Introduction: The sacroiliac joint has been defined by many authors as a cause of back and buttock pain. Though thought to be common, the means of diagnosis and accurate differential diagnosis has not been established.
Methods: The sample consists of 67 SIJ fusions. Sixty-two cases had pre- and post-op functional data available for comparison. Forty-seven out of 62 cases demonstrated a net functional improvement at last follow-up after surgery, as reflected on the Million Visual Analog Scale. Prior to the decision for surgery, all patients were studied for confirming clinical findings, injection response, and correlation to clinical history. Elements of the decision making process were ranked in order of importance to the final decision for surgery. ANOVA was performed on functional improvement after separating the sample into groups by primary elements of diagnosis .
Results: There was a significant improvement in average Million VAS score (95% confidence interval of 16 to 31 points of improvement), yet no statistically significant association of outcome with any individual subset of clinical findings was found, including history, physical examination, imaging and diagnostic injection.
Conclusions: The diagnosis of surgical level SIJ disease and its qualification for surgical approach is a complex series of close history taking, cautious repeated physical examination, and evaluation of other etiologies which could explain the patient's symptoms. The failure of clinical response of lumbar spine surgery to relief of symptoms or improvement, as demonstrated in the SPORT study, should prompt a closer evaluation of the totality of patient symptoms, and sufficient weight (without overemphasis) to all inclusive and exclusionary criteria.
Patient Care: The data presented should give practitioners better information on how to diagnose sacroiliac joint pain and differentiate it from other low back pain with similar presentation.
Learning Objectives: 1. Review the literature on the correlation and diagnostic weight of lumbar spinal surgery decision making.
2. Review the literature, discriminant ability and clinical correlation of sacroiliac clinical findings.
3. Postulate and emphasize the differential diagnostic findings preventing, if possible, wrong site surgery.