IS BACK PAIN FROM ROAD TRAFFIC ACCIDENTS AND OTHER TRAUMATIC INJURIES RELATED TO THE SACRO ILIAC JOINT?

Abstract

Aim: This study was a sub group analysis of a larger study. The aim was to quantify pain relief and quality-of-life benefit from a single diagnostic SIJ (Sacro-Iliac joint) injection.

Methods: Between August 2008 and February 2009, 56 consecutive patients were retrospectively recruited with unilateral low back pain, pain mapping compatible with a sacroiliac origin, tenderness over the SIJ, no obvious source of pain in the lumbar spine and no neurological deficit. These were selected for a diagnostic SIJ injection. A structured questionnaire was completed both pre- and post-injection. Median patient age was 63. All patients were injected under fluoroscopic imaging with Triamcinolone 40mgs and 3mls of 0.5% Ropivacaine hydrochloride.

Results: 6 patients were excluded from the study on the basis of incomplete answers. 38 patients (76%) had some form of previous non-operative treatment. No patients had previous injection or surgery. 8 patients (16%) were smokers. 17 patients (34%) had a desk based job, 22 patients (44%) had a manual job, 7 patients (14%) had heavy manual job. 18 patients (36%) had sustained previous back injury including rear ended road traffic accidents. A numerical rating score was carried out for low back pain and pain in the affected and unaffected leg; both pre- and post-injection. In 27 patients (54%) significant improvement was recorded, 16 patients (32%) reported no change in their symptoms, and only 7 (14%) reported worsening. When considering the Oswestry Disability Index score, 58% improved, 18% reported no symptom change, and 24% worsened. The mean pre injection Numerical Rating Score of back pain in patients who had a previous injury to the back was 7.66 and that improved to 5.72 (P = 0.0287).

Discussion: Sacroiliac joint as a potential source of back pain has had less focus following the identification of the disc pathology by Mixter and Barr. The pain from the joint is real and needs to be addressed specifically with injection as a diagnostic measure. Blanket prescription of “low back - core stability exercises” without identification of other potential non red flag causes of back pain should be discouraged. The mechanism of sacroiliac joint syndrome following road traffic accidents occur due to one leg being on the brake pedal stabilizing one half of the pelvis, whilst the opposite hemipelvis twists forward following a rear end collision.

Conclusion: History and physical examination can enter SIJ syndrome into the differential diagnosis, but cannot make a definitive diagnosis. Fluoroscopically guided diagnostic SIJ injection is the gold standard test for making the diagnosis whilst also conferring substantial pain relieve and quality-of-life benefit. This benefit is also seen in back pain following traumatic injuries including rear end motor vehicle collisions.