Board Certified Neurosurgeon Brain & Spine Care 860-889-9035
Mark Hornyak, MDBoard Certified Neurosurgeon
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Spine Case

Sacroiliac joint (SIJ) dysfunction

57 year-old presents with primary complaint of pain in his left gluteal region (buttocks) that radiates down to the back of his left thigh.

Description

No numbness, tingling, or weakness
Did not respond to epidural steroid injection
Neuro exam unremarkable (no sensory or motor deficit)
Musculoskeletal exam with signs of left SI joint mediated pain
Patient engages in physical therapy for back and hips
Patient return to interventional pain management physician who performs left SIJ injection
Gluteal pain improves from 8/10 to 5/10

Gallery

Images

Figure 1Sagittal (left) and axial (right) T2-weighted MRI images of lumbar spine showing some diffuse degeneration. In this case, abnormalities were more prominent on the right side.
Figure 2Fluoroscopic image (A, left) and diagram (B, right) demonstrating SI joint injection performed by interventional pain management physician
Figure 3Image captured from intraoperative image-guided navigation workstation showing the trajectory used to place the first screw across the left SI joint. Note the planned trajectory of the screw (pink outline), the position of the tap (blue) and the trajectory upon which the tap is being advanced (yellow).
Figure 4Images captured from intraoperative image-guided navigation workstation showing the placement of the first (left, A1 & A2) and second (right, B1 & B2) screws across the left SI joint.
Figure 5Video captured from intraoperative image-guided navigation workstation showing screw being advanced across the left SI joint
Figure 6X-rays of the left hip/pelvis obtained 3 months after the procedure showing the two screws traversing the left SI joint.

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