NeuroTalk Support Groups - Sacroiliac Joint Dysfunction ?

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- - Sacroiliac Joint Dysfunction ? (https://www.neurotalk.org/spinal-disorders-and-back-pain/19219-sacroiliac-joint-dysfunction.html)

This is my 1st post so if it doesnt look right sorry, getting the hang of this site.

Sorry your going through this.

I had a pelvic and SI slip that turned into dysfunction due to a horseback riding accident. It was bad enough I had a 2 inch difference shortening one leg. It was quite painful, as im sure you are aware. Im not really sure if this would apply to you but have you tried chiropractic care and physical therapy? PT alone didnt touch it, I will admit that, but I had good luck using both. I visited the Chiropractor 3x a week for 2 months plus exercises to strenghten the muscles that would help stabilize. The only real time I have an SI problem now is during mid pregnancy but the SI belt helped even during that. They were seriously talking about the stabilization surgery for me but I wasnt so comfortable with the idea. Im glad now I didnt. Plus if chiropractic didnt work I didnt really loose out on anything. I could still have the surgery if it didnt work.
Either way good luck and I hope you get relief.

Quote:

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.

Chronic si joint pain since 2005

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. :-)

I'm going to make copies of the last few posts since they are from new members and start new threads for each of them.:grouphug:

you'll be able to find them here -
http://neurotalk.psychcentral.com/forum22.html

I feel your pain

Quote:

Originally Posted by nomorehorses (Post 522840)

I really can relate to what you're going through, especially with the SIJD. The money and time spent on doctors who really don't seem that interested is so discouraging. And when you go from a really active person to someone who feels disabled...it is hard to deal with. I'm only 4 months since the accidents and just coming to grips with how my life will change. I want to stay positive, don't we all. But some days are tough. I will just encourage you to hang in there, you have alot to deal with besides SIJD, your dad's passing, selling a home, etc. Try to do the things every day that make you feel a little better. Treat yourself here and there, we deserve it!!! And keep writing and talking about it.

Yes, I have days that I cry & don't know how much longer I can stand this pain. It is so difficult to not be able to sit for very long. I have an appointment with my pain doc tomorrow and the drive is 45 minutes to 1 hour - 1 way. I can't sit that long so I have to plan stops along the way. So it will take even longer. I'm not looking forward to it but I need to keep trying to get better. I can't sit at the computer long enough to do much research & am so glad I found this site. I will keep you informed on what I find out. I hope you all find relief soon.
Linmarie

I had some more trigger points in the lower gluts yesterday. I told the pain doc that the ischium area has been the area that is most interfering with my sitting lately. He couldn't inject over the bone but did several injections around the area. Sore from the injections but some relief. I'm scheduled for more next week. I also got a RX for the botox. He said one of his patients ordered it online and had it sent directly to their pharmacy so they could check it out. I asked if it was from Canada & he said maybe. So, I will check some of their online pharmacies. He does some nerve burning & I asked what his success rate was with the procedure. He wasn't sure but thought it might be about 60%. Too low for me to try it. If the trigger point injections don't greatly diminish this pain, I will have the botox injected into the piriformis. If anyone knows where I can order the botox please let me know.
I will keep you posted on what I am trying.
Linmarie

sijoint fixation

Quote:

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.

Hi,
I'm new at this,and I hope I'm doing this right. I would love to hear how your sijoint screw fixation went? I'm having a terrible problem with mine at this time. Just wanted to know if this type of surgery is successful and what type of problems you had that required you to have surgery. Thanks! Sharon

Quote:

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

I know it has been a while since your surgery. Just wanted to know if it was a success. I'm having a terrible time with my right sijoint. New Member Sharon

Quote:

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

Just wondering if you had the surgery with Dr. Weiss. I am a new member and just trying to get some info on this problem. Would love to hear from you. New Member---Sharon Waredell

SI Joint surgery

I underwent my first SI jointn fursion at Emory University in Atlanta in 2006. I,like every one else had exhausted every kind of option there is/was. After realizing I has (or my insurance) had spent $30,000.00 on pain management which mostly consisted of SI joint, facet joint and some disc injectionj. Theren was never any improvement. When I asked the not so nice physician (I didn't see that side of him until I started asking about alternative treatments). So I researched the radiofrequency ablations as well as the surgical options. What scared me about the ablation was the anatomy of the nerves. A large bundle of nerves run through the SI joint and the doctor I spoke with was honest enought to say that it could not be positive that you were ablating the right nerve and the end results were real iffy.

By this time I was getting real desparate. I was getting where I couldn't do my job and the thought of going out on disability was terrifying. It seens like you have to almost hit bankruptcy before youcna get any help. So to make a long story short, I opted for what seemed like a very risky surgery but I didn't fell I had any options. I just wanted my life back. So in May of 2006, I drove to Atlanta from Charleston. The staff were very pleasant, but reall thy pleasantness ended there. This was my fourth back type surgery and the pain was like I never experienced. I was completely unable to walk for about three weeks. I faithfully followed the physical therapy protcol but could never build up any strength or stamina. I went through aqua therapy which did help with regaining some stamina. But then the pain started to return. I was convinced the pain was coming from the pins in the pelvis but no real test definitively could prove that. I did have an SI joint steroid injection which suggested haloing (A signof pin mobility) My orthopedist did a CT scan and it did not show any signs of mobility. Since I was getting worse and worse, I went to a second opiniond and he agreed thatc the pins showed haloing and a year after the fujsion, very little bone growth had occurred, so I wsa actually no better than I started off.
As you know there are very few MDs who treat SI joiny dysfunction but I was luchy that I liven a citywithamedical university who just happened to have an orthopedist whose research specialty was, you guess it, SI joint dysfunction.
He agreed, rather reluctantly to attempt salvage surgery with the understanding that this was hopefully for pain relief. I probably would never be mobile nor physically as well again. There was a chance I would come out worse,better orno difference. It has been one year nor this week. He told me it would take months to a year to get better. H was right.He pulled no punched when he warned me about how much pain would be involved during recovery. He did NOT soften or talk me into this in any way.If anything he made it sound worse. So now ayear later. I still walk with a cane,probably always will. There are still some real bad days that I use the walker still. The pain is finally under control, but I still take long acting narcotics and somee brekthrough meds.I am far less depressed becauseI am finally starting to get out anad have a little fun. I takes a LOT OF MIND OVER MATTER. iF yOU ASKED ME IF WOULD GO THROUHG THIS LONG ARDUOUS EXPERIENCENE AGAIN, I
WOULD HAVE TO SAY YES JUST BECAUSE FINALLY after 2 years, the pain is controlled well enough most of the time that I have some sort of life again. I would be happy to talk to anyone contemplating this complex sugery.