Low Back Pain’s Missing Piece: Diagnosing the Sacroiliac Joint

Free On-Demand Transcript of Live Chat Discussions with Dr. Nick Shamie – Available Below!

Live Chat Guest:

Dr. A. Nick Shamie
UCLA School of Medicine
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Nick Shamie, MD, is Associate Professor of Orthopaedic Surgery and Neurosurgery and Co-Director, UCLA Comprehensive Spine Center. Dr. Shamie is a Board Certified Spine Surgeon who has served on the UCLA School of Medicine faculty since he joined the Department of Orthopaedic Surgery in 2000.

Diagnosed with Sacroiliac Joint Dysfunction or Sacroiliitis? Suffering from lower back pain? Then we invite you to review the Q&A answered by orthopedic surgeon Dr. Nick Shamie during a Spine-health Virtual Office Hour live chat event focused on the Sacroiliac Joint held May 24, 2011.

The over 30 Q&A cover topics such as what sacroiliac joint pain feels like, which doctors to see and when, how it’s diagnosed, pain management, and surgery including less invasive methods.

This event was sponsored by SI-BONE, the maker of the iFuse Implant System® for minimally invasive surgical (MIS) sacroiliac joint surgery. For additional resources on Sacroiliac Joint problems and treatments, visit:

5/24/2011 Sacroiliac Joint Virtual Office Hour – live event transcript, brought to you by SI-BONE:

8:34 SI-BONE:
Welcome to the first live SI Joint Virtual Office Hour, sponsored by SI-BONE. SI-BONE representatives and Board Certified Orthopaedic Specialist Dr. Nick Shamie will join us tonight at 9:30 PM CDT, sharing their insights and answers on Sacroiliac (SI) joint topics: when lower back complaints might be caused by the SI joint, how SI joint problems are diagnosed, treatment options for the SI joint, preventive advice and more.

8:35 SI-BONE:
This event will be a live chat where users can post questions and Dr. Shamie will answer them in return posts. The blog is now open for individuals to submit questions. Dr. Shamie and the SI-BONE team will begin to answer them at 9:30 PM Central Time.

9:20 [Nona] -
I've lived with si joint dysfunction for 7 years.My pm doctor said it may make it worse if I have this surgery.I am in constant severe pain most days.What do you think?

Dr. Nick Shamie:
I think if you have been properly diagnosed with SI joint pathology and injections are no longer helpful, minimally invasive fusion like iFuse not only will not make you worse, most patients have great results from this surgery. The key to good results from surgery is proper diagnosis. Find a surgeon in your area who has experience with this condition to diagnose and treat you appropriately.

9:21 [Cathy M.] -
Hi Dr. Shamie - I was wondering if you could describe what SIJ pain feels like?

Dr. Nick Shamie:
The pain is typically in the lower back over the sacroiliac joint. It is usually on one side and not bilateral. Sometimes the pain can radiate down the thigh. It’s worse when walking or upright. It can be aggravated when lying on the side where the SI joint pain is symptomatic.

9:30 [Mac] -
Hello - What's the best type of doctor to first see for pain like this? My regular primary care doctor wasn't familiar with sacroliac related pain. I'm taking advil but its not helping.

Dr. Nick Shamie:
I suggest seeing a pain management doctor or an orthopaedic spine specialist who is interested in this disorder.

9:33 [Amy] -
Can you please explain how this procedure is different from a fixation with pedical screws? If problems arise after the joint fuses what can be done?

Dr. Nick Shamie:
The pedicle screws are used for lumbar fusion and not the sacroiliac joint fusion.

Fusion rods inserted minimally invasively are used to fuse the SI joint. If the joint fuses successfully, there should not be any more pain from the joint.

9:36 [dorothy] -
what is the treatment for SI joint pain?

Dr. Nick Shamie:
Anti-inflammatory meds, PT, Injections in the joint, and if all fail then surgery to fuse the joint.

9:36 [Amy] -
How will pain management help fix an SI problem?

Dr. Nick Shamie:
Steroid injection in the joint
Radiofrequency ablation of the nerves surrounding the joint
Both of these options have initial success, but long-term are less effective treatments

9:38 [dorothy] -
do you think acupuncture or PT can help this disorder?

Dr. Nick Shamie:
In my opinion, patients need to try non-surgical options before going to surgery. PT and acupuncture are good non-surgical options.

9:39 [Mac] -
Mac again - how can i find out which doctors know about SIJ?

Dr. Nick Shamie:
You can call SI Bone at 408-207-0700 (X3219) to find experts in your local area.

9:42 [Amy] -
What about prolotherapy as an option for strengthening the damaged ligaments so then pelvis can then be held in place without surgery. What about simply fixating the joint - is there ever an indication for that verses fusion?

Dr. Nick Shamie:
There is no proof that prolotherapy helps, even though it is low risk and can be tried before surgery. Fusion is the same as “fixation of the joint”

9:44 [rachel] -
Hello Dr. Shamie, what has been your experience with the Ifuse product? Do you always use it instead of traditional joint fusion now and if so how did you come to that decision?

Dr. Nick Shamie:
I have been very selective about who I treat with this surgery. I have had great success treating my patient with this device. Prior to this minimally invasive surgery, I was not offering any surgical treatment for my patients with SIJ pain because the traditional surgery is too invasive and I didn’t believe it was worth the collateral damage that is seen with the big open surgery.

9:45 [Keith] -
Hi ! Is there a way to distinguish SI Joint pain from possible Disc herniation pain ?

Dr. Nick Shamie:
The location of the pain is typically different; disc herniation pain travels down below the knee and SI pain typically doesn’t. Furthermore, SIJ pain is a diagnosis of exclusion. If you have another reason like a disc herniation that may be responsible for buttock or SI joint area pain, that condition is typically treated first.

