Failed SI Joint Fusion

Tagged: SI joint fusion failure

Viewing 6 posts - 1 through 6 (of 6 total)

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staciela
Participant

August 19, 2019 at 12:06 pm

Post count: 3

#30920

Hi Dr.Corneman.

I have had low back pain for years. I have had to have both hip labrums replaced, which took care of some of the pain. However, my left side pain continued to get worse. After many tests (CTs, MRIs, xrays, test to also see if radiofrequency ablation would work and it had a failed result), my left SI joint was fused. The fusion worked great for the first 5-6 months after which the pain returned. I am 13 months post fusion and the diagnosis is a failed fusion as the MRIs have shown “no evidence of bony fusion”. The pain is worse than before the fusion and is getting worse. I have had to resign my teaching position and I have no quality of life. I can not sit in a chair or stand for more than a few minutes before the SI joint starts to get painful.
Over the past month, I have had 2 coudal injections with no relief. My dr (pain specialist in Fruita, CO) is telling me my last “Hail Mary” is to have a spinal cord stimulator implanted.
While his office is working on insurance approval, I was referred to you for a 2nd opinion. Is there anything you could do to help a failed SI joint fusion other than a SPS?

Donald Corenman, MD, DC
Moderator

August 21, 2019 at 5:11 am

Post count: 8660

#30938

Generally, spinal cord stimulators are not too effective for sacroiliac pain. They are more effective for nerve pain (leg pain). I hope you have had a CT scan as an MRI is not a great test to indicate fusion status. Depending upon the technique used to try and obtain fusion of the SI joint, you might be a candidate for a fusion revision.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

staciela
Participant

August 21, 2019 at 11:23 am

Post count: 3

#30942

Thank you so much for your reply. I have had a CT scan and it also said, “no evidence of bony fusion”. Do you perform SI fusion revisions?

Donald Corenman, MD, DC
Moderator

August 23, 2019 at 7:57 am

Post count: 8660

#30955

I have performed SI fusion revisions but it depends upon the original technique used and failure mode of the pseudoarthrosis.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

staciela
Participant

September 27, 2019 at 10:56 am

Post count: 3

#31202

The original technique was a iFuse Sibone implants. I have 3 implants on my left SI joint. The surgical technique was closed technique.

MRI results date 7/9/19:FINDINGS:Three internal fixation screws bridge the left SI joint. These do produce moderate metallic artifact. Portions of the SI joint which are visualized without artifact appear normal. No evidence of bony fusion. No abnormal signal present within the osseous elements. No edematous change or evidence of inflammation within the SI joints. Joint spaces within the hips appear relatively well maintained. No mass lesions or abnormal fluid collections. Soft tissue structures appear unremarkable. Uterus appears surgically absent.

CT results date 4/22/19:CONCLUSION:1. Three fusion devices bridges the left SI joint. No definite bony fusion. Findings similar to 11/23/2018.Dictated by: Charles Fowler M.D. on 4/22/2019 at 10:28

MRI results date 12/31/19:
FINDINGS:PARASPINAL AREA:New postsurgical hypointense metallic artifacts from hardware fixation device about the left sacroiliac joint. No marrow edema or fluid signal is seen about the SI joints or in the adjacent bone marrow. No definite fluid within the sacroiliac joint. Right SI joint is normal. No marrow edema to suggest a sacral insufficiency fracture or stress reaction. The metallic blooming artifacts abut the lateral margins of the left sacral neural foramina but the exiting nerve roots appear unremarkable. On the prior CT exam, the sacral neural foramina appear intact. Paraspinal soft tissues
unremarkable. No soft tissue fluid or edema. The gluteal muscles appear normal in size signal and bulk. No fluid collection or soft tissue edema.BONES:Bone marrow signal is maintained. Normal alignment of the lower thoracic and lumbar spine. Vertebral heights maintained. Intervertebral disc spaces are within normal range. Minimal degenerative endplate osteophytes throughout lumbar spine. No suspicious marrow signal abnormalities.CORD/CAUDA EQUINA: Normal caliber, contour, and signal intensity. Conus lies at the L1 level.
LUMBAR DISC LEVELS:L1-L2:No significant disc/facet abnormality, spinal stenosis, or foraminal stenosis.
L2-L3:Mild disc bulging. Normal facet joints. No canal or foramen stenosis.L3-L4:Unchanged minimal disc bulging. Small posterior annular disc tear without change. Mild facet hypertrophy. No canal or foramen stenosis.
L4-L5:Left laminectomy changes. Mild facet hypertrophy. Small left facet effusion. No significant change. No disc protrusion. There is unchanged mild left foraminal disc bulging. Mild left foramen stenosis without change. No nerve root compression seen. Normal right foramen.
L5-S1:Unchanged mild posterior disc bulging and small posterior annular disc tear. No new disc protrusion. No canal stenosis. Mild bilateral facet hypertrophy. No joint effusion. Normal bilateral lateral recesses. Both neural foramen are normal. The exiting L5 and S1 nerve roots appear intact.

CONCLUSION:1. Lumbar spine shows no significant change.2. Mild degenerative disc bulging with small posterior annular disc tears at L3-4 and L5-S1. Unchanged.3. No canal stenosis.4. Unchanged left foraminal disc bulging at L4-5 with mild left foramen narrowing. No nerve root compression or displacement seen5. New postop changes of left SI joint fusion. Sacral neural foramina appear patent.6. No abnormal fluid or marrow signal abnormality about the sacrum or sacroiliac joint.

Is there any possibility that you would be able to help? I have SI bone pain and some nerve pain that is in the low back, butt area, and down the leg.

Donald Corenman, MD, DC
Moderator

September 28, 2019 at 8:44 am

Post count: 8660

#31203

Taking the “SI Bone” fusion devices out can be very difficult as these devices have bony ingrowth surfaces. Even if one side does not fuze (let’s say the sacral side is loose), the other side can bond to bone and these interfaces can be quite resistant to removal. If the end of the device is not prominent and also buried in iliac bone, it is especially much harder to remove. Call my office and talk to Lori about sending the CT scan for me to review.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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