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Sacroiliac Joint Dysfunction ?
I was wondering if anyone has Sacroiliac Joint Dysfunction and if you have it, did you have surgery for it? Has the surgery been successful? As I read more about this I think this might be a part of my pain and problems since my surgery. When I read this article it describes my pain, during the night especially. I really do not want more surgery. If you have had surgery, has it been successful for you? This seems like a very big surgery...I was wondering the success for it. Does anyone know?
A Patient's Guide to Sacroiliac Joint Dysfunction http://www.eorthopod.com/eorthopodV2...f61e50b/area/5 http://www.eorthopod.com/images/Cont...nt_intro01.jpg Introduction A painful sacroiliac joint is one of the more common causes of mechanical low back pain. Sacroiliac (SI) joint dysfunction is a term that is used to describe the condition - because it is still unclear why this joint becomes painful and leads to low back pain. Sacroiliac joint dysfunction can be a nuisance but it is seldom dangerous and rarely leads to the need for surgery. Most people who suffer from this problem can reduce the pain and manage the problem with simple methods. This guide will help you understand how the problem develops how doctors diagnose the condition what treatment options are available Anatomy What part of the back is involved? http://www.eorthopod.com/images/Cont..._anatomy01.jpg At the lower end of the spine, just below the lumbar spine lies the sacrum. The sacrum is a triangular shaped bone that is actually formed by the fusion of several vertebrae during development. The sacroiliac (SI) joint sits between the sacrum and the iliac bone (thus the name “sacroiliac” joint). You can see these joints from the outside as two small dimples on each side of the lower back at the belt line. The SI joint is one of the larger joints in the body. The surface of the joint is wavy and fits together similar to the way Legos® fit together. Very little motion occurs in the SI joint. The motion that does occur is a combination of sliding, tilting and rotation. The most the joint moves in sliding is probably only a couple of millimeters, and may tilt and rotate two or three degrees. The SI joint is held together by several large, very strong ligaments . The strongest ligaments are in the back of the joint outside of the pelvis. Because the pelvis is a ring, these ligaments work somewhat like the hoops that hold a barrel together. If these ligaments are torn, the pelvis can become unstable. This sometimes happens when a fracture of the pelvis occurs and the ligaments are damaged. Generally, these ligaments are so strong that they are not completely torn with the usual injury to the SI joint. The SI joint hardly moves in adults. During the end of pregnancy as delivery nears, the hormones that are produced causes the joint to relax. This allows the pelvis to be more flexible so that birth can occur more easily. Multiple pregnancies seem to increase the amount of arthritis that forms in the joint later in life. Other than the role the joint plays in pregnancy, it does not appear that motion is important to the function of the joint. The older one gets, the more likely that the joint is completely ankylosed, a term that means the joint has become completely stiffened with no movement at all. It appears that the primary function of the joint is to be a shock absorber and to provide just enough motion and flexibility to lessen the stress on the pelvis and spine. Causes What causes this problem? There are many different causes of SI joint pain. Pregnancy may be a factor in the the development of SI joint problems later in life. Also, if a person has one leg is shorter that the other, the abnormal alignment may end up causing SI joint pain and problems. Often, an exact cause leading to a painful SI joint condition can't be found. The joint simply gets painful, and the patient and provider don't have an answer as to why the joint has become painful. The SI joint is a synovial joint, similar to all joints such as the knee, hip and shoulder. Because of this, different types of arthritis that affect all the joints of the body will also affect the sacroiliac joint. This includes conditions such as rheumatoid arthritis, gout and psoriasis. The joint can be infected when bacteria that travel in the blood settle in the joint causing a condition called septic arthritis. This is perhaps the most worrisome cause of SI joint pain and may well require surgery to drain the infection. http://www.eorthopod.com/images/Cont...t_causes01.jpg Injury to the SI joint is thought to be a common cause of pain. Injury can occur during an automobile accident. One common pattern of injury occurs when the driver of a vehicle places one foot on the brake before a collision. The -->magnetic resonance imaging (MRI) scan can be used to look at the lumbar spine and pelvis in much more detail and to rule out other conditions in the area. The MRI scan uses magnetic waves rather than x-rays and shows a very detailed picture of the soft tissues of the body. A computed tomography (CAT) scan may also be used to show a much more detailed look at the bone of the pelvis and the sacroiliac joint. A bone scan is useful to see how the skeleton is reacting to any type of "stress," such as an injury, an infection, or inflammation from arthritis. This test involves injecting chemical "tracers" into your blood stream. The tracers then show up on special spine X-rays. The tracers collect in areas where the bone tissue is reacting strongly to some type of stress to the skeleton, such as arthritis and infection of the SI joint. The most accurate way of determining whether the SI joint is causing pain is to perform a diagnostic injection of the joint. Because the joint is so deep, this must be done using X-ray guidance with a fluoroscope (a type of realtime X-ray) . Once the doctor places a needle in the joint, an anesthetic is injected into the joint to numb the joint. If your pain goes away while the anesthetic is in the joint, then your doctor can be reasonably sure that the pain you are experiencing is coming from the SI joint.. http://www.eorthopod.com/images/Cont...iagnosis05.jpg Treatment What treatment options are available? Nonsurgical Treatment Doctors often begin by prescribing nonsurgical treatment for SI joint dysfunction. In some cases, doctors simply monitor the patient's condition to see if symptoms improve. Anti-inflammatory medications, such as ibuprofen and naproxen, are commonly used to treat the pain and inflammation in