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  • SpinelessWench
    Member
    Post count: 38

    Dr. Corenman,

    First, I want to thank you for your input and explanation regarding SI Joint Dysfunction, as well as your adamacy in exercising discretion when firming up or seeking definitive diagnoses. Just a quick update, and question..

    Yesterday, 10/18, I had an amazingly productive and educational consult with a surgeon here in NC who’s certified / trained in the “iFuse SI Joint System.” He’s performed over 40 of these procedures (MIS vs traditional anterior invasive approach), with an 85-90% success rate in patient recovery and eradication of symptoms. One of his patients, a female about my age (48), is not fusing well, and her recovery isn’t progressing as expected… He indicated he’s still working adamantly to solve her issues..

    At the clinic, he ordered standard films of just the SI joints… While SIJD is largely undetectable via MRI or X-rays, he indicated that both of my SI joints revealed deterioration and signs of “wearing out”… He conducted a ~thorough~ physical and neurological exam, and repeated the 5 provocative joint maneuvers. He reviewed every aspect of my medical and surgical history, and asked relevant and pertinent questions geared toward specifically diagnosing (or ruling out) this condition. He stated that while many patients arrive at his practice with what they suspect is SIJD, only about 25% are actually confirmed with a definitive, confident diagnosis. Upon completing his exam, he indicated with a “high degree of confidence” that my pain and symptoms are due to an advanced stage of SIJD. My prior 9 spine surgeries, which include 3 multi-level fusions, to S-1, are also highly correlated with my SI degeneration, which he said was fairly severe hypermobility dysfunction.

    I am being scheduled for bilateral fusions via “iFuse”, and will be having the first one done in about two weeks. After 6-8 weeks of healing, I’ll then be scheduled for the right side fusion.

    While a firm diagnosis was relieving beyond belief, he told me I could ride my Harley-Davidson about 3 months post-op IF I behave and follow all recovery protocol. One is to stop smoking immediately, as this impedes healthy bone fusion. He rides a Harley, so I nearly hugged him upon realizing he understood my concerns… I did, however, forget to ask him one important question:

    While I’ll be able to ride my motorcycle again 3-months post-op, how long would you recommend waiting before driving a vehicle? In my excitement about the bike, I completely failed to remember that I also drive a truck. Your input would be greatly appreciated.

    Thank you again, as always..

    S.W., NC

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    Well- I’m glad to hear you found someone you trust and has experience. Every surgeon’s protocols are different. Some require you to wear a temporary brace called a hip-spica. Others feel that just reduction of activity is enough. Part of the decision process is made during surgery. If the implants have solid purchase and the bone seems strong, there is less need to use bracing and less restrictions are necessary.

    Let the forum know how your progress goes after surgery.

    Dr. Corenman

    SpinelessWench
    Member
    Post count: 38

    Dr. Corenman,

    While at my iFuse surgical consult, my orthopedic surgeon ordered a few views of just the SI Joints themselves… He spoke with me about his impressions of the films during my clinical exam, and also included his impressions from the X-rays within his dictated clinical notes. There’s one small part of his impression that I was hoping you could explain. His notes read, in part:

    “SI joint views show bilateral degenerative changes with sclerosis, evidence of joint space incongruity, and some early suggestion of gas formation / intra-articular nitrogen.” His diagnosis and assessment reads, “Severe bilateral sacroiliac joint disruption, probably secondary to effects of previous lumbar fusion surgery … Essentially every sacroiliac joint evaluation is severely positive for reproduction of typical concordant pain, including Gaenslen’s, posterior thigh thrust, Patrick’s testing, and compression testing.”

    QUESTION: I understand everything within this assessment except for the remark concerning “early gas formation and intra-articular nitrogen” … I’m assuming from the language, there is gas accumulation within the joint spaces, but can you explain why this is remarkable, and what it means or suggests? The left SI fusion is Nov. 3, followed by the right in February…

    Much appreciated, as always..

    S.W., NC

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    Joints are typically filled with synovial fluid and are distensible. This means that no matter what the position of the joint, there is always synovial fluid that fills the entire joint. When the joint (or disc space for that matter) wears out, there will be certain positions that increase the joint space that the synovial fluid cannot fill. This will create a vacuum and something has to fill that vacuum.

    What fills the vacuum is nitrogen gas. This gas is pulled out of solution similarly to opening up a can of soda and watching the gas bubbles form out of the liquid.

    Good luck with the surgery. Please report your progress to allow forum members to see your progress.

    Dr. Corenman

    SpinelessWench
    Member
    Post count: 38

    Dr. Corenman,

    Thank you for the quick reply and answer to my question. The neurosurgeon who “caught” this by carefully listening and following his instincts will be traveling 3 hours to observe my iFuse procedure in the operating room. He’s an excellent example of a clinician and surgeon who constantly seeks to learn new techniques, and further expand his ability to care for his patients. I admire him.

    I’ll post a post-operative update on the left SI joint fusion… Now if I can only figure out how to install some chrome and a V-Twin engine on my walker.

    Continued success to you in the meantime.

    S.W., NC

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