[SpinelessWench]

#7480

Hi Dr. Corenman,

I’m 2 1/2 weeks post-op from my left SI Joint procedure utilizing the “iFuse MIS System”, and wanted to send you a quick update and summary of the experience. Beforehand, I wanted to thank you for fielding several questions I had regarding SIJD, as well as the “iFuse” procedure. Given this technology is rather new, and not many patients have had this surgical option available to them, I hope my update can also help SIJD patients in better understanding the protocol.

My SIJD is severe, but the left joint was in the worst shape… So, the surgeon recommended fusing that side first. The entire surgery took almost two hours, under general anesthesia, and with me positioned prone on the table. The fusion “implants” are titanium, 3-sided rods with a porous plasma surface to facilitate arthrodesis of the joint. My fusion involved using three of these rods, which is fairly standard for a “normal sized” patient. The rods (30-35 mm) are emplaced through a 3-inch incision over the hip / upper buttock area, and are positioned with the aid of fluoroscopic guidance. Care is taken to avoid encroaching on the S-1 nerve outlet, and the incision is closed with Vicryl and standard external staples (about 6 or 7).

The surgery requires a 1-night’s stay in the hospital. Patients are released with strict limitations … Non-weight bearing for 6 weeks, then weight-bearing as tolerated through 8 weeks. You’re either sent home with crutches or a walker, and believe me, if you put weight on the operative side, you’ll know it. Post-operative pain is adequately managed with Percocet (2 every 3-4 hours)… I can already detect an improvement in the joint itself… While I have post-op pain, the joint feels more stable, and the severe, intractable pain is eradicated. My attending surgeon has performed 51 of these surgeries, with a high degree of success so far. I can honestly tell you that this surgery was both necessary and a smart decision… My quality of life was taking a nosedive fast. The right side will be fused in late January, once I’m capable of full weight-bearing on the operative side.

If I had any advice for candidates for this surgery, I’d say “follow the surgeon’s advice and don’t get cute with doing too much too soon”… A stable, solid fusion is what you’re needing, so making sure to keep your foot off the floor is undeniably important.

If anyone here on the forum has a question about “iFuse”, I’d be happy to give them a patient’s perspective of the surgery and recovery. It’s made a huge difference in my life, so far…

Thank you again…

S.W., NC

[Donald Corenman, MD, DC]

#7482

Thanks for notifing us about your recovery. Please keep us up to date every four weeks to let us know how you are doing.

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.

[K_Mom]

#7702

Dear Dr Corenman,
I am 5weeks post-op of the IFuse procedure.
I have read and re read everything that I can find about what to expect after the IFuse.
So many people post that they have noticed an improvement of some kind.
I have yet to read about anyone worried that the procedure didn’t work. I have followed my
Surgeons instructions to the T . I lay in bed and crutch around as much as possible to keep strong but I can’t sit down for more than 5 minutes at a time without freezing my butt/hip with an ice pack.. The pain has not improved at all. Will that just take time? Do you think that will improve? I can’t lay on my back without ice and pain med, however, at night I don’t take any pain meds and I wake up on my back pain free. As soon as I wake up enough and my muscles start to tighten up the pain starts in. I have lots of questions but I will stop for now. Any help you can give will be greatly appreciated.
Thanks, K_Mom

[Donald Corenman, MD, DC]

#7715

In my opinion, you need to have three months to really know how effective the IFuse procedure will be. You typically should feel better at this point but don’t be disappointed as there are patients who recover more slowly than others. What does your surgeon say about your progress?

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.

[K_Mom]

#7731

Dr Corenmen,
My Surgeon said the same thing that you said.
That I really need to wait longer and be patient.
I’ve just read so many stories that seem to show
a very quick recovery. I’ll try to stay positive.
Thank you,

[SpinelessWench]

#8257

Dear “K_Mom” and Dr. Corenman,

I logged in to provide another update on my iFuse procedure, and upon reading K_Mom’s posting, I’d like to include her in this message — perhaps something I include in my update will benefit her insofar as her concerns over a slow recuperative process.

I had my first iFuse SI joint procedure in early November, 2012. My surgery went smoothly, and after a one-night’s stay in the hospital, I came home to recuperate. I followed my surgeon’s postoperative directives to the letter — toe touch non-weight bearing for 5-6 weeks (crutches or a walker), then applied weight as tolerated. I had the usual postoperative discomfort for a few weeks, then it slowly dissipated and resolved after about 6 weeks.

In early February 2013, we fused the right SI joint. Again, everything went well, and I was released after an overnight stay. When I arrived home, it was snowing, so we took every precaution to make sure I didn’t slip or fall. Although we tried to be careful, my right crutch slipped out to the right, and my right leg (which had just been operated on 18 hours before) adducted… I stepped hard off the walkway, about 8 inches down, and heard two “pops”… I called my surgeon given the extreme pain I was experiencing, and he immediately prescribed a 7-day steroid dosepack to reduce any swelling. He advised me to call back if I wasn’t improving in 3-4 days. I called back, and was advised to come in for X-rays, which revealed 2 (out of 3) displaced titanium bolts. The top bolt had actually broken loose from its drilled port and was shoved forward into the S-2 nerve outlet, completely crushing the nerve. We scheduled yet a third surgery to back the displaced bolts out, thus relieving the S-2 nerve.

Needless to say, this unforeseen accident and subsequent third surgery to repair the bolts has delayed what was likely to be a normal recovery. The repair surgery was on Feb. 28, and I’m still experiencing discomfort. However, it’s to be expected due to the S-2 nerve undergoing such a traumatic impingement.

K_Mom, here’s some advice (supportive comments) that may help… If you’re still experiencing pain that you feel isn’t the expected, usual postoperative pain, have a candid discussion with your surgeon. Has he obtained postoperative X-rays to evaluate the placement of your implants? Sometimes, albeit rarely, a bolt can be slightly off center, or was drilled in a tiny bit too far… If that occurs, and the bolt (implant) is impinging or touching your S1 or S2 nerves, it can cause discomfort. This could be inflammation around the nerves, and maybe a steroid dose-pack would help. Is the pain isolated around your incision site, or does it radiate down the thigh or into your leg? And most importantly, is the pain you have now *identical* to the pain prior to your fusion? If not, you may have something else going on underneath the original problem.

Be patient… I’ve had both sides fused, and ideally, each one takes 26 weeks to ~fully fuse~ and return to some semblance of normalcy. Every individual heals at a different rate, in different ways, and with different results. Don’t be discouraged when you see others posting about their miraculous recuperations, or their ability to run a marathon the day after surgery. I can attest to the fact that one side of your body will heal differently than the other… My shoulders have both been operated on (twice on each side), and the right side has never been as good as the left. My iFuse surgeries were the same… My right side is healing more slowly than the left, which is largely attributable to the broken bolts from my hard landing.

If you’re still miserable after this many weeks, I’d revisit the surgeon and request a re-exam of the operative site. The muscles around a fusion site are also key here… Since the surgery renders a part of your body immovable and completely stable, those surrounding muscle groups aren’t active anymore. Your muscles thus atrophy, or shrink and deteriorate from not being fired. Muscle spasms occur, and the nerves that travel through those strands of muscle become entrapped and painful.

If I’ve misspoken here, I’m sure Dr. Corenman can correct me… A slow recovery is frustrating and can lead to depression and a sense of despair. Don’t let yourself get to this point, so see your surgeon and TALK to him or her. Write down all of your symptoms, and ask that all of your questions be addressed before the surgeon leaves the room. A positive attitude does wonders.

Good luck.

S.W., NC

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