the joint. Acetominiphen (for example, Tylenol) can be used to treat the pain, but it will not control the inflammation. Your doctor may ask that you rest your back by limiting your activities. The purpose of this is to help decrease inflammation and calm the muscle spasm. Some patients benefit from wearing a special brace called a sacroiliac belt. This belt wraps around the hips to hold the sacroiliac joint tightly together, which may ease your pain. http://www.eorthopod.com/images/Cont...reatment01.jpg Patients often work with a physical therapist. After evaluating your condition, a therapist can assign positions and exercises to ease your symptoms. The therapist may design an exercise program to improve the strength and control of your back and abdominal muscles. Some therapists are trained in manipulative techniques that attempt to treat the pain in this manner. You may be able to learn how to adjust your SI joint yourself and ease the symptoms. If your physical therapist is not trained in manipulation, he/she may be able to suggest a chiropractic physician or osteopathic physician in your area who can provide this treatment. If conservative treatment is unsuccessful, injections may be suggested by your doctor. As described above, injections are used primarily to confirm that the pain is coming from the SI joint. A series of cortisone injections may be recommended to try to reduce the inflammation in and around the SI joint. Cortisone is a powerful anti-inflammatory medication that is commonly used to control pain from arthritis and inflammation. Other medications have been injected into the joint as well. A chemical called hyaluronic acid has been used for years to treat osteoarthritis of the knee. This chemical is thought to reduce pain due to its lubricating qualities and the fact that it nourishes the articular cartilage in the synovial joints. The true mechanism of action remains unknown, but it has been used with some success in the SI joint. All of these injections are temporary and are expected to last several months at the most. Another procedure that has been somewhat successful is called radiofrequency ablation. After a diagnostic injection has confirmed that the pain is coming from the SI joint, the small nerves that provide sensation to the joint can be "burned" with a special needle called a radiofrequency probe. In theory, this destroys any sensation coming from the joint, making the joint essentially numb. This procedure is not always successful. It is temporary but can last for up to two years. It can be repeated if needed. http://www.eorthopod.com/images/Cont...reatment03.jpg Surgery Surgery may be considered if other treatments don't work. Surgery consists of fusing the painful SI joint. A fusion is an operation where the articular cartilage is removed from both ends of the bones forming the joint. The two bones are held together with plates and screws until the two bones grow together, or fuse, into one bone. This stops the motion between the two bones and theoretically eliminates the pain from the joint. http://www.eorthopod.com/images/Cont...reatment04.jpg This is a big operation and is not always successful at relieving the pain. The operation is not commonly performed unless the pain is debilitating. SI joint pain is seldom this severe. Rehabilitation What should I expect as I recover? Nonsurgical Rehabilitation Doctors often recommend physical therapy for patients with SI joint dysfunction. Patients are normally seen a few times each week for four to six weeks. In severe and chronic cases, patients may need a few additional weeks of care. When movement of a joint is limited, the pain and symptoms of SI joint dysfunction may worsen. Getting more motion can give you the relief you need for daily activities. If you don't have full range of motion, your therapist has several ways to help you get more movement including joint manipulation, stretching, and exercises. Active movement and stretching as part of a home program can also help restore movement and get you better faster. Therapists commonly prescribe a set of stretches to improve flexibility in the muscles of the trunk, buttocks, and thighs. In addition to the treatment you receive by your therapist, you may be given ways to help your own SI joint if your pain returns. These exercises usually require that you position your hip and pelvis in a certain way and either stretch or contract and relax specific muscles. Follow the instructions of your therapist when doing these exercises. If the SI joint has too much mobility and problems keep coming back, you may need extra help to stabilize the SI joint. You may be issued a SI belt to stabilize the joint. A belt like this can often ease pain enough to let you exercise comfortably. You'll learn some exercises to help you build strength, muscle control, and endurance in the muscles that attach around the SI joint. Unfortunately, few muscles actually connect to both the sacrum and the pelvis. Key muscles to work are the gluteus maximus, as well as the abdominal and low back muscles. After Surgery You will normally need to wait at least six weeks before beginning a rehabilitation program after having SI joint fusion surgery. You should plan on attending therapy sessions for six to eight weeks. Expect full recovery to take up to six months. During therapy after SI joint surgery, your therapist may use treatments such as heat or ice, electrical stimulation, massage, and ultrasound to help calm your pain and muscle spasm. Then you'll begin learning how to move safely with the least strain on the healing area. As your rehabilitation program evolves, you'll begin doing more challenging exercises. The goal is to safely advance your strength and function. As your therapy sessions come to an end, your therapist helps you get back to the activities you enjoy. Ideally, you'll be able to resume your normal activities. You may need guidance on which activities are safe or how to change the way you go about your activities. When treatment is well under way, regular visits to your therapist's office will end. Your therapist will continue to be a resource. But you'll be in charge of doing your exercises as part of an ongoing home program. |
:eek:
i have spondylolisthesis from a back injury. mine has been progressive. last time a dr checked..i was at a stage 4. but oh man...what you posted is discribing the pain i have been having for the last few months. :( i have been over doing it getting ready to move. can't help on the surgery part. i haven't had any for my back. :hug: gentle hugs. back pain sucks! |
Hello GJZH!
