The impact of Sacro-Iliac Joint Dysfunction in the Management of Low Back Pain and Failed Back Surgery Syndrome

Only 25% of patients with Low Back Pain (LBP) have a clear clinical and radiological evidence of a lumbar spine disease and about 30% of patients surgically treated for LBP develop a Failed Back Surgery Syndrome (FBSS). So in the light of this is necessary to ask some questions: is the origins of the LBP always located in the lumbar spine or are there any other pain generators which can provoke it? Why so many patients operated for lumbar disease develop FBSS? Is the FBSS always related to a failure of the procedure or may it be attributable to other causes? The sacroiliitis is responsible for about 1⁄4 of cases of LBP and FBSS. This is due to the fact that the lumbosacral fusion alters the biomechanics of complex sacrum-pelvis causing a joint overload that ends in a real adjacent segment disease. The LBP is a multifactorial condition in which the pain generator must be carefully studied before planning any therapeutic strategy.