Failed SI Joint Fusion

///Failed SI Joint Fusion
Failed SI Joint Fusion
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  • Avatarstaciela
    Participant
    Post count: 3

    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?

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7058

    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.
    Avatarstaciela
    Participant
    Post count: 3

    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?

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7058

    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.
    Avatarstaciela
    Participant
    Post count: 3

    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.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7058

    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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