I suffer daily from pain originating in my SI joint. I was in the Army and during a pt test (after 3 days in the field, in full battle dress, carrying a 40 pound rucksack, and a 35 pound M-60 - my back herniated at L-5/S1 during the situps - I continued on with the 2 mile run though) I had severe cramps going up and down both legs and spasming at the same time. This was the worst run of my life - and at that point I had been running for 15 years - daily. Suffice it to say that along with the low back injury - the SI joint pain is the worst. I was told that the SI joint ligaments were torn. As a result in an office visit my doctor showed that one leg was longer than the other, because the more injured side had retracted. As a result the joint has never worked the same since. I walk with a limp. Apparently when the ligament is torn and frozen in a certain position it aggravates the SI nerve. I was only recently told about options for surgery but the neurosurgeon I spoke to talked about cutting the nerve completely - my Orthopedic Surgeon disagrees with doing that because then I would lose all feeling in my legs. After they both spoke another option was inserting a pain stimulator into the base of my back - supposedly that would also help with the SI joint pain. Would your doctors consider the pain stimulator for you? At least it is reversable - which is not so with the more invasive surgeries. While waiting for the pain stimulator - I cope by stretching, exercising and I see a chiropracter who manipulates me to pull out my legs. Meds cannot calm this pain - Ice packs work wonders. All the best to you..... Kim |
Yep, I do. I've not had surgery, but my ortho. surgeon noted that I'm a "candidate" for bilateral SI Joint "arthrodesis."
He also stated (to me and in his written reports to my other docs) that a university surgeon would have to perform the surgery, since it's rarely done by those in private practice - at least in the area where I live (the nearest teaching university is UC Davis, and the nearest counties where I live are packed with hospitals that do perform myriad spinal surgeries, but not SIJ fusion). To help ease the pain, I've had bilateral SI Joint injections (late in 2005 and early 2006); I've also had multi-level, bilateral pulsed RF (radiofrequencing) from the L-4 - S1. My bone scans and CTs helped my docs in making the dx, thankfully (by that I mean, the films also helped positively rule out bone cancer, which was what the neuroradiologist was thinking was going on). The SI Joint probs., I can live with, as much as pain as it is; the bone cancer scare helped put stuff into perspective for me. Other than fusion, what options have your docs mentioned? For me, the surgery isn't "right" right now; my surgeons have assured that they will tell me when "it is time." (They've also my C- and T-spine that they're monitoring closely. No time, to me, would be the "right" time, but... .) Because I do have Ankylosing Spondylitis (AS), and fusion is an effect, one "benefit" of the SI fusion would be to better assure that proper alignment has an increased chance of happening. I had posted some links, I found helpful, here: http://neurotalk.psychcentral.com/sh...17&postcount=2 |
Bobbi, AK, and Curious,
Thanks for answering this post....It is the most response I have gotten from anyone on the boards...My pain doc suggested this to me as a pain generator. I asked the surgeon that did my cervical fusion a few weeks ago about it and he would not discuss it with me. He was just furious that I went ahead with the lumbar fusion. I see the surgeon that did my lumbar fusion tomorrow...I am going to speak to him about this as being a possible pain generator. It makes sense to me since I have been reading about it. The surgeon that did my cervical fusion has suggested a spinal cord stimulator for the pain, but I have been told since my pain is all over the spine it would not help much. I have cervical pain as well. They could only get rid of the pain in either the back or the legs too not both so I do not know how much good that would do either...It seems as though I would still be on drugs...and then be hooked up to wires...though it is something to think about.... I will talk to my surgeon tomorrow about the SI Joints to see what he determines...He is a smart guy and top doc....He knows more than any of them.... Have any of the treatments helped you Bobbi? |
:o i don't post much about my back. why? don't really know. i'm in constant pain and have been for year and years. i have nevr been able to tolerate pain meds. i just can't function.
i do lurk. :D but i promise i will get more active here. i hope you get lots of feedback. i'm glad you made the choice yourself about the fusion. i know it is the pits to have dr's not agree with treatments. |
Curious,
Thanks for posting...Please post more often....I think it is great that this site is here for us...and we need to keep it going.... Bobbi, Thanks for the links....I am going to try to get to those tonight and print out material to read on my way into NYC tomorrow...I know you have been getting these injections for awhile Bobbi....Do they seem to help you? My only problem is that I think I need facet and SI injections. Would they do both? I had hoped the cages they put into the front of the spine would have helped with the facets, but I think they have not...I need to ask tomorrow why they have not...At least on the right side they have not....I still have a lot of right sided pain...Unless, it is scar tissue...I had not thought about scar tissue, but that would be a possibility too, I guess... Gloria |
For me, the injections did help tremendously. I know that, for some, they either provide little relief or shorter term relief. Mine? The effects or benefits (pain relief) was longer lasting.
