Determination of the Prevalence From Clinical Diagnosis of Sacroiliac Joint Dysfunction in Patients With Lumbar Disc Hernia and an Evaluation of the Effect of This Combination on Pain and Quality of Life

Hilal Telli, Berrin Hüner, Ömer Kuru, Hilal Telli, Berrin Hüner, Ömer Kuru

Abstract

Study design: A prospective cross-sectional study.

Objective: To evaluate the prevalence of sacroiliac joint dysfunction in patients with lumbar disc hernia and examine the variations in clinical parameters cause by this combination.

Summary of background data: Although one of the many agents leading to lumbar pain is sacroiliac dysfunction, little progress has still been made to evaluate mechanical pain from sacroiliac joint dysfunction within the context of differential diagnosis of lumbar pain.

Methods: Two hundred thirty-four patients already diagnosed with lumbar disc hernia were included in the study. During the evaluation, sacroiliac joint dysfunction was investigated using specific tests, pain levels with a Visual Analog Scale, and the presence of neuropathic pain using Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale. Other clinical assessments were performed using the Beck Depression Inventory, Health Assessment Questionnaire, and Tampa Kinesiophobia Scale.

Results: 63.2% of patients were female and 36.8% were male. Mean age was 46.72 ± 11.14 years. The level of sacroiliac joint dysfunction was 33.3% in the research population. In terms of sex distribution, the proportion of women was higher in the group with sacroiliac joint dysfunction (P < 0.05). No significant difference was observed in pain intensity assessed using a Visual Pain Scale between the groups (P > 0.05), but the level of neuropathic pain was significantly higher in the group with dysfunction (P < 0.05). In the group with sacroiliac joint dysfunction, the presence of depression was significantly higher (P = 0.009), functional capacity was worse (P < 0.001), and the presence of kinesophobia was higher (P = 0.02).

Conclusion: Our study results will be useful in attracting the attention of clinicians away from the intervertebral disc to the sacroiliac joint in order to avoid unnecessary and aggressive treatments.

Level of evidence: 2.

