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Let's talk about sciatica...shall we?

KimD592KKimD592 Posts: 435
edited 06/11/2012 - 8:56 AM in Sacroiliac (SI) Joint Problems
For the last few months I've been suffering from sciatica on and off, but these days it is getting worse and worse. My disc problems are in my thoracic spine. I had a two-level thoracic discectomy in July. Prior to my surgery, they did a lumbar MRI, which came back perfectly normal...no herniations or stenosis. When I mentioned the sciatica to the surgeon, he said it's not caused by the thoracic spine and that was the end of that.

As I said before, it's getting worse and worse. I'm in the process of being diagnosed with ankylosing spondylitis, and I know SI joint dysfunction is a common finding with this disease. That being said, can problems with the SI joint cause sciatica? It's the only thing I can think of, being that my lumbar spine looked fine. I am meeting with my PM doc today and a rheumatologist in two weeks.


  • dilaurodilauro ConnecticutPosts: 9,839
    Kim, if you havent already done so, look at Spine-Healths articles on:

    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • Sciatica means pain traveling down the leg. In your situation with a normal MRI of the lumbar spine the most common reasons for this referred pain is as you mentioned sacroiliac joint pain or piriformis syndrome.

    Sacroiliac joint pain will present with lumbosacral pain or buttock as the primary painful complaints. As this primary area of pain intensifies with various activities (sitting on the affected side, standing on the affected side) you may notice secondary painful referral patterns along the thigh and even the calf. This is why specialists may get the MRI first of the lumbar spine to rule a radiculopathy that could mimic your current set of symptoms. But since your MRI is normal now how can we ascertain whether the sacroiliac joint could be your current source of painful symptoms. Once your rheumatologic workup is completed you may entertain the idea of obtaining a diagnostic sacroiliac joint injection under xray guidance. The purpose of this injection to see evaluate your painful symptoms before the injection and after evaluating the pain with exam tests that increase your pain or simple activity of daily living tasks. When the injection is performed typically a needle is placed into the sij joint using xray and confirmed by injecting contrast. Then anesthetic like lidocaine or bupivicaine (no more 1.5 ml to 2.0 ml) is injected into the joint. Then we are looking for greater than a 75 percent reduction of your typical pain compared to before the procedure. If demonstrate this findings and are satisfied then repeat it again in a few days to see if the painful reduction is similar. If positive again then I think it reasonable to assume you may have sacroilaic joint pain. If the diagnostic sacroiliac joint under xray is negative then you may be inclined to having an electrodiagnostic evaulation of the lower limb to see if you have a sciatic neuropathy because of possible tight piriformis muscle. If so then you may want the piriformis muscle injected with anesthetic and cortisone and see if the referred pain and primary pain start to resolve within 2 weeks. Hope this helps. Best
    Amish R Patel DO, MPH
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