I think what helped was that my doc did other things (like testing, testing 1-2-3 :)) and nerve blocks prior - to assess whether I was in the running as a candidate for, i.e., RF'ing. I've had facets and nerve nuking of my C-spine, T-spine, L-spine and the good ol' SI Joints. Because my doc does use steriods (though he can leave that component out), and with all the radiographic imaging I've had since my fall, I've not had any procedures in a while. I was a bit worried about the cummulative toll everything combined was having on my body; my adrenal glands were acting screwy and it was also messing up my cycles - to the point (you may recall, and if not, that's okay) I was mis-dx'd as prematurely post-menopausal. That would have been okay, only it was incorrect and I spent so much time at labs, etc., being poked and prodded with U/Ss - since the lining measurements would have been too high if I were post menopausal; those levels were scaring my OB/GYN. Normal levels, though, for someone not post-menopausal. Because the procedures do make the pain bearable (some of it, depending where, such as the scapulas, non-noticeable), I will have the procedures again, only without steroids in the mix. Before my first procedure, I did cancel it; I just didn't know enough about it and was scared outta my mind. It was before I interacted with others whom are familiar with the procedures. Only people I was getting info. about ESIs from, for instance, was women whom have gone through childbirth. They had never heard of ESIs in the C-spine, etc. Until I felt that I really understood the procedures, I waited. If my foot could have reached, I would have kicked my own bum for waiting so long. Seriously. Diff. docs approach things differently, as you know :cool:. Mine has a certain protocol he uses, and, so far, it's worked like a charm for my pain management. I don't expect any of my doctors to be Mr. or Ms. Personality of the Year, yet it does help greatly when there is a solid rapport and the communication doesn't leave me feeling as if I may have understood, but that I do understand. As you might also remember, I have a set of steps I also follow (created from trial-and-error) that I use before each procedure. I think that that has also helped me in the recovery time. If you do have any injections, and if you want the list, I'd be happy to share it :D. It's just simple things, but... they do work for me. P.S.: I don't know if you've had a doc check out your PSIS (Posterior Superior Iliac Spine), yet that might be something to have looked at as well. Mine gets "knotted" at times. Too, if you've not had a bone scan or CT since the pain, it's something I'd also not rule out. Mine did discern inflammation, among other things. |
Bobbi,
I saw my surgeon on Thursday...He has ordered a test of the right sacroiliac joint only. I really think he should have ordered both since I think both sides are symptomatic, but that is just my way of thinking... He thinks that the screw, looks to me to be about six inches long, into the pelvis for pelvic fixation, is causing the pain into the sacroiliac. They are going to do the injection next Thursday with both numbing medication and steroids. Please tell me what to expect with this and how to prepare. If this is the pain generator, he will then do surgery to remove the screw into the pelvis. I really do not look forward to this, but another surgeon, the surgeon that did my cervical fusion, told me these screws break at about the two year mark. It might be a good thing to have it removed, but I really, really had hoped this would be last surgery. I really do not know though if this screw could be causing hip and sciatica pain too...We shall see.... |
Bobbi,
Do you know anything of the following procedure? It seems rather simple or reads as a rather simple procedure....I think if they detect I have problems with the sacroiliac....this sounds like an option...but it does say that a contraindication is pelvis fixation...so that might rule me out...as usual...I have been reading up on sacroliliac fusion....It seems like a gruesome, fusion...Just the incison alone seems horrific...I am hoping the injection works..and I do not have to go the route of screw removal... Sat., 10/11/03 Pediatrics/Spine, Paper #60, 11:49 AM Iliosacral Screw Stabilization Guided with Computed Tomography for Treatment of Posttraumatic Sacroiliac Disease: Preliminary Report Bruce H. Ziran, MD1; Dan J. Heckman, MD1; Wade R. Smith, MD2; 1University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; 2Denver Health Medical Center, Denver, Colorado, USA Purpose: The sacroiliac joint is a common location of chronic lower back and pelvic pain with many known causes. When a painful sacroiliac joint is refractory to nonoperative therapy and causes severe functional inhibition, fusion of the sacroiliac joint may be considered. The traditional techniques for sacroiliac joint fusion involve an extensive surgical exposure with union rates of 60 to 85%, but the risks of bleeding, neurovascular injury, and infection are significant. A surgical protocol for sacroiliac joint stabilization without formal joint exposure and grafting, stemming from a technique described previously for fixation of posterior pelvic ring fractures, was evaluated. Our hypothesis was that, instead of achieving true arthrodesis, stabilization of the sacroiliac joint with the described technique would sufficiently stabilize it to provide ongoing relief. We report on the preliminary clinical outcomes and efficacy of this technique for treatment of sacroiliac joint disease. Methods: Seventeen patients with chronic sacroiliac joint pain after some traumatic event, ranging from low-energy lifting and twisting, childbirth, to a nonoperatively treated posterior ring injury, were treated. Patients who had had prior posterior pelvic fixation were excluded. All