References

    1. van Tulder M, Malmivaara A, Esmail R, et al. Exercise therapy for low back pain: a systematic review within the framework of The Cochrane Collaboration Back Review Group. Spine (Phila Pa 1976) 2000; 25:2784–2796.
    1. KopecF JA, Sayre EC, Esdaile JM. Predictors of back pain in a general population cohort. Spine (Phila Pa 1976) 2004; 29:70–77. discussion 77-8.
    1. Resnick D, Niwayama G. Resnick D, Kransdorf M. Degenerative disease of the spine. Bone and Joint İmaging 3rd ed.Philedelphia: W.B. Saunders Company; 1992. 413–439.
    1. Marshall WJ, Schorstein J. Factors affecting the results of surgery for prolapsed lumbar intervertebral. Disc Scott Med J 1968; 13:38–42.
    1. Maigne JY, Aivaliklis A, Pfefer F. Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine (Phila Pa 1976) 1996; 21:1889–1892.
    1. Goldthwaite GE, Osgood RB. A consideration of the pelvic articulations from an anatomical, pathological, and clinical standpoint. Boston Med Surg J 1905; 152:593–601.
    1. Albee FH. A study of the anatomy and the clinical importance of the sacroiliac joint. JAMA 1909; 16:1273–1276.
    1. Zelle BA, Gruen GS, Brown S, et al. Sacroiliac joint dysfunction: evaluation and management. Clin J Pain 2005; 21:446–455.
    1. Madani SP, Dadian M, Firouznia K, et al. Sacroiliac joint dysfunction in patients with herniated lumbar disc: a cross-sectional study. J Back Musculoskelet Rehabil 2013; 26:273–278.
    1. Chou LH, Slipman CW, Bhagia SM, et al. Inciting events initiating injection-proven sacroiliac joint syndrome. Pain Med 2004; 5:26–32.
    1. Laslett M. Evidence-base diagnosis and treatment of the painful sacroiliac joint. J Man Manip Ther 2008; 16:142–152.
    1. Cibulka MT, Delitto A, Koldehoff RM. Changes in innominate tilt after manipulation of the sacroiliac joint in patients with low back pain: an experimental study. Phys Ther 1988; 68:1359–1363.
    1. Delitto A, Shulman AD, Rose SJ. On developing expert-based decision-support systems in physical therapy: the NIOSH low back atlas. Phys Ther 1989; 69:554–558.
    1. Dreyfusss P, Dreyer S, Griffin J, et al. Positive sacroiliac screening tests in the asymptomatic adults. Spine (Phila Pa 1976) 1994; 19:1138–1143.
    1. van der Wurff P, Hagmeijer RHM, Meyne W. Clinical tests of the sacroiliac joint. A systemic methodological review. Part 1. Man Ther 2000; 5:30–36.
    1. Prather H, Hunt D. Conservative management of low back pain, part I. Sacroiliac joint pain. Dis Mon 2004; 50:670–683.
    1. Galm R, Fröhling M, Rittmeister M, et al. Sacroiliac joint dysfunction in patients with imaging-proven lumbar disc herniation. Eur Spine J 1998; 7:450–453.
    1. Holmgren U, Waling K. Inter-examiner reliability of four static palpation tests used for assessing pelvic dysfunction. Man Ther 2008; 13:50–56. Epub 2007 Jan 8.
    1. Bernard TN, Jr, Kirkaldy-Willis WH. Recognizing specific characteristics of nonspecific low back pain. Clin Orthop Relat Res 1987. 266–280.
    1. Slipman CW, Sterenfeld EB, Chou LH, et al. The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome. Arch Phys Med Rehabil 1998; 79:288–292.
    1. Weksler N, Velan GJ, Semionov M, et al. The role of sacroiliac joint dysfunction in the genesis of low back pain: the obvious is not always right. Arch Orthop Trauma Surg 2007; 127:885–888. Epub 2007 Sep 8.
    1. Fortin JD, Aprill CN, Ponthieux B, et al. Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part II: Clinical evaluation. Spine (Phila Pa 1976) 1994; 19:1483–1489.
    1. Cibulka MT. The treatment of the sacroiliac joint component to low back pain: a case report. Phys Ther 1992; 72:917–922.
    1. Cibulka MT, Erhard RE, Delitto A. Vleeming A, Mooney V, Snijders C, Dorman T. Pain patterns in patients with and without sacroiliac joint dysfunction. Proceedings from the First lnterdisciplinary World Congress on Low Back Pain and its Relation to the Sacroiliac Joint. San Diego, CA: 1992. 362–369.
    1. Mennell JM. Back Pain: Diagnosis and Treatment Using Manipulative Techniques. Little, Brown Co., 1st ed.Boston: 1960.
    1. Porterfield JA, De Rosa C. Gould JA. The sacroiliac joint. Orthopaedic and Sports Physical Therapy 2nd . Louis: C.V. Mosby Company; 1990. 564–573.
    1. Porterfield JA, DeRosa CP. Mechanical Low Back Pain: Perspectives in Functional Anatomy. W.B., Saunders Company, 2nd ed.Philadelphia, PA: 1998.
    1. Shaw JL. Vleeming A, Mooney V, Snijders C, Dorman T. The role of the sacroiliac joint as a cause of low back pain and dysfunction. Proceedings from the First Interdisciplinary World Congress on Low Back Pain and its Relation to the Sacroiliac Joint. San Diego, CA: 1992. 67–80.
    1. Stoddard A. Donatelli R. The lumbar-pelvic-hip complex. Manual of Osteopathic Practice Hutchinson & Company, 2nd ed.London, England: 1983.
    1. Slipman CW, Jackson HB, Lipetz JS, et al. Sacroiliac joint pain referral zones. Arch Phys Med Rehabil 2000; 81:334–338.
    1. Ebraheim NA, Lu J, Biyani A, et al. The relationship of lumbosacral plexus to the sacrum and the sacroiliac joint. Am J Orthop (Belle Mead NJ) 1997; 26:105–110.
    1. Cheng MB, Ferrante FM. Health related quality of life in sacroiliac syndrome: a comparison to lumbosacral radiculopathy. Reg Anesth Pain Med 2006; 31:422–427.

Source: PubMed

3
Sottoscrivi