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La Importancia de la Articulación Sacroilíaca en el Dolor Lumbar

A pesar de que los trastornos de la articulación sacroilíaca están bien documentados como una fuente clínicamente significativa del dolor lumbar, siguen siendo una de las áreas peor diagnosticadas y tratadas de la ortopedia.

En este video, presentaremos las generalidades de las técnicas de diagnóstico para la articulación sacroilíaca, con un enfoque multidisciplinario. Hablarán tres especialistas clave, que cuentan con años de experiencia en diagnóstico de articulaciones sacroilíacas dolorosas. Si sus antecedentes, especialidades y capacitación son muy diferentes, los tres concuerdan en la necesidad de identificar a los pacientes con dolencias lumbares atribuibles a problemas en la articulación sacroilíaca y en los métodos a utilizar para lograrlo.

La articulación sacroilíaca podría ser responsable de hasta el 25% de las dolencias relacionadas con el dolor lumbar.  Dicha cifra incluso podría ser más elevada en las fusiones largas que incluyen el sacro.

El iFuse Implant System está previsto para la fusión sacroilíaca en afecciones como la disfunción de la articulación sacroilíaca, que es resultado directo de la desalineación de la articulación sacroilíaca y de la sacroileítis degenerativa. Se incluyen afecciones cuyos síntomas comenzaron durante el embarazo o en el periodo periparto y han persistido después del parto durante más de 6 meses. Existen riesgos potenciales asociados con el iFuse Implant System. Es posible que no sea adecuado para todos los pacientes y es posible que no todos los pacientes se beneficien. Para obtener información sobre los riesgos, visite:

Dr. Garfin es consultor pago de SI-BONE Inc. y tiene participación accionaria en la empresa.

"While sacroiliac joint dysfunction has been well documented as a clinically significant source of low back pain, it remains one of the under-diagnosed and under-treated areas in orthopedic practice.

Noted orthopedic surgeon Dr. Steven Garfin will review some important background about the SI Joint.
The SI joint may be responsible for up to 25 or 30% of complaints related to low back pain.  That number may be even higher in long fusions that include the sacrum.  

Despite the fact the literature on the SI joint goes back a long way it has truly been an under-appreciated, under-studied and under-diagnosed joint.  

The SI joint was nothing we ever paid attention to.  You learn about it in anatomy but diagnostically or therapeutically it just wasn’t an issue.

Recently there has been a summit meeting of individuals who are familiar with the SI joint and academic spine surgeons and clinically active spine surgeons such as me to talk about the SI joint.  

Meta analysis was done of available literature.  The discussions were summarized and we were able to come up with an agreement as to a consensus how to diagnose and potentially treat SI joint related problems that fortunately has been accepted for publication.

I realized that this is something I should listen to, pay attention to, and try to diagnose and try to teach my residents and fellows.

The algorithm lays out questions to ask for the history and for the physical exam.  It includes examining the hip and neurologic exam for the spine, and then there are roughly five tests for the SI joint that stress the SI joint. 

Three of them should be positive to lead or strongly lead to the diagnosis of the SI joint as a cause of pain. 

These tests are not very complicated or too sophisticated.  Most health care providers no matter what their specialty have learned them somewhere along their training.  Unless you think about the SI joint you don’t do these tests.  To add them in takes maybe five minutes maximum and it’s really sort of a thought process and a completeness of the exam and anybody can do that.

It’s critical for physicians and non-physicians, surgeons and non-surgeons to pay attention to the joint as a possible diagnosis and etiology related to low back pain."