patients underwent out-patient percutaneous CT-guided sacroiliac joint fusion with use of conscious sedation and local anesthesia. With use of the technique, at least one screw was placed into both S1 and S2, with an occasional third screw if sacral morphology permitted. Preoperatively, diagnostic CT-guided sacroiliac joint bupivacaine-steroid injections were used to confirm the sacroiliac joint as a source of pain and to quantify the response to intervention. Pain levels, evaluated by using a visual analog scale from 0 to 10, were assessed before injection (PRE-I), after injection (POST-I), and at the last follow up after fixation (FIX). Univariate analysis was used to compare interval scores, and Spearman correlations were performed to compare relations between pre- and post-injection and final scores. Only patients who experienced some pain relief after the diagnostic injection were offered the procedure. Perioperative and outcome data were recorded, including procedure time, amount of local anesthetic and intravenous sedation used, complications (infection, blood loss, nerve injury, or technical failure), accuracy of screw placement, pain relief, and cost. All procedures were performed on an outpatient basis, and patients were restricted to partial weight-bearing with an assistive device for 6 weeks. No other restrictions applied. At the first follow-up examination, patients were evaluated for their recall of the procedure. Results: Forty-nine iliosacral screws were placed in 17 patients (10 women, 7 men) with a mean age of 35 years (range, 24 to 45) and a mean follow-up of 24 months (range,11 to 48). There were no complications, technical difficulties, or misplaced screws. The mean procedure time was 26 minutes per screw. The average amount of intravenous sedation was 142 mcg of fentanyl and 3 mg of versed, and the average amount of local anesthetic was 19 cc of lidocaine and 11 cc of bupivacaine. The mean pain levels were 8.3 (range, 3 to 10) PRE-I, 3.5 (range, 0 to 8) POST-I, and 3.3 (0 to 9) FIX. Overall, four patients (17.6%) had complete and 11 patients had significant pain relief at the final follow-up examination. Two patients (11.8%) experienced little to no pain relief; however, both suffered from multiple pain sources not of sacroiliac origin and had a limited response to the preoperative injection. None of the patients experienced increased pain after the procedure, and there were no infections or hardware or technical complications. Patients had little recall of the procedure. Univariate analysis found statistically significant differences between the patient's response to the diagnostic injection (PRE-I vs. POST-I, P <0.0001) and the patient's final condition compared with that before the procedure (PRE-I vs. FIX, P <0.0001) but not between the post-injection state and the final condition (POST-I vs. FIX, P = 0.8906). A statistically significant correlation (Spearman coefficient +0.57, P <0.02) was found between final pain score (FIX) and the magnitude of response to the diagnostic injection (difference of POST-I to PRE-I). Surgeon/implant/medication fees for the procedure averaged approximately $2600 per case as compared with the cost for standard sacroiliac screw placement in the operative suite ($12,500). Conclusions: In the present study, we found that CT-guided stabilization of the sacroiliac joint for chronic dysfunction seems to provide satisfactory relief of sacroiliac joint pain. We found that patients with the greatest response to the diagnostic injection experienced a higher likelihood of pain relief. We surmise that by using two screws with some separation, the sacroiliac joint may be sufficiently stabilized that either a stable ankylosis or a spontaneous fusion occurs. Although we did not perform a CT evaluation of the sacroiliac joint looking for bony fusion, it is possible that, in the absence of such a phenomenon, there would be loosening over time and recurrence of symptoms. Thus far, this has not happened and the poor results appear related to selection criteria. Because the cause of vague and recalcitrant pelvic pain is complex, a diagnostic injection is not only important but also prognostic of response to treatment. The percutaneous approach under conscious sedation minimizes procedure time, recovery time, and complication rates relative to open fusion techniques. The results of this study are useful for traumatologists because we are often consulted regarding posttraumatic pelvic pain. |
do any of you know of a picture of the possible pain radiation of the SI joint?
I've had some pain recently and am not sure if it is si or piriformis related... Great topic, Thanks! :) |
Jen, I don't know if this will help, yet there are some images on these pages:
http://www.orthogate.org/patient-edu...sfunction.html (which GJZH shared in her thread-opening post ;)) and... http://www.hughston.com/hha/a.sacjnt.htm GJZH, I may have read about the screw stabilization in the past; I read so much that it something become fuzzy :o. Sacroliliac fusion (by surgery) does seem rather scary; I'd rather take the natural route, since it's gonna happen anyway, but... to get the alignment, surgery may be the better option. Let us know how your injection goes, and whether it seems to help you. |
Thanks, Bobbi;
I've been having arthritis-type pain that is getting pretty bad and I had a fusion l4 thru S1. I'm not sure if it is the joint or the fusion. If it is the joint, then some more attention to my arthritis is in order. I was just trying to figure out a way of isolating the pain without a whole bunch of tests...it's not like we haven't been through enough already! :D |
Jen, I'll do some more looking around for images that might display the most probable areas where referred/radiating pain from the SI Joints could happen. It'll likely take me a couple of days to more searching :).
