SI-BONE, Inc. a San Francisco Bay-area, medical device company, announced the first ever meeting of thought leading spine surgeons to review data and develop a clinical diagnostic process for identification of SI Joint pathology, a frequent cause of low back pain.
Some of the assembled spine experts included Steven Garfin (former president of NASS, Chief of Orthopedics at UCSD), John Glaser (MUSC-Charleston), Arnold Graham-Smith (Jacksonville, FL), Leonard Rudolf (Lebanon, NH), Nick Shamie (UCLA), EJ Donner (Loveland, CO) and Jonathan Sembrano and Charles Ledonio (U of MN), and Mark Reiley (founder of Kyphon). The group was selected in order to have a balance of academicians and private practitioners with significant clinical expertise in diagnosis of LBP due to SI Joint pathology and over 400 SI Joint fusion procedures between them.
The SI Joint's primary responsibility is to transfer the weight of the upper body to the lower extremities. Despite the large number of patients with SI Joint symptoms today, most of the treatment focus in the spine has been centered on the disc. According to the speakers and numerous scientific clinical publications, 15-25% of individuals who present with lower back complaints actually had problems in their SI Joint. In the U.S., it is estimated over one million patients annually with low back pain (LBP) complaints may have SI Joint problems like degenerative arthritis and/or mal-unions of pelvic trauma. According to the group, this patient population may be underserved in terms of identifying the actual causes of LBP, and in formulating definitive treatment.
The Summit group reviewed over 80 peer-reviewed publications on SI Joint diagnosis to ascertain what diagnostic methodologies would yield the most practical clinical applications in spine surgery. Currently, according to Mark Reiley, MD, "orthopedic surgery residents are rarely taught to consider SI Joint arthritis and/or old SI Joint trauma as the cause of the patient's problems and few, if any, lumbar imaging extends below S1 to examine this joint."
Diagnosing SI Joint difficulties can be difficult. Individual clinical tests are not highly reliable. Because of this, the orthopedic surgery community has insufficiently addressed this important joint. As a result, diagnosis and treatment of SI Joint dysfunction have become the purview of physical therapists, who provide temporary relief through muscle strengthening techniques, and sometimes a pelvic belt for support.
To counter this trend, the Summit group determined that a combination of 3-5 diagnostic tests are optimal for evaluating an LBP patient suspected of having SI Joint pathology. These tests include provocative maneuvers, positioning and pain injection exams. Significantly, most of these tests alone have low sensitivity in determining the SI Joint as a source of LBP, but combined have a greater likelihood of providing the rationale for intervention to treat SI Joint pathology. However, it was the consensus of the attendees that the diagnosis of SI Joint Disease should include one injection that alleviates at least 75%, or 2 injections that both alleviate at least 50%, of the patient's pain.