly known as facet) joints, and the disc complex. Symptoms caused by these three areas can be distinguish by a thorough history and physical, with complimenting studies. It should not be that difficult for an orthopedic spine surgeon or neurosurgeon to determine what area your symptoms are coming from. It is possible for problems in all three areas to coexist and the exact pain generators within the spine are still not that well known.
    You state: "...beginnings of facet joint hypertrophy due to a left paracentral disc herniation at L5-S1...". The facet joint hypertrophy is not due to the herniation. But it may be coming from the same process that caused the disc tear and resulting herniation. Hypertrophy about a joint is the body's way of stabilizing an unstable segment.
    Discuss your concerns with your surgeon and inquire about the options you mention in your post. Good luck.

  • Thorough H & P...difficult to do in a 3-5 minute exam.
  • Unfortunately, it does sometimes fall upon the patient to be somewhat proactive in their healthcare. If you feel you need a new thorough exam, don't schedule a 3 to 5 minute follow-up appointment. Those are only for a quick assessment of stable patients that don't need anything more than maybe a medication refill. Make sure the person making the appointment knows that the appointment is not a follow-up, but is for a concern that will take more time. When you see the surgeon, quickly review things and how you're doing, but direct him/her to the new area of concern as soon as possible. If you don't speak up, most surgeons assume everything is status quo and on track. Good luck.

  • with two physical medicine physicians recently have been one of they shake their heads; offer me meds, pt, pain pump and SCS. Even when viewing my xrays with my surgeon, he decreased the view on the computer screen to only look at the fusion area, when I have disease from T5-S1. A diagnosis would be nice. I don't mean to sound like a conspiracy theorist, but it just seems odd to me. I have limited experience in the "neuro world" (<2yrs). Unfortunately, the first 18 months, I seemed to find myself in situations where I find adequate information on the back end of procedures, i.e. there is always a PUSH to do procedures before I have had an opportunity to understand them thoroughly and can make a truly informed decision.

    Today I have better tools to deal with these issues, but you need to understand it is much more complex than just being proactive. There are financial, social, and disability issues that are of consequence in every decision made. It can be very confusing, frustrating, scary and impactful.

    As far as being more proactive, maybe I should do a spine fellowship...I'm certainly getting a layperson's spine fellowship. I feel as if I must protect myself since every invasive procedure that I have had, has left me in a worsened state.

    I will continue my search for ultimate answers...


  • I can relate completely to your comments about feeling like you may need a degree to understand the procedures being done to you. I too, have been made worse by decisions made in a 5 minute dr's appt. My last decision was to have a stand-alone XLIF at L4-5. What I came out of surgery with was complete right leg paralisis, permenant nerve damage and a non-union of the fusion which I am now scheduled for a "total lock-down" with screws and rods. I feel like a fairly intelligent person but my surgeon certainly trumps me. I research things almost obsessively and still find myself leaving appts feeling baffled and, yet again, scheduled for some new surgery.
  • Hi SoFarAway,

    Generally you don't need a imaging modalities to see if you have facet of SI joint problems. A doctor can usually determine the diagnosis of either of the two by asking several questions and asking you to exercise the body in different ways.

    To answer your question:
    Facet Joint Syndrome (or sprain) is often localized to the back with referred pain down the back of the leg and hip/butt. It is more of a sharp catching pain that is aggrevated by moving a lot especially when extending!

    SI Joint Syndrome (or sprain) can be similar in nature. Instead the pain is around the hip and butt area and there is no back pain above that area. It is usually felt when you rise from a stooped position (sitting to standing).

    In the sense, both of these usually happen after an activity. Falling sharply, bending down to pick up a pencil etc.

    In some cases an MRI can help determine the space between the joints and if there is any neurological problems associated with the MRI findings. Neither are caused by a herniation as is found in your MRI.

    Hope that helps.

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