I might also have some images in materials my doctors had given me. If so, I'll scan those and post 'em. For me, I know the pain is a pain in the ... y'know what. I think that my bone and CT scans were the most telling - for surgeons - along with the films taken during procedures. |
My Si Joint Fusion Experience
Hello to all on this thread. Perhaps I can help by sharing my experience, although I hardly know where to begin. I haven't been closely following forums like this one since I had bilateral SI-joint fusion in August of 2004. In my case, this surgery gave me my life back! I also have had a prior bi-level lumbar posterior fusion of L4-L5 and L5-S1 in 1996, a lumbar discectomyin 1995, a spinal cord stimulator, an intrathecal morphine pump implanted in 2000, and various and sundry injections. So I have a basis to compare the trauma from my SI-joint surgery. In my case, this surgery was much less painful and difficult than my spinal fusion.
I severely injured my pelvis in an auto accident at age 19, recovered seemingly completely, then developed pain in a sciatic pattern at age 45. Was misdiagnosed with degenerative disc disease, had the above-mentioned spinal surgeries which only made my pain worse. I continued to suffer increased pain which baffled the many orthopedic and neurosurgeons who examined me over an eight-year period post-lumbar fusion surgery. They were baffled because noone thought to consider the possibility that my pain originated from my sacroiliac joints! My pain increased to the point that I had to retire from my career as a marine scientist, permanently disabled, from the chronic pain. By 2004, at age 46, I could no longer stand or sit except for very brief periods due to the severity of the pain radiating from my lumbar area to my feet. Even lieing on my back was painful due to the pressure of my body weight on my Si joints. My wonderful pain specialist at UC-San Francisco ordered a CT scan, then, which suggested SI joint degeneration. My pain doctor told me that if the degeneration was visible on a CT scan then it was really bad. She gave me diagnostic lidocaine nerve blocks into each SI joint, the gold standard test for diagnosing Si joint degeneration, and I was pain free for 6-8 hrs until the lidocaine wore off! Finally, an accurate diagnosis! I was so excited to have a rational explanation for the baffling, debilitating pain I suffered from. I researched SI-joint fusion in medical journals and located a superb surgeon in Loveland, Colorado who is very accomplished and experienced at this form of surgery. He is fantastic. His name is Dr. Jeffrey Donner. He performed a bilateral fusion, with screws, on both of my severely degenerated Si joints, then prescribed a conservative regimen of NO weight bearing on the joints for a minimum of three months. This allows the joints to fuse properly. The screws ultimately were painful for me and 13 months after fusion surgery, I had the screws removed. This did lessen the pain. I repeat, this surgery gave me my life back. I can now walk long distances, sit for up to an hour without pain, and live a somewhat active, low-impact lifestyle. I am still in pain but at a much lower level. I have no assocaition with Dr. Donner other than as a surgical patient. And I present my long story to offer hope to those of you who suffer with this affliction and feel hopeless at times. |
Thank YOU for relating your background and sharing what you've felt to reach where you are now, Franck :cool:. I'm sorry you've been through so much pain and also how it affected your life.
What you've relayed also highlights the fact that there just are not enough Dr. Donner types around; I wish he was in California. By what your doc told you about the CT and SI Joints ... that's the part that grabbed me. Since the probs. o'mine display within the films, I know that's not good, only... as, you also mentioned: It also takes away the potential for "guessing" and faulty dx's. I hope that you'll continue posting, though I am not pleased that you've been through so much pain. Jen, I found this site yesterday... and will continue looking for images: http://www.ic-network.com/iclifestyles/april02.html |
I hope that your move doesn't increase the progression, Curious, and that you find relief from pain you feel... maybe some things that help.
In looking for info. about SI Joints for Jen, I also read some about spondylolisthesis; it sounds rather painful. Quote:
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Too few experienced surgeons
Thank you for the kind words, Bobbi. You are right about the seeming lack of surgeons in California with SI joint experience. I took Amtrak to Denver from Oakland, Calif. for my surgery (I was unable to tolerate sitting for the flight) after failing to find an experienced surgeon in the San Francisco area.
I was told by one surgeon that many doctors were taught in med school that the SI joints are not a significant potential cause for lumbar/pelvic pain, and it seems that it's only been research in the past 15 yrs or so that has proven otherwise. Also many surgeons are not comfortable in performing a nonroutine procedure like Si-joint fusion. So fusion candidates dshould definitely try to locate an experienced specialist. I've also been told by phys. therapists and chronic pain doctors that SI-joint dysfunction is often overlooked or mistaken as lumbar spine issues. Fortunately, the diagnostic nerve block into the SI joint, under guided fluoroscopy), is a great means to confirm SI joint dysfunction. I sympathize with all of our fellow sufferers of this awful condition. Franck |
Now I know where to go for the fusion... but heck of a way to have to find out - based on the pain you've suffered :(.
