Sacroiliac Joint Disease

Sacroiliac (SI) joint dysfunction is a common but often underrecognized source of lower back pain. The SI joints connect the spine to the pelvis, and inflammation or abnormal motion in these joints can cause pain that may mimic other spine conditions.

Aqib Zehri, MD, is a fellowship-trained neurosurgeon in Portland, Oregon, specializing in complex spine care. He evaluates patients with lower back pain to identify whether the SI joint is a contributing factor and offers targeted treatment options, including non-surgical management and minimally invasive procedures when appropriate.

What is sacroiliac joint disease?

Sacroiliac (SI) joint disease, also called SI joint dysfunction or sacroiliitis, refers to pain originating from the joints that connect the lower spine to the pelvis. These joints transfer load between the upper body and legs and play a key role in stability.

Although the SI joints have limited motion, inflammation or abnormal movement can cause pain and functional limitation. Because of their location, SI joint symptoms are often mistaken for lumbar spine conditions such as disc herniation or spinal stenosis.

What causes sacroiliac joint disease?

SI joint dysfunction can develop from a variety of mechanical and inflammatory factors.

Common causes include:

• Degenerative changes in the SI joint

• Arthritis affecting the joint

• Injury to the pelvis or lower back

• Pregnancy-related ligamentous laxity

• Abnormal gait or biomechanics

• Prior lumbar spine fusion

Inflammatory conditions, including certain autoimmune disorders, can also affect the SI joint.

What are the symptoms of sacroiliac joint disease?

Pain in the lower back or buttock is the most common symptom. Pain may occur on one or both sides and can radiate into the hip, groin, or upper leg.

Common symptoms include:

• Pain worsened by standing, walking, or climbing stairs

• Discomfort after prolonged sitting

• Lower back or pelvic stiffness

• Pain that improves when lying down

Because these symptoms overlap with other spine conditions, accurate diagnosis is essential.

How is SI joint pain different from lumbar spine pain?

SI joint pain can closely resemble lumbar spine pathology, but certain features may suggest the SI joint as the source.

SI joint pain is more likely when:

• Pain is localized to the buttock region

• Pain worsens with standing or transitional movements

• Pain is reproduced with specific physical exam maneuvers

• Imaging of the lumbar spine does not fully explain symptoms

Distinguishing between SI joint and spine-related pain is critical to selecting the appropriate treatment.

How is sacroiliac joint disease diagnosed?

Diagnosis begins with a detailed history and physical examination, including specific maneuvers that stress the SI joint.

Imaging may include:

• X-rays to evaluate alignment

• MRI or CT scans to assess surrounding structures

A key step in diagnosis is a diagnostic SI joint injection, which involves placing a small amount of anesthetic into the joint.

• Significant temporary pain relief after injection helps confirm the SI joint as the primary pain source

What are the treatment options?

Treatment is individualized and typically begins with non-surgical care.

Non-surgical treatment may include:

• Anti-inflammatory medications

• Physical therapy focused on stabilization

• SI joint injections for both diagnosis and symptom relief

Surgical treatment may be considered when there is:

• Persistent pain despite conservative care

• Confirmed SI joint as the pain generator

• Functional limitation affecting daily activities

Surgical options may include:

• Minimally invasive SI joint stabilization

Dr. Zehri selects treatment based on confirmed diagnosis and focuses on addressing the true source of pain.

When is SI joint surgery appropriate?

Surgery is considered selectively and only after the SI joint has been confirmed as the primary source of pain.

Candidates for surgery typically have:

• Persistent symptoms despite appropriate non-surgical treatment

• Positive response to diagnostic SI joint injection

• Functional limitations affecting quality of life

The goal of surgery is to stabilize the joint and reduce pain while preserving surrounding structures.

Take the next step

If you are experiencing persistent lower back or buttock pain and are unsure of the cause, a comprehensive evaluation can help determine whether the SI joint is contributing to your symptoms.

Call the office or request an appointment online to get started.