Welcome, Friend!

It looks like you're new here. If you want to get involved, click one of these buttons!

Veritas-Health LLC has recently released patient forums to our Arthritis-Health web site.

Please visit http://www.arthritis-health.com/forum

There are several patient story videos on Spine-Health that talk about Arthritis. Search on Patient stories
Protect anonymity
We strongly suggest that members do not include their email addresses. Once that is published , your email address is available to anyone on the internet , including hackers.

All discussions and comments that contain an external URL will be automatically moved to the spam queue. No external URL pointing to a medical web site is permitted. Forum rules also indicate that you need prior moderator approval. If you are going to post an external URL, contact one of the moderators to get their approval.
Attention New Members
Your initial discussion or comment automatically is sent to a moderator's approval queue before it can be published.
There are no medical professionals on this forum side of the site. Therefore, no one is capable or permitted to provide any type of medical advice.
This includes any analysis, interpretation, or advice based on any diagnostic test

Is it L5/S1 or SIJ dysfunction

SteveCSSteveC Posts: 63
edited 06/11/2012 - 8:56 AM in Sacroiliac (SI) Joint Problems
Hi All,

I've had a longish history of back problems. Disc bulge and nerve impinglement definitively diagnosed and treated with a disc/laminectomy at L5/S1. There is also possible bone spurs. Since then I have had problems which my pain doc (specialises in back and neck) has said is SIJ, a chiropracter has said disc (I have a bulge at the same level on the other side to the disc/lami) and a physiatrist has said is disc. In their defense, sometimes it does feel like the pain is axial, and other times it does feel more like it is the SI joint.

I have had plenty of SIJ steroids, which seem to help some of the time, same for epidurals (which always help when the problem is clearly my back). I went to PT which also helped. I also work out daily and do yoga and try to stretch to some degree each day. The twisting chiropractic-style alignment also helps and sometimes I feel a little "pop" and a slight tingle and a lot better.

The problems are back and seem to be getting progressively worse. I probably have a background pain level of 2, but can go up to 4-6. Dosing up on ibuprofen sometimes helps. Muscle relaxants (like soma) nearly always help. Lidoderm patches always help. I don't think the epidural/SIJ injections are definitive enough. Everyone says MRIs of the SIJ area are no good diagnostically. CT Scans seem to be out of vogue at the moment as well.

Are there any diagnostic techniques which can be used to differentiate the problems I am having? Should I see an orthopod?

Thank you!


  • This is a very good question. Delineating pain emanating from the intervertebral disc verse the sacroilaic can be challenging. Here is a viewpoint.

    Typically patients that suffer from pain emanating from the disc will have more intense low back pain (axial symptoms as you mentioned) than perpheral symptoms (buttock or pain along the sacroilaic joint region). Typically prolonged sitting and/or bending forward will increase the axial symptoms the quickest and as the pain intensifies then referred pain may occur but not limited to the buttock and/or thigh/region. In contrast to sacroiliac joint pain patient will complain of more intense pain along the buttock region than the axial area. So proportion of axial to peripheral symptoms is a very important question your health care professional should ask. Also there are exam manuevers your healthcare professional can perform to see if the sacroiliac joint could be a potential pain generator. If so then a diagnostic sacroilaic joint injection under xray is the next step to eliminate vs include the disc as the major source of your current painful symptoms.

    If the differential is simple... disc verse sij then a diagnostic sacroiliac joint under xray guidance should be performed. Typically we are looking for greater than 75 percent reduction of your current painful symptoms with movements that typically increase the pain. The diagnostic injection should be performed on 2 separate occasions for consistency of results. Also contrast should be injected into the sacroilaic joint when performed under xray to make sure the medication (anesthetic only like lidocaine or bupivicaine) is going into the joint. Typically no more than 1.5 to 2 ml of fluid to go into the joint to minimize the possibility of anesthetizing other structures adjacent to the sacroiliac joint (L5, S1 nerve roots or lumbar sacral plexus nerves). Hope this helps! best

    Amish R Patel DO, MPH
  • Thank you.

    At the moment it wouldn't surprise me if I have 2 sets of things going on...the disc bulge and SIJ dysfunction, one of them exaserbating the other.

    The discomfort is most definitely along the top of my butt, does not go down my leg at all and it is not numbing. I would describe it more as "grinding" and/or "pressure-like/dull aching" if anything. I do get the problems worse when I stand (more than 10-15 mins) or walk for a prolonged period (15 mins, under a mile). Then I typically have to curl up into a ball (which hurts) but it alleviates some of the immediate pain.

    I guess I need to get some more nerve blocks :( Not that they are uncomfortable or anything. I would just rather not have them done!
Sign In or Register to comment.