9:52 [Dorothy]
are there any specific exercises to help the SI joint? Also,

Dr. Nick Shamie:
Gluteal area strengthening, low back and abdominal exercises can help stabilize the SI joint and help with the abnormal/painful motion.

9:53 [Dorothy]
I have another question-can acupuncture help?

Dr. Nick Shamie:
PT and acupuncture are good non-surgical options.

9:56 [Nona]
Hello, Nona again, I am going to see Dr.Varley, then Dr. Cordova an orthropedic surgeon there.He wants me to see the spine diagnostic dr, first.I know alot about this.I have been studying it on-line for several years.I have been scared to pertake in the regular fusion, I am glad someone has finally found a better way to stabilize the joint.Thank You in giving me the answer awhile ago, now I feel at ease in leaving Miss.for the surgery.

9:59 [Nona]
Can si joint dysfunction on the left cause your L4 lumbar vertabrae to herniate?

Dr. Nick Shamie:
Not a typical complication from an SI joint dysfunction. Probably two different unrelated diagnoses.

10:01 [Kory]
Do you believe there is a correlation between SIJ dysfunction and disc herniation? In other words, does one cause the other?

Dr. Nick Shamie:
No correlation has been reported.

10:02 [Susie]
why are the Ifuse implants not requiring correct alignment of the joints prior to surgery? And also different people have different weight bearing restrictions-what is the weight bearing restriction accomplishing?

Dr. Nick Shamie:
Intraoperative alignment is a surgeon's preference and dependent on each individual patient's needs. Weight bearing status is dependent again on bone quality but 3-6weeks of partial weight bearing is the recommended post-operative recommendation.

10:07 [Susie]
If I was to have the surgery-how long afterward approximately would I feel able to go back to normal activities?

Dr. Nick Shamie:
Walking is started the same day. Bone fusion takes around 3 months during which time strenuous activity (exercise) is not recommended.

10:07 [Karen Dugan]
what is the rate of surgeons that are currently being trained in the ifuse procedure? It is extremely difficult to find one in many cases - as an example I had to travel 4 hours away to find an experienced surgeon and I was lucky. Many have to travel by air to find any satisfaction?

Dr. Nick Shamie:
More and more surgeons are adopting this minimally procedure in their practice. Approximately 5-10 surgeons are being trained a month.

10:08 [Dorothy]
sorry-didn't finish the question Is a bilateral nerve block the same as

10:09 [Dorothy]
is a si joint injection the same as a bilateral nerve block?

Dr. Nick Shamie:
No. A bilateral nerve block addresses pinched nerve in the lumbar spine.

10:13 [Nona]
Nona again, If you have piriformis muscle syndrome or piriformis entrapment, can that surgery also be done during the I-Fuse procedure, like during traditional si joint fusion?

Dr. Nick Shamie:
These are two separate diagnoses. An expert needs to diagnose the patient correctly. If someone is suffering from both conditions, then surgery may be needed to treat both conditions. Minimally invasive surgery for SI fusion is still preferable to a traditional open surgery.

10:16 [Amy]
What is your opinion on what causes SI dysfunction?

Dr. Nick Shamie:
Abnormal motion or joint contact of the SI joint from trauma or arthritis. Inflammation of the joint from any other cause i.e. autoimmune.

10:17 [Tracy]
How long should a person try conservative treatment before you decide to do surgery?

Dr. Nick Shamie:
At least 6 months.

10:21 [Rachel]
are there any studies comparing ifuse directly to traditional fusion?

Dr. Nick Shamie:
That is a difficult comparison to make prospectively. Most patients who learn about the two techniques would pick the less invasive surgery. Ethically we cannot force patients to have a more invasive surgery for the purpose of a study. We can compare our current results to published data but that is yet to be done since we don’t have long enough follow-up (less than 2 years) on our minimally invasive fusion patients.

10:23 [Amy]
can you please address why you think the pelvic girdle needs, or does not need to be put in proper anatomical positioning prior to fusion.

Dr. Nick Shamie:
Some physical therapists and surgeons believe this is important. However,there is no published clinical, scientific data that supports this position.

10:25 [Tracy]
One more question...After the I-Fuse procedure, how long of a recovery time is it to go back to a physical labor job? Thanks so much for these answers !!

Dr. Nick Shamie:
It will be 3 months before you can get back to more strenuous types of activities.

10:28 [Karen Dugan]
why is there such a disconnect regarding alignment prior to si joint surgery?

Dr. Nick Shamie:
There is no published clinical, scientific data that supports pre-operative alignment of the SI joint.

10:32 [Nona]
I had the same question as Susie, I've read where Vicki Sims,p/t works with the surgeon to stabilize the joint before fused? Do the I- fuse surgeons work with P/T?

Dr. Nick Shamie:
PTs are an important part of treatment for the SI joint patient. Exercise and strengthening are helpful pre and post-operatively. However, there is no published clinical, scientific data that supports this position.

10:33 [Amy]
... the SI joint is the ONLY joint that isn't reduced prior to a fixation surgery... how does that make any sense? I honestly just don't understand this part.

Dr. Nick Shamie:
There is no evidence that the SI joint “dislocates” and therefore reduction of this joint makes no medical sense. If a patient has dislocation of the joint, although very uncommon in the SI joint, it should be reduced before fixation.

10:39 [Karen Dugan]
Want to thank you for doing this online "office hour" - I think these should be done on a regular basis because there are many people out there who are suffering and don't know where to turn! Thank you for bringing this problem to the forefront!

10:49 SI-BONE:
Thank you for all who participated and we hope that the answers are helpful.

To receive a FREE information kit (including a doctor discussion guide) and to find a surgeon trained in the iFuse™ procedure, please click here.