BettybMemberJanuary 17, 2013 at 11:45 pmPost count: 2
Hello Dr. Corenman, I have several things wrong with my spine but I will keep this short. My first surgery, a laminectomy, L5-S1 was done 9/08. Shortly thereafter my disc ruptured. This led to an L5-S1 fusion in 2/09. Next surgery was 9/09 – right SI joint fusion. This fusion failed and in 9/10 I had the iFuse surgery to the same SI Joint. I had no pain for the first 15 days. I followed post op instructions to a T. It’s over 2 years later I am in more pain now than I was before the SI joint surgeries. A couple of months ago I had another Cat Scan and Xray and it showed the pins were still stable. I am currently enrolled in a pain management program however I have problems with discs in my thoratic spine that prohibit me from doing many of the exercises for my lower spine. I can barely move as the pain in my right SI joint is so severe. I have tried many things, most recently acupuncture, physical therapy (again), Tens unit, etc. and while it’s too soon to give a fair report on the acupuncture, I feel so much worse after the physical therapy. My physical therapist uses ultrasound and massage and I can barely move for days, sometimes weeks afterwards. I am at my wits end. Nothing I do improves my pain, it only makes it worse. Do you have any suggestions? Thanks. SusanDonald Corenman, MD, DCModeratorJanuary 18, 2013 at 11:32 amPost count: 8460
First-is your L5-S1 fusion solid? If so, was that proven by a CT scan or by standard X-rays?
Second, how was the SI joint demonstrated to be a pain generator? Commonly, the SI joint is a referral point for radiculopathy. Did you have SI blocks and also nerve blocks of the lumbar roots prior to the SI fusion?
How was the first attempt at an SI fusion carried out? How do you know the “pins” of the Ifuse procedure are stable? They may be “stable’ but they really need to be incorporated. Does a CT scan demonstrate that?
Where is your pain now? Where does it radiate? What makes it better and worse?
There are many unanswered questions. The more thorough you can answer these questions, the better an understanding can be gained of the pathology.
Dr. CorenmanBettybMemberJanuary 20, 2013 at 9:53 amPost count: 2
Hello Dr. Corenman, Thanks for replying. It seems the L5-S1 fusion is stable with bone growth according to x-rays and a CT scan. As for my SI joint, over the period of 8 years or so I have had upwards of 17 SI joint injections under fluoroscopy and Cat Scan with 75 percent relief for 6 to 8 weeks. I have had other cortisone injections at other locations in my spine as well with little to no relief. After my L5-S1 fusion, even though I got relief from the injections I felt I had way too many and when my spine surgeon said he could help, I didn’t think twice. He did a few in-office tests like moving my leg, etc. to determine that indeed a fusion should work to help with the pain. 8 months or so after the first SI joint fusion, I was in quiet a bit of pain so I had another type of scan done. The scan showed only minor bridging with no other bone growth – failed fusion. That SI joint fusion was done with 2 screws. Since it had been 8 months my surgeon felt that it was not going to fuse on its own, which is why I had the iFuse surgery done in 9/10. I had a CT scan in May of 2012 and that scan report stated that there was no significant change and pins were still in place. I am not sure what you mean by incorporated so I am going to pull out my medical report of that scan to see if anything like that is mentioned. As for the pain, at times it does radiate down my leg to just above my knee. It hurts when I turn, it hurts when I sit, it hurts when I walk, etc. Ice helps as does pain medication but that’s about it. Lying down and exercise aggravates my entire spine. I have problems at T-8, T-9, T-11, T-12 as well as L4 and when lying on my back I get electrical shocks and knife blade pain in my thoracic spine, with nerve pain radiating around to my abdomen. My concern is that I will have to live with this SI joint pain for the rest of my life and I’m told that now the injections aren’t even an option since I have hardware in that joint. Hope this gives you a better picture and answers to your questions. Thank you. SusanDonald Corenman, MD, DCModeratorJanuary 20, 2013 at 7:51 pmPost count: 8460
By your description, the SI joint has failed to fuse. The IFuse device is designed to have the bone grow directly into the metal “pins”. After this ingrowth, bone should grow across the joint first at the area where the pins cross and then at other areas.
The CT scan should show bone growing directly into the edges of the “pins”. If there is any evidence of a halo around the pins (an area of thin black space outlining the pins), this indicates these pins are loose and the fusion attempt has failed. If the fusion has failed, you will need a revision.
The pain in the thoracic spine is probably not related to the pseudoarthrosis of the sacroiliac joint.
If the SI joint fusion has failed, there are surgeons who are good at revision of the failure of the SI joint fusion. Search around for someone in your area to determine who you would want to garner a second opinion.
- You must be logged in to reply to this topic.