Originally Posted by SallyE5756 (Post 264033)

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.

Originally Posted by lcc78 (Post 274636)

Hi Sally, Just want you to know you are not alone. No
ne quite understands how debilitating this SI Joint Dysfunction is....not even people with disc pain. I WISH I had a herniated disc that could be "fixed" with a simple, well-known surgery. I am tying to heal without fixation or fusion surgery, but I am certainly not counting it out. It has been a year and half of sheer hell for me. I have been undergoing prolotherapy treatments which do help: (it's prolotherapy.org) . but I belive my pelvis is twisted pretty badly out of place and keeps losing its correct positioning. Don't give up. There is a doctor out there who will help you. Please email me if you ever feel like chatting. I would be happy to let you in on all my "research" findings. I am currently wearing an SI belt that is great: it's .
I definitely feel a lot more stable with it. Don't give up. I have felt like throwing the towel in more than a few times so I know how you feel. I know I will never be the same as I was, but I do have hope for a "somewhat" normal life again.

Originally Posted by Dee911Lady (Post 278982)

Sally, I have heard that the Dr in Atlanta that does the SI Fuisions in Atlanta only uses one screw to hold them in place. There needs to be at least 2 screws to give it stability from what I have read.

I'm so very sorry that you went through all the pain of surgery and it didn't work and now facing surgery to have the pins removed.

Originally Posted by SallyE5756 (Post 274656)

Thanks for the support and you are absolutely right. People don't understand that it isn't just a bad back. Right now I am still unsure what to do. The fusion failed and it appears the pins are moving. I really don't plan on going back to Atlanta for a repeat however when it gets real bad who knows. My family MD is angry that I won't go back to Atlanta. I told him the worse case scenario is that I'll show up at ER door and the orthopedist here will have to remove these damn pins. Started a new long acting pain med yesterday, Opana ER. Seems to be working.

Originally Posted by SallyE5756 (Post 264033)

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.

Originally Posted by lcc78 (Post 284565)

I called the Gainesville GA PT office to make a phone consultation appointment with Vicki Sims (I want to ask her about her expereince with Doppler imaging since no standard imaging shows torn ligaments in the SI region). I was informed by the woman Claudia who made my appointment that Dr. Lippitt is assisting in surgery with a Dr. Weiss in Gainesville. I just about cried tears of relief/happiness. There is another surgeon out there who is an expert in SI surgery AND he is in the OR with Dr. Lippitt's assistance. I am giving prolotherapy a few more months and then flying out get the surgery.
Sally, maybe this is the answer to our prayers!

Originally Posted by machoochoo (Post 429345)

This is my first post so, pardon my inexperience. I've been having SI joint pain since I fell on the ice two years ago. I've had trigger point injections in my right hip, pt, two sij injections. The injections each relieved the pain for a day and then it's back to the burning and deep aching of the rear. My neurologist thinks its time to consider surgery. I can't believe this has so taken over my life. Those of you who've been through the surgery, what am I in for? Would you do it again? I can't believe the symptoms that are caused by this, but I'm definitely ready for some relief.

Originally Posted by kaydee (Post 427184)

Hi. I'm new to this forum. Did you end up having surgery with Dr. Weiss? I have an appointment scheduled with him in early Feb. Hoping someone can tell me a bit about their experience with him. I've had chronic low back pain for past nine years and was recently told I have significant degeneration of SI join and will need SI fusion for pain relief. I've tried PT (x3) , injections, prolotherapy, chiropractic, accupuncture, massage. You name it, I've done it! Anyway, was thrilled to find this forum.

Originally Posted by nschoony (Post 434147)

Hi. I am sorry to hear about your pain. I also have been experiencing SI joint pain for about 4 years. I live in Ohio and have traveled all over Ohio to physicians and even to Chicago. All of my diagnoses were degenerative disc disease based on MRI results, but every doctor said the pain I was having was not indicative of DDD and that I was too young for surgery.

Finally, a local physiatrist sent me to Toledo Hospital to see Dr. Ebraheim. He is awesome. I have worked with him for about a year and 3 months. He did not jump into surgery given my age. He worked with me and his pain management colleagues using various pain management techniques. I got relief for about 3 months at a time. These were all good diagnostic tools and it was great to get a little relief. Finally, he said I was ready for an SI joint screw fixation.

I just had the surgery last week. I am still a little sore, but I am up and weight bearing. I know it will take awhile to know if this has been a success, but I am confident and hopeful. I want my life back too. I go back to see him on Jan. 3rd to get my physical therapy, recovery, and activity protocol. I am so hoping that I will be able to return to my morning walks.

His name is Dr. Ebraheim and he is with the University of Toledo Medical Center.

Good Luck!:)

Originally Posted by aussie (Post 435758)

Hi all im new to this so excuse me if i stuff up, im an Aussie and im coming to Utah in Feb 09 i think i have SIJ Dysfunction no one in Australia seems to know much about it, and im looking for a Physical therapist in Salt Lake City who is experienced in SIJ problems any help much appreciated it has been 9 years of hell ive had L4/5 and L5/S1 fused and it hasnt helped at all.:(
but im not giving up no way.........

Originally Posted by kaydee (Post 453229)

Aussie: Hi. Sorry for taking so long to get back to you. I have seen three physical therapists in the SLC area and did not find one who helped me.

