Question: About seven weeks after a two-level fusion, I am having moderate hip and groin pain…Would recent fusions inhibit the treatment program that should be done for my sacroiliac joint?

About 7 weeks after a two-level fusion in my lower back (L4-L5 and L5-S1), I am having moderate hip and groin pain and think it could be sacroiliac joint pain. It hurts when I walk for a long time, when I roll over in bed and go up steps or walk up hills. I've never had this hip groin pain before fusion. My post-op x-rays were good and don’t explain this pain. The fusion has gotten rid of my terrible lower back pain. Is this sort of thing common and would my recent fusions inhibit the treatment program that should be done if this is from my sacroiliac joint? I don’t want the low back pain back, but also don’t want the hip and groin pain to get worse.

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Doctor’s Response: A sacroiliac joint fusion can be done after a spinal fusion

The primary reason for needing to fuse the sacroiliac joint is that the joint is overstressed secondary to a lumbar-sacral fusion. In essence, it would appear, although this is not proven in the literature, that the longer the fusion the greater the stresses on the sacroiliac joint. Sometimes, the joint is involved with the initial pain process; the surgeon does not know this, and does a very good fusion of the lumbosacral spine and relieves the low back pain, but the sacroiliac joint is left hurting.

In such circumstances, the sacroiliac joint needs to be injected, under image, with a Novocain and a steroid to assess both for short-term relief while the Novocain is working, as well as the potential for long-term relief secondary to the steroid. The steroid may or may not be effective. If the sacroiliac joint is found to be a significant pain generator, then rather than proceeding right to a fusion, it would be appropriate to first explore non-surgical options for treatment of the sacroiliac joint. It should also be noted that hip and groin pain are frequently primary symptoms of sacroiliac joint dysfunction.

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In Spine-health’s Doctor Advice section, physicians respond to frequently asked questions about back pain issues. These responses represent the opinion of one physician, and do not necessarily reflect the views of the broader medical community. The advice presented has not been peer reviewed by Spine-health’s medical advisory board.