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The misjudged back pain

From: Sprechstunde Doktor Stutz

Do you suffer from back pain in the lower lumbar region and nobody can find the real reason? Then tell your doctor it could be an arthropathy of the sacroiliac joint.

About three-quarters of the population have back pain in the lower lumbar region at some point in their lives. Older people are particularly affected. In many cases, the symptoms are harmless and disappear on their own or respond well to simple painkillers or warmth. It becomes difficult when the pain is of a chronic nature. Then the search for a cause can drag on for weeks, months or even years, often with no tangible result. Those affected are passed from Pontius to Pilate until they finally end up with a psychiatrist.

“One of the most frequently overlooked causes of deep-lumbar back pain is the arthropathy of the sacroiliac joint, i.e. the sacroiliac joint,” says Prof. Clément Werner of the Ortho Clinic in Zurich. Because the symptoms can be very different and the anatomy of this joint is very complex, the underlying problem often goes undetected. In addition, hardly any specialist feels responsible for this neglected joint. “We’re talking about a classic ‘No Man’s Land’.”

Patients typically report lateral pain at the transition from the lumbar spine to the coccyx, in the hip region and on the leg. The knee remains painless. Equally typical are restless sitting and frequent changes of position.

Reliable and fast diagnosis

If an arthropathy of the sacroiliac joint is suspected, experienced hands are required. “There is a good manual test. It allows a reliable and quick diagnosis,” explains Prof. Werner. Something that doesn’t help at all is the classic X-ray image. In order to confirm the diagnosis, an infiltration with a local anaesthetic is made directly into the affected joint.

If the symptoms improve significantly, the findings are clear. However, error-free infiltration is a major challenge for anatomical and technical reasons and requires a great deal of experience. Prof. Werner: “In order to increase the accuracy, the procedure should always be performed with the aid of imaging procedures”.

Different treatment options

The treatment of acute pain is almost exclusively conservative, with painkillers and cooling. In a later phase, the patients respond better to heat. If the leg lengths are different, orthopaedic insoles are needed. In order to stabilize the joint, the muscles must be built up through active physiotherapy. If all this does not help, surgical interventions are possible. Possibilities are so-called denervation and a minimally invasive fusion of the joint. Prof. Werner: “During denervation, radiofrequency ablation is used to cut through the nerve tracts surrounding the sacroiliac joint. A special implant system has recently been developed for fusion and stabilization of the joint. The results so far are very encouraging.”

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