Severe Lower Back Pain? It Could Be Sacroiliitis.

Deborah Howell (Host): You know, back pain can be a debilitating condition, making it hard to complete everyday activities and decreasing one's quality of life. If you have intense pain where your lower spine and pelvis meet, it could be sacroiliitis. Welcome. I'm Deborah Howell. And today, let's find out more about sacroiliitis and what can be done about it.

Our guest is Dr. Amandeep Bhalla, a board-certified, fellowship-trained orthopedic spine surgeon who serves as the medical director at Memorial Care Spine Health Center. Hello, Dr. Bhalla, so glad you're with us today.

Amandeep Bhalla, MD: Hi, Deborah. Great to be with you.

Host: All right. Let's get rolling. What exactly is sacroiliitis?

Amandeep Bhalla, MD: You chose a great topic today. Sacroiliac joint pain is a very common condition of low back pain. The sacroiliac joint is a key component for the body's ability to transfer load between the lumbar spine and the lower extremities. That joint actually sits between the sacrum and the ilium. The way I think about it is it's the joint where your spine docks into your pelvis. Basically, it can be a common cause of low back pain, because it's such a large joint that's susceptible to degenerative changes or traumatic changes over time. There's also a lot of large ligaments around the joint that help stabilize it. And those ligaments can be susceptible to inflammation or sprains, which can contribute to sacroiliitis, which is inflammation or pain arising from that joint.

Host: So, everyone I know, including myself, who plays pickleball, who's right-handed, has this.

Amandeep Bhalla, MD: I think it's common. In fact, I think the advent and rise of pickleball has kept a lot of orthopedic and spine doctors pretty busy.

Host: Yeah. We all have it from reaching for that forehand. So, you know, I now know what my sacroiliac is. And yeah, I've made lots of friends with it. And we compare things like, "Can you tape up the back of your leg to make it..." You know, we do all these comparison studies every single day where we're on the courts and it's just kind of humorous. So, do we know what causes sacroiliitis and how does it affect everyday activities?

Amandeep Bhalla, MD: Yeah, it really is most commonly inflammation of the joint, attributable to either micro trauma to the joint or osteoarthritic changes within the joint, which is basically a breakdown of the cartilage. Also, dysfunction of the large ligaments that surround that joint can cause sacroiliitis. And because it's such a central key location where the spine kind of docks into the pelvis and helps transfer load to the lower extremities, it can be an uncomfortable area throughout activities of daily living, particularly with prolonged sitting.

Host: Right. Why do you think sacroiliitis is so hard to diagnose, and how do clinicians diagnose it?

Amandeep Bhalla, MD: That's a great question. There's a lot of things that are in the same neighborhood as the sacroiliac joint, for example, the hip joint, as well as the lumbosacral joints, as well as lumbar discs. And there can be overlap with some of the symptoms patients might have from piriformis syndrome or trochanteric bursitis or hip osteoarthritis or lumbosacral disc disease or osteoarthritic changes. So, because there's a lot of potential overlapping clinical pathologies, one really has to be thoughtful in working up and establishing the diagnosis of sacroiliitis.

Host: Okay. Now, the good part, how is sacroiliitis treated?

Amandeep Bhalla, MD: Sacroiliitis, typically, first we really want to establish the diagnosis, and that's done through clinical history, physical examination, and also the use of diagnostic injections. Basically, by introducing local anesthetic or local anesthetic mixed with corticosteroids into the SI joint under x-ray or CT guidance and determining if that alleviates the patient's symptoms can help establish the diagnosis of sacroiliitis.

Once that is done, oftentimes you know, physical therapy or anti-inflammatory medicine, can be really the mainstay of treatment. And those are the things we recommend first. If symptoms persist in spite of a reasonable course of physical therapy or activity modification and pain medication, we may then consider doing corticosteroid injections to see if that can help knock back some of the inflammation from the sacroiliac joint. And if in certain cases, if the symptoms persist in spite of conservative measures, one can consider a sacroiliac joint fusion, which is an immobilization of that joint by placing a mechanical typically screws across the joint to prevent further movement in that joint given that it's believed that the joint is causing the majority of one's pain.

Host: Interesting, so that, stabilizes it, but does it prevent movement?

Amandeep Bhalla, MD: Exactly. You know, so the sacroiliac joint itself doesn't move a lot. It's not like, for example, your elbow joint or your wrist joint. It moves very little relatively. And if it's determined that one can't treat it conservatively, and that someone also has excellent concordant relief with the injections, then one can be pretty sure that that's really the pain generator, the SI joint. And at that point, immobilizing that joint that already does not move a lot is considered a reasonable option to alleviate symptoms. And yes, when I say immobilize or stabilize, I'm referring to a fusion surgery across that sacroiliac joint.

Host: And post fusion surgery, how long does it take for a person to heal and get back to everyday activities?

Amandeep Bhalla, MD: Because the mechanical integrity of the instrumentation tends to be pretty excellent, particularly using modern techniques and technology, we promote early mobilization and early return to activities of daily living. In fact, when we do this surgery at Long Beach Memorial Medical Center, we actually typically will do it on an outpatient basis. The overall healing time for the fusion to take place can really be anywhere from a few months to six months. Although the return to activities of daily living, that happens almost right away.

Host: Oh, wow. That's great. So, you mentioned the medical center. Why is Long Beach Medical Center unique in its care for complex conditions like sacroiliitis?

Amandeep Bhalla, MD: Well, I think, one of the differentiating things about Long Beach Medical Center and our Spine Center is there's really excellent technology, available to the surgeons that practice there. And that involves 3D navigation, intraoperative navigation, using a variety of different platforms, including the use of robotic-assisted surgery. And these different platforms which are available to the surgeons allows for doing the surgery in a minimally invasive fashion, through a smaller incision and also doing the surgery while visualizing virtually the patient's own anatomy in 3D. So, it helps for a safer operation in making sure that nearby neurologic structures are not irritated. And I think that helps us excel in treating not only this condition of sacroiliitis, but a whole complement of spinal pathology and helps us differentiate ourselves regionally due to our depth of technology and expertise.

Host: Great. And when a patient comes in, they don't get just one physician, they get an entire team, correct?

Amandeep Bhalla, MD: They do. And because of the spine center at Long Beach Medical Center is well-established, it's a busy center, they have access to excellent nursing that is well-trained in staffing and caring for spine patients, as well as excellent physical therapy, occupational therapy, and a whole host of health professionals to help them specifically with spinal pathology, because it's, you know, an important focus of the health center.

Host: Sure. And where can patients learn more about treatments for sacroiliitis?

Amandeep Bhalla, MD: I'd recommend visiting the MemorialCare Spine Health Center at Long Beach Medical Center or you can visit memorialcare.org/lbspine, I'll just repeat that, memorialcare.org/lbspine.

Host: Great. Is there anything else you'd like to add to our conversation, Dr. Bhalla?

Amandeep Bhalla, MD: No, I appreciate the opportunity to sit down and speak with you today. I think it's an important topic. We see a lot of sacroiliitis in the community, particularly with our aging population and demographic, particularly with our active and elderly population with things like pickleball, as I mentioned earlier, increased need to treat a variety of degenerative conditions and have a thoughtful approach. I feel like we're well-equipped at our center to help address not only treatment surrounding sacroiliitis, but a whole host of spinal conditions.

Host: Wonderful. Thank you so much, Dr. Bhalla, for your time and your expertise today. We really enjoyed having you on the podcast.

Amandeep Bhalla, MD: Thank you, Deborah.

Host: For more information, once again, or to listen to a podcast of this show, please visit memorialcare.org/lbspine. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.