It is quite unfortunate that it's been only relatively recent (15 or so years) that doctors have taken a closer look at what role SI Joints may have in some people's conditions, particularly considering that the SI Joints are often where some diseases manifest first - such as with Ankylosing Spondylitis. If you or anyone else takes Amtrak for future trips, I don't know if you might already know this (and it's very possible that you and others do): Amtrak offers a discount on tickets for the disabled and also bumps the sleeping quarter size (not at an added cost for the larger space) automatically as long as it knows in advance :winky:. |
SI joint fusion
Hello everyone. I am new to this forum and am very interested in hearing about SI joint fusion. My Dr. just told me I need to have it done. Bilateral. Two yrs. ago I had Bilateral Sacroiliac joint stabilization. Did okay for about a yr. then started to experience the same symptoms as before the screws (4 titanium) were put in. Several Dr's, 2 different physical therapy groups and a chiropractor later, I think I have finally found the Dr that can help me. He has done 2 ct guided injections on me to determine if it is still my SI joint and it is, from all indications. Apparently the screws were not put in the right location to start with and that is why I am still having pain. I need to know what to expect from this surgery! I am a 57 yr old female. Have always been very active, UNTIL THIS! Horseback riding, golf, 4 grandchildren, etc. I want to have my life back if possible. Can anyone give me some idea what to expect?
SharonK |
Franck, please give me some more info on your si joint fusion.
SharonK |
Me Too!
I used to be a regular on the PN board, but this post did catch my eye. I've had SI joint problems for over 30 years. When it is at it's worst...and it is right now...I get tingling around my kneecap...outer thigh, occasional sharp groin pain...and I sometimes wonder if the toe pain I feel has been due to the SI joint dysfunction. I didn't think it could skip my leg and go right to the bottom of my toes. I ended up with surgery on both feet...suspected neuromas....and who knows....it may have been the back all along. Right now...it hurts more than it has ever. Just icing and taking ibuprofen. I know that arching my back can make it worse.
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Thanks
Thanks B for the imformation on Amtrack,i feeel this might be best
way for me and old buddy Bob to travel now. Bob fell and broke his pelvis Bone age (78) since he was in a head on collision in 96 one of his many injuries was a shattered Pelvis. They had to do so much surgery They could only find the recent broken bone with a MRI. For the last 3 months,they said no more surgery the bone had to heal on it's own. Now he has been complaining in his quiet way of pain from hip down. I been in hospital,but willl get him a steriod shot with pain meds. I come over here because i worry about him. And ther's always so much caring and information. Jack i'm sure they could help you,good luck to you and everybody. :hug: Sue |
Franck,
Thank you for posting your story about the SI joints...I did get an injection, but I am not certain the doc doing the injection used fluroscopy...I thought he did, but then was not certain that he did.... I am going to call a different facility tomorrow to ask if they do it under fluroscopy and if they do I am going to get a script for another injection. I might try an injection into both sides this time... |
Jakatak, you are the first person I ever heard of that talks of outer thigh pain. I have it all the time, if I try to walk it gets worse and worse, tighter and tighter with every step until it is almost impossible to walk anywhere anymore. I have had sacroiliac pain off and on for years. Tried looking up thigh pain with no answer yet. Does it hurt your thighs to walk? Both of mine do the same thing but one does it far more than the other. Right now I am having lots of pain trying to sleep due to the lower back pain and all the butt pain. OUGH! Tried icing and think it is better than heat. Just wish I could find a doc that could give me some insight so am going to ask my ortho about it. If only I thought I could get help for it I would be so glad. Froggie
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If you do travel - or anyone disabled travels - by Amtrak, also make sure to arrange for an attendant to do the "in-seat" meal stuff (you give the order and it is brought to you) if ordering off the "menu." Once again, Amtrak has to be made aware up-front and in advance so that there is no extra service charge applied - in addition to the cost of menu items ;).
Another tip? for train travel? Take luggage (no carry-ons) in advance. It makes it so much easier to have luggage dispatched/transported ahead of travel time. Though no mode of travel can absolutely guarantee luggage will not be lost, Amtrak didn't lose a single item when my luggage was taken in advance; I don't travel light so I was suprised when nothing was lost. My luggage arrived at my destination and was there before I got there. It was also difficult to convince Amtrak people to accept a tip; they were so reluctant but they did above and beyond, I thought. It felt as if I had to pressure them to take the darn tip :D. They treated me - and others also travelling in the "disabled/seniors" car - so well! Any probs. arise during travel, a passenger doesn't need to resolve it; there are attendants present and they take care of everything. For instance, some passengers were stowing luggage under the table where my chair was parked (with me in it; I made space for a senior traveller and gave up my passenger seat and decided to sit in my chair). The carry-ons were cramping my "zone." An attendant just relocated the luggage to the carry-on area. Sure, I got a few stares and glares, but... my footrests do need some space :). For carry-ons, I took an ice chest (food and water), computer, purse and a tote (that didn't count against the luggage criteria). Neither does a chair (power or manual). Any lengthy trip I make, I know that I'll prefer the train. It was so stress-free. (And I am a total control freak, so ... I was impressed with how smoothly everything went.) Quote:
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Thigh pain? I'd ask a doc to do a differential on whether there may be trochanteric involvement.