I would recommend that you try to get an appointment with Vicki Sims at Gainesville Physical Therapy in Gainesville, Georgia. Phone: 770.297.1700.

Vicki is supposed to be the best in the U.S. and also works with a surgeon (Dr. Weiss) in the area who does SI fusion if needed. I will be traveling to see both Vicki and Dr. Weiss in a couple of weeks. I would be happy to fill you in following my appts. with them.

I'm so sorry you had those spinal fusions with no relief! I've read that it's common for people with SI joint degeneration to also have compression at L4/L5/SI. I guess when the SI is really off, it also throws the alignment of the spine off. My last doc here had been treating me for compression of the L4/L5/SI and I was considering surgery. But, a recent x-ray showed significant degeneration of my SI joint.

Best of luck to you. I too have had this problem for a long time and refuse to give up!!

Take care!
Kaydee

Originally Posted by GJZH (Post 249558)

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>...

Originally Posted by nicki (Post 492451)

JMO,
I read about you going to Dr. Donnor in Loveland, CO. One question on the MANY that I have as I am considering ther surgery is did you have to fly home? I would have to take a flight and cannot figure out how to not put any weight on the area as I try to get home. Also, how long was the recovery? I have such a similar case as yours and have been considering the
spinal cord stimulator instead of the surgery. One reason is because I have been diagnosed with so many things that I am not sure that the surgery for my SI joint will even help. I do have pelvic pain from my pelvis being tilted forward and my hip is raised up on the right making my right leg shorter. Does the Dr. set your joint before placing the screws in place? Also, I think that they will have to use bone to graft my joint instead of just placing the screws. Did you just have the screws to keep your si joint from moving? I
know that everyone is different, but when I read your info. I was taken back
like wow that is me. I have had disk surgery, been told that I have DDD, and facet arthritist. All along I kept saying well that may be true but the pain seems to be coming from my SI joint moving. It feels like it rides up on my L5 SI nerve in the spine and causes unbelivable 10 plus pain. I really appreciate you taking the time to answer my questions. Not sure if I can face this big of a surgery after everything else that I have been through, but since I have very little quality of life it might be worth a try. One last question.... did the SCS help with your SI Joint Pain? Thanks!

Praying for Answers, Nicki

Originally Posted by GJZH (Post 98728)

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.

Originally Posted by nomorehorses (Post 522840)

Good morning everyone! I will be 54 in Dec. I fell on the basement floor (wet floor and bare feet) and as my backside hit the concrete full force, my lower back also hit the last wooden step in March 2005. My life has changed drastically since that day. I used to ride horses, swim, garden and have a job. Now I am about useless. I have taken care of my dad for the last 7 months and he has recently passed away from brain cancer (May 18) This took a toll on my back as well as emotionally. Since 2005 I have seen a total of 13 Doctors and Chiros. I have had therapy/water therapy (I still do exercises every day) si injection (lasted 4 days) spinal injection (lasted 2 weeks) thousands of dollars in Chiro adjustments and last month I was on the Medrol pack which ended with me in the ER. I have taken no pain medication this entire time until the newest Dr recently put me on the Medrol and a muscle relaxer (Xanax) for muscle spasms and I have stopped both since they made me sick and a little crazy. Ultram took the pain away but made me sick as well. I am in the city now getting my father's Condo ready to sell. My husband and I are now talking about selling our farm and moving back closer to the city so I can continue with treatment here. My question is what do I do next? I am afraid of any kind of surgery which will make it worse and THAT I could not tolerate. I have had terrible headaches since I was 12. The day I fell, the headaches stopped and the tailbone/sciatic pain started. Go figure? I have also changed mentally since the fall. I never used to be afraid of anything, my husband and I used to fish on the river all the time. Now I am petrified of water and crossing bridges over water. My horses are now pasture ornaments. My husband doesn't know who this new person is and frankly, neither do I. I HATE it! Sorry to make my first posting so long but I am in real need of advice. I have been alone at my father's Condo since Dec 1, I cry everyday from the pain and frustration. My husband is back at the farm (2 1/2 hours away) taking care of my horses and dogs and working his regular job. I try to think of other people who have it worse than I do, but I am SO tired of fighting pain since age 12. Again, sorry to make this post so long but I am looking for advice and maybe a miracle. :-)

Originally Posted by just drea (Post 450827)

WOW..small world I began seeing Dr.Ebrheim in Oct 08..and I agree he is wonderful, and has helped my tremendously! I would love to share your fusion experiences..as I may end up getting that done.

Originally Posted by SharonK (Post 104687)

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

Originally Posted by mbhall99 (Post 462436)

I am so happy to hear that you all are talking about SI joint dysfunction. It is true that the general medical community knows little about the disorder. I have had severe problems for 4 months, and have been practically bedridden. I have been through all the tests and traditional and holistic treatments with limited success. I currently go to Body Mechanics PT in Atlanta which Vicki Sims co-founded but have never been treated by her. I have been going to PT for 3 months and have my first appointment with her tomorrow Jan 9th to discuss surgery. I cannot live like this anymore! I would love to know and share any experiences with Vicki and Dr. Weiss regarding surgical treatment.
Thanks
Melissa