The sacroiliac joint (SI joint) is located in the pelvis; it links the iliac bones (pelvis) to the sacrum (lowest part of the spine above the tailbone). It is an essential component for shock absorption to prevent impact forces from reaching the spine.
Do you have SI Joint Problems?
The SI joint is a significant cause of low back pain.Clinical publications have identified the SI joint as a pain generator in 15-30% of chronic low back pain patients.1-4 In addition, the SI joint is a pain generator in up to 43% of patients with continued or new onset low back pain after a lumbar fusion.
Like any other joint in the body, the SI joint can be injured and/or become degenerative. When this happens, people can feel pain in their buttock and sometimes in the low back and legs. This is especially true while lifting, running, walking or even sleeping on the involved side.
According to scientific data, it’s common for pain from the SI joint to feel like disc or low back pain. For this reason, SI joint disorders should always be considered in low back pain diagnosis.
Do you experience one or more of the symptoms listed below?
Low back pain?
Sensation of low extremity: pain, numbness, tingling, weakness
Feeling of leg instability (buckling, giving way)
Disturbed sleep patterns
Disturbed sitting patterns (unable to sit for long periods, sitting on one side)
Pain going from sitting to standing.
Making a Diagnosis
A variety of tests performed during physical examination may help reveal the SI joint as the cause of your symptoms. Sometimes, X-rays, CT-scan or MRI may be helpful in the diagnosis of SI joint-related problems.
The most relied upon method to accurately determine whether the SI joint is the cause of your low back pain symptoms is to inject the SI joint with a local anesthetic. The injection will be delivered under either X-ray or CT guidance to verify accurate placement of the needle in the SI joint. If your symptoms are decreased by at least 50%, it can be concluded that the SI joint is either the source of or a major contributor to your low back pain. If the level of pain does not change after SI joint injection, it is less likely that the SI joint is the cause of your low back pain.
Once the SI joint is confirmed as the cause of your symptoms, treatment can begin. Some patients respond to physical therapy, use of oral medications, or injection therapy. These treatments are often performed repetitively, and frequently symptom improvement using these therapies is temporary. At this point, you and your surgeon may consider other options, including minimally invasive surgery.
SI Joint Fusion with the iFuse Implant System®
The iFuse Implant System is designed to provide stabilization and fusion for certain SI joint disorders. This is accomplished by inserting triangular-shaped titanium implants across the sacroiliac joint to maximize post-surgical stability and weight bearing capacity. The procedure is done through a small incision and takes about an hour. Multiple published studies on iFuse have documented procedure safety and effectiveness.
Bernard TN, et al. Recognizing specific characteristics of nonspecific low back pain. Clin Orthop Relat Res. 1987;217:266–80.
Schwarzer AC, et al. The Sacroiliac Joint in Chronic Low Back Pain. Spine. 1995;20:31–7.
Maigne JY, et al. Results of Sacroiliac Joint Double Block and Value of Sacroiliac Pain Provocation Tests in 54 Patients with Low Back Pain. Spine. 1996;21:1889–92.
Sembrano JN, et al. How Often is Low Back Pain Not Coming From The Back? Spine. 2009;34:E27–32.
DePalma MJ, et al. Etiology of Chronic Low Back Pain Patients Having Undergone Lumbar Fusion. Pain Med. 2011;12:732-9.
Polly, D.W.* et al., Neurosurgery. 2015. A list of additional published studies is available at www.si-bone.com/results ;
* Dr. Polly is an investigator on a clinical research study sponsored by SI-BONE. He has no financial interest in SI-BONE. Research was funded by SI-BONE, Inc.
The iFuse Implant System® is intended for sacroiliac fusion for conditions including sacroiliac joint dysfunction that is a direct result of sacroiliac joint disruption and degenerative sacroiliitis. This includes conditions whose symptoms began during pregnancy or in the peripartum period and have persisted postpartum for more than 6 months. Clinical studies have demonstrated that treatment with the iFuse Implant System improved pain, patient function, and quality of life at 12 months post-implantation. There are potential risks associated with the iFuse Implant System. It may not be appropriate for all patients and all patients may not benefit. For information about the risks, visit www.si-bone.com/risks
Computer Navigation Technique
Computer navigation technique is the latest revolution in orthopaedic surgery. This technology is used for replacement of arthritic knee joints.
Computer navigation provides the surgeon with the real time 3-D images of the mapped patient’s knee and the surgical instruments during surgery. The data for the images is provided by the infrared sensors fixed to the bones of the knee and the surgical instruments. Their position is tracked by an infrared camera placed above the surgical table connected to the computer. The computer than generates the real time images with the help of the appropriate software to guide the surgeon to precisely resurface and cut the bones of the knee and fix the implant precisely & accurately according to the pre-operative surgical plan. Thus the surgery is done by the surgeon only. Computer navigation is just a tool to guide the surgeon and improve the outcome of the surgery. It cannot replace the skills of an experienced surgeon.
The life of the implant can be extended by precise alignment of the implant and this can be achieved by the use of computer navigation for total knee replacement surgery.
Minimally Invasive Spine Surgery
Minimally Invasive Spine Surgery (MISS) is the latest advanced technology available to perform spinal surgeries through small, less than one inch long, incisions. It involves the use of special surgical instruments, devices and advanced imaging techniques to visualize and perform the surgery through such small incisions. MISS is aimed at minimizing damage to the muscles and surrounding structures. MISS possesses numerous benefits over the traditional spine surgery that includes:
Small surgery scars
Reduced risk of infections
Less blood loss during the surgery
Less post-operative pain
Shorter hospital stay
Quicker return to work and normal activities
Minimally invasive spine surgery is done through small incisions. Segmental tubular retractors and dilators are then inserted through these small incisions to retract muscles and provide access to the spine by creating a working channel for the surgery. This minimizes the damage to the muscles and soft tissues and decreases the blood loss during the surgery. An endoscope is inserted through one of the incisions to provide images of the operation field, on the monitor in the operation room. The surgery is done with special surgical instruments passed through the working channel. Sometimes surgical microscopes may also be used to magnify the visual field. The tissues fall back in place, as the various instruments are withdrawn. The incision is then closed and dressed.
Risk and Complications
The risks and complications of the surgery may include infection, bleeding, nerve injury, or spinal cord injury. Complications due to general anesthesia may also occur.
Cutera laser for toenail fungus, plantar warts, & scar revisions.
The Cutera GenesisPlus laser is the premium podiatric laser for toenails and is a fast and effective way to increase clear nail in patients with onychomycosis without the use of drug therapy. Currenty oral medications present with many side effects that can be detrimental and topical medications have an extremely low success rate. The laser treatment is performed in office by a physician and does not require any sedation. The laser is effective and has replaced many out of the outdated and unreliable treatments of the past.
Sacroiliac fusions (SI fusions)
The SI joint is a synovial joint, similar to joints such as the knee, hip and shoulder and is prone to develop arthritis due to a number of causes. If conservative treatment does not cure painful symptoms, one may benefit from a SI joint fusion which is very effective in relieving pain due to motion that is eliminated in the joint.
On-site electromyogram (EMG) measures the electrical impulses of muscles at rest and during contraction
Custom-fit knee implants using 3D imaging are often more accurate and less traumatic
Comfort and Support
We participate in Medicare's Therapeutic Shoe Program allowing 1 pair of diabetic shoes and 3 pairs of inserts per year for those who qualify