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Thigh pain
I must have misspoke. My pain can be very sharp on my right groin. It can occur on the outside of my left calf. I can get tingling around the kneecaps and lower leg. Right now, getting up from a sitting position is really bad. My left leg is shorter than my right do to an auto accident where I broke my left leg. I cannot rotate my left leg outward when it is bent...because the tightness in my inner thigh is so bad and it feels like it is impinging on a nerve. I wish I knew specifically what exercises I should do and avoid. My pain does ebb and flo, depending on how much backwork I do around the house.
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Obturator neuropathy?
My left groin, medial thigh and knee were causing me a lot of pain, and... then, along came the dx: Obturator neuropathy. |
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As he explained it, it wasn't until recently that doctors were figuring out the SI joint connection and assumed the pain was all because of the spine problems. I've had bilateral SI injections every year since then...painful as they are. And they've always helped. I've been in too many car accidents and suffered physical abuse at the hands (and boot-clad feet) of an ex-husband and he used to kick me in my lower back when he'd get me on the floor curled in a ball trying to protect myself. I have a feeling my degeneration started way back then...add several car accidents to that and voila. Joint dysfunction. I'm glad I saw this thread because I didn't even know about the surgery option. The SI pain is bad, but I have worse sacrum and tailbone pain. Have broken my tailbone a couple of times and fallen on it also too many times to count. Very good thread, lots of information. Thanks folks! :hug: |
Sacroliliac Joint Dysfunction
Hello,
I have been reading the threadsabout SI Dysfunction and I am happy to say that I am post SI fixation and it is 100% effective. |
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Sally,
I would not be so quick to allow removal of the hardware...I had a screw removed and it did not do much for the pain...I just had injections done yesterday...I think the injections do more for the pain than hardware removal...JMO>... |
I had an injectio that only seemed to flare things up and after a few weeks I really was no better. Now this isn't spinal hardware, this is pins though the sacrum and iliac. I know they are causing me pain when I walk.
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Hi Brendaschoenherr,
Please share who performed your surgery. I think I am going to need to have it done. I have already met with Dr. Amaral (took over for Dr. Lippitt in GA). I am not so sure about him and would like to meet with a different surgeon. Glad to hear you are doing well. Thanks, LCC Quote:
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Franck,
How did you manage "no weight bearing" on SI joints for 3 months? That is what scares me most about this surgery. How do you eat (sitting up is weight-bearing)...can you et up to use the bathroom? Please share. Thanks, LCC78 Quote:
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SI Joints
:rolleyes:Just reading all the threads about the SI Joints and was wanting to know does your pelvis tilt on any of you and cause a lot of pain. My PT told me my pelvis is tilting and she put it back and the next time I go it is back out she said it was my SIjoint.I have so much pain in it that I can not sleep,sit,stand without being in pain.
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Newcomer, thankful for the info
Hi to everyone - found you on a Google search and am thankful I found this thread.
My husband was injured in a car accident about a year ago and has suffered from chronic low back pain ever since. Based on layman's reading and doctor input, we think (but don't know for sure) that the pain originates in his SI joint. He hasn't had any diagnostic injections yet, let alone SI injections, so we're operating sort of on the fly here, but I have a handful of questions about the SI injections. For those who have received the injections, are they painful to receive? Is the relief you get from them worth the pain? How long do they last before they need to be repeated? Do you have yours done under Fluro, CT, or MRI? And if you're willing to share, what does each injection session cost on average? We're trying to manage his pain conservatively, but I don't know how much longer he can take the daily pain and disruption - if this offers relief, he may have to go this route. :( Thanks for the informational reading and for any insight you can provide. |
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This sounds like what happens to me after doing too much lifting and twisting-gardening for instance. Low back pain starts, then after a day or so moves a bit to one side. If it is not too bad, a long walk taking extra long strides can put it back in place, but failing that it is off to the chiro. Happens to me all the time. Joint actually locks up. Then you get muscle spasms as it tightens all around it, so becomes VERY painful and debilitating. Pain meds, anti-inflams, muscle relaxant and a good chiro. Walking, if you can, is very good. On several occasions I have had to stop walking, being in a spasm, and had to return home and lie down. That's when you know it's time for the chiro. Not sure if this is what he has, but worth a try. |
SI joint problems
Well my new orthopedist that had thought he wanted to take out the pins decided that it probably would not give me the results I'm praying for. An SI joint injection reproduced the pain so definitively that they feel that more of my pain is coming from the joint and not the pins. With a failed fusion and incomplete bridging, in my mind, I am seeing pieces of bone that I know is what I feel everytime I take a step. The pins are a component though. SO it sounds like no one wants to help me even the pain management people. My family MD is prescribing longacting narcotics with breakthrough medication. I work about 6 hours a day and spend the rest of my life lying on the sofa or my bed. This sucks so bad I don't know what to do. It is so painful to move around so I just don't. I know this is not the way I want to live. I live and work at one of the finest medical schools in the southeast. The doctor I work for is a pediatric heart surgeon. He saves little babies lives with little conduits that look like cocktail straws or smaller. Yet, no one can fix ONE damn bone in my body. The new orthopedist says that the joint needs to be cleaned out and probably re-fused and no one around wants to attempt that.
My life is absolutely screwed. |
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