Originally Posted by GJZH

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

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

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

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

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