Other Spine Conditions

SI joint dysfunction, compression fractures, scoliosis, and revision surgery

Beyond common lumbar and cervical nerve conditions, pain and functional limits may arise from the sacroiliac joint, a vertebral fracture, spinal deformity, or a problem after prior surgery. Each requires a diagnosis-specific evaluation because the symptoms can resemble more common back or leg conditions.

Sacroiliac (SI) Joint Dysfunction

Quick Overview: The sacroiliac joints connect the spine to the pelvis and can be one source of lower-back or buttock pain. Symptoms overlap with lumbar, hip, and other pelvic conditions, so location alone does not establish the diagnosis.

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 limited movement
• 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: May alter loading across the pelvis and is one factor considered during evaluation

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: A cluster of maneuvers may reproduce the patient’s familiar pain and support further evaluation
• Image-guided diagnostic injection: A meaningful temporary response can support the joint as a pain source, but is interpreted with the history and examination
• Imaging: X-rays, CT, or MRI may evaluate the SI joints and competing causes; imaging findings alone do not establish that the joint is painful

Treatment Options

Options are selected according to the diagnosis, severity, functional impact, prior response, and patient-specific risk:

• 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 may be considered in carefully selected cases after the diagnosis and nonoperative response have been reviewed

Learn More: Read the detailed SI joint dysfunction guide.

Vertebral Compression Fractures

Quick Overview: A vertebral compression fracture occurs when part of a vertebral body loses height. Osteoporosis is common, but trauma, malignancy, infection, and other bone disorders may also need consideration. Some fractures are painful; others are discovered incidentally.

What Causes Compression Fractures?

• Osteoporosis: A common cause in which reduced bone strength can allow fracture after little or no recognized 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

• New focal back pain: May begin after lifting, bending, or a minor fall, particularly when bone strength is reduced
• Pain worsens: With standing, walking, or twisting
• Pain improves: With lying down
• Height or posture change: Multiple vertebral fractures can contribute to loss of height or increased forward curvature

Diagnosis

• X-rays: Show vertebral collapse and height loss
• MRI: Can assess marrow changes, neural structures, and whether a fracture appears recent; additional evaluation may be needed when malignancy or infection is a concern
• Bone density and laboratory evaluation: May help identify osteoporosis or another cause of reduced bone strength
• CT scan: Evaluates fracture pattern and stability

Treatment Options

Treatment depends on fracture severity and underlying cause:

• Nonoperative care: Symptom management, selected bracing, safe movement, and activity modification are tailored to fracture stability and medical risk
• Bone-health treatment: Medication, nutrition, fall-risk, and secondary-cause decisions should follow an individualized bone-health assessment
• Vertebral augmentation: Kyphoplasty may be considered for selected painful fractures after imaging, timing, alternatives, and procedure-specific risks are reviewed
• Rehabilitation: Mobility and strengthening are advanced according to pain, balance, fracture stability, and bone health

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: A curve originating earlier in life that persists into adulthood and may or may not change over time
• 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 symptoms, function, neurologic findings, alignment, and change over time:

• Observation: Monitoring curves that aren’t causing symptoms
• Physical therapy: Core strengthening and flexibility
• Pain management: Medications, injections, nerve blocks
• Surgery: Decompression and reconstruction may be considered when a surgically addressable problem causes substantial disability, neurologic compromise, or progressive imbalance and the expected benefit justifies the risk

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: Postoperative scar tissue that may be considered when it matches the clinical pattern
• Adjacent segment disease: New symptoms and corresponding pathology at a level next to a prior fusion
• Pseudarthrosis: Failure of fusion to heal properly
• Spinal stenosis: Ongoing or new nerve compression
• Residual nerve injury: A nerve may not fully recover after prolonged or severe compression

Symptoms

• Persistent back or leg pain: Did not meaningfully improve 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

Evaluation begins by identifying whether there is a correctable structural problem and whether it explains the current symptoms:

• Thorough review: Examining prior surgery records and imaging
• Updated imaging: MRI, CT, or dynamic X-rays may evaluate compression, alignment, fusion, implants, or motion
• Conservative options: Physical therapy, medications, injections
• Revision surgery: Carefully planned revision procedures when appropriate
• Pain management: Multidisciplinary approach including pain specialists

Learn More: Explore the detailed failed back surgery syndrome guide.

Key Takeaways

• Similar pain patterns can arise from the spine, SI joint, hip, fracture, deformity, or a non-spine condition; a label should follow the evidence rather than replace the evaluation.
• A new vertebral fracture should prompt attention to stability, neurologic status, and the underlying reason the bone failed.
• Revision surgery is not automatically the next step after persistent pain. It is most useful when a specific, surgically addressable cause is identified and expectations are realistic.
• Sudden weakness, new loss of bladder or bowel control, saddle numbness, symptoms after major trauma, or severe pain with fever require urgent or emergency medical assessment.

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.