Other Spine Conditions
SI joint dysfunction, compression fractures, scoliosis, and revision surgery
Beyond the common lumbar and cervical conditions, several other spine problems can significantly impact quality of life. This chapter covers four important conditions that Dr. Greenberg frequently treats in Fort Wayne: sacroiliac joint dysfunction, vertebral compression fractures, adult scoliosis, and failed back surgery syndrome.
Sacroiliac (SI) Joint Dysfunction
Quick Overview: The sacroiliac joints connect your spine to your pelvis. When these joints become inflamed or move abnormally, they can cause lower back and buttock pain that's often mistaken for sciatica or disc problems.
Understanding the SI Joint
You have two SI joints, one on each side of your sacrum (the triangular bone at the base of your spine). These joints:
- Transfer weight from your upper body to your legs
- Allow minimal movement (only a few millimeters)
- Are stabilized by strong ligaments
- Can become painful when inflamed or unstable
Common Causes
- Pregnancy: Hormonal changes and weight gain stress the joints
- Arthritis: Osteoarthritis or inflammatory arthritis (ankylosing spondylitis)
- Trauma: Falls, car accidents, or sudden impacts
- Leg length discrepancy: Uneven gait stresses the joints
- Prior lumbar fusion: Increased stress on adjacent SI joints
Symptoms
- Lower back pain: Usually one-sided, below the belt line
- Buttock pain: May radiate into the back of the thigh
- Groin pain: Occasionally present
- Pain worsens: With standing, climbing stairs, or getting out of a car
- Pain improves: With lying down or changing positions
Diagnosis
Diagnosing SI joint pain requires careful evaluation:
- Provocation tests: FABER, Gaenslen's, and distraction tests reproduce pain
- Diagnostic injection: Numbing medication into the joint confirms the source
- Imaging: X-rays and MRI rule out other causes
Treatment Options
Treatment progresses from conservative to interventional:
- Physical therapy: Core and hip strengthening, pelvic stabilization
- Medications: Anti-inflammatories and pain management
- SI belt: External support to stabilize the joint
- Injections: Corticosteroid injections for inflammation
- Radiofrequency ablation: Nerve ablation for chronic pain
- SI joint fusion: Minimally invasive fusion for severe, persistent cases
Learn More: Read the detailed SI joint dysfunction guide.
Vertebral Compression Fractures
Quick Overview: Compression fractures occur when a vertebra collapses, usually due to osteoporosis or trauma. They cause sudden, severe back pain and can lead to height loss and spinal deformity if multiple fractures occur.
What Causes Compression Fractures?
- Osteoporosis: Most common cause—weakened bones fracture from minimal trauma
- Trauma: Falls, car accidents, or high-impact injuries
- Cancer: Metastatic disease or multiple myeloma weakens vertebrae
- Steroid use: Long-term corticosteroid use weakens bones
Symptoms
- Sudden, severe back pain: Often after lifting, bending, or minor fall
- Pain worsens: With standing, walking, or twisting
- Pain improves: With lying down
- Height loss: Multiple fractures cause progressive height loss
- Kyphosis: Forward curvature of the spine ("dowager's hump")
Diagnosis
- X-rays: Show vertebral collapse and height loss
- MRI: Determines fracture age (acute vs. old) and rules out cancer
- Bone density scan: Assesses osteoporosis severity
- CT scan: Evaluates fracture pattern and stability
Treatment Options
Treatment depends on fracture severity and underlying cause:
- Conservative care: Pain medications, bracing, activity modification (6-12 weeks)
- Osteoporosis treatment: Calcium, vitamin D, bisphosphonates to prevent future fractures
- Kyphoplasty: Minimally invasive procedure to stabilize the fracture and restore height
- Physical therapy: Gentle strengthening after healing
Learn More: Explore the complete compression fracture guide.
Adult Scoliosis
Quick Overview: Adult scoliosis is a sideways curvature of the spine that develops or worsens in adulthood, often causing back pain, leg pain, and difficulty standing upright.
Types of Adult Scoliosis
- Idiopathic: Childhood scoliosis that progresses in adulthood
- Degenerative (de novo): Develops in adulthood due to disc and joint degeneration
- Secondary: Results from other conditions (osteoporosis, prior surgery, neuromuscular disease)
Symptoms
- Back pain: Mechanical pain from muscle fatigue and joint stress
- Leg pain: Nerve compression from spinal stenosis
- Visible deformity: Uneven shoulders, waist, or rib prominence
- Difficulty standing upright: Forward lean or imbalance
- Fatigue: Muscles work harder to maintain posture
Treatment Approach
Treatment focuses on managing symptoms and preventing progression:
- Observation: Monitoring curves that aren't causing symptoms
- Physical therapy: Core strengthening and flexibility
- Pain management: Medications, injections, nerve blocks
- Surgery: Decompression and fusion for severe pain, progression, or neurological symptoms
Learn More: Read the comprehensive adult scoliosis guide.
Failed Back Surgery Syndrome
Quick Overview: Failed back surgery syndrome (FBSS) refers to persistent or recurrent pain after spine surgery. Despite the name, it doesn't mean the surgery "failed"—rather, it describes ongoing symptoms that require further evaluation and treatment.
Common Causes
- Recurrent disc herniation: New or recurring herniation at the same level
- Epidural fibrosis: Scar tissue around nerves causing pain
- Adjacent segment disease: Degeneration at levels above or below a fusion
- Pseudarthrosis: Failure of fusion to heal properly
- Spinal stenosis: Ongoing or new nerve compression
- Nerve damage: Permanent nerve injury from original condition
Symptoms
- Persistent back or leg pain: Never improved after surgery
- Recurrent pain: Initial improvement followed by return of symptoms
- New symptoms: Different pain pattern than before surgery
- Functional limitations: Difficulty with daily activities
Evaluation and Treatment
Dr. Greenberg takes a comprehensive approach to FBSS:
- Thorough review: Examining prior surgery records and imaging
- New imaging: MRI, CT, or dynamic X-rays to identify the cause
- Conservative options: Physical therapy, medications, injections
- Revision surgery: Carefully planned revision procedures when appropriate
- Pain management: Multidisciplinary approach including pain specialists
Important: Revision spine surgery is more complex than primary surgery and requires a surgeon with specialized expertise. Dr. Greenberg's fellowship training and experience make him well-suited to evaluate and treat complex revision cases.
Learn More: Explore the detailed failed back surgery syndrome guide.
Key Takeaways
- SI joint pain is often mistaken for disc problems but requires different treatment approaches.
- Compression fractures from osteoporosis can be effectively treated with kyphoplasty when conservative care fails.
- Adult scoliosis treatment focuses on symptom management; surgery is reserved for severe cases.
- Failed back surgery syndrome requires expert evaluation to identify the cause and determine the best treatment path.
Medical Disclaimer: This chapter provides educational information only and is not intended as personal medical advice. Every patient's condition is unique. Consult with Dr. Greenberg or another qualified spine specialist for an accurate diagnosis and personalized treatment plan.