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Hi Dr. Corenman,

This past Thursday, I underwent diagnostic testing for suspicion of SI Joint Dysfunction. All 5 provocative maneuvers on the sacral and pelvic area were positive (with the first 2 maneuvers being the most critical). The exam was actually intolerable at some points. I then underwent a bilateral SI Joint anesthetic injection under fluoroscopy, which after 10 minutes resulted in a 95% resolution of my pain. The orthopedist conducting the procedure also said that the replication of severe pain upon the needle entering the joint (especially when she introduced the dye) was another positive indication of degeneration in the joints. I told her that was just great, but that I’d prefer to not do that again for another 50 years. Or ever.

Until Thursday’s injections, I had been experiencing intractable, chronic pain between 7-10/10. Twenty minutes after the injections, I left the medical center *carrying* my cane, and walking with completely upright posture. Flexion and extension, even with my lumbar instrumentation, was both possible and painless … had there not been a good chance of the police showing up, I would’ve seriously contemplated a celebratory pole dance in the parking deck.. By 11:00 pm that night, the anesthetic dissipated, so I was back to my usual symptoms — but, that was the best 7 hours I’ve had in years.

I’m now scheduled with an orthopedic surgeon who is one of 400 surgeons in the US trained by iFuse to perform the SI Joint fusion implant surgery. He’s done a good number of these, and is highly regarded insofar as successful outcomes. In the meantime, and prior to my surgical consult with him, I had a few questions for you about the iFuse surgery, and I’d really appreciate any input or advice:

QUESTIONS:

1. I need bilateral SI Joint implants. Obviously, I’ll have one side done, recuperate, then have the other done. What is the general recovery time for an iFusion procedure? Partial or non-weight bearing? How long before I could ideally return to the classroom, stand, and lecture for about 4 hours per day? How about driving, household cleaning, and other daily stuff?

2. I’m an avid Harley-Davidson rider. Can patients return to riding a motorcycle? Harleys are notoriously high in vibration… will this be a risk?

3. After bilateral SI implants, how is ROM affected?

4. My right leg is 3/4″ shorter than my left. I’m assuming this is due to the pelvic, lumbar, and sacral ligament complex having to compensate for numerous lumbar fusions. During the iFuse surgery, does the surgeon adjust for this? If the sacrum is subluxed or otherwise out of position, is there a process for realigning those joints prior to fusing them into place? If the sacrum or pelvis is torsed or out of position, will that be corrected in the O.R.?

5. After a bilateral iFuse on a patient with lumbar instrumentation to S-1, what kind of PT, if any, could be recommended to prevent atrophy of the muscle and ligament structures in the lumbosacral and pelvic regions?

The initial recovery protocol is my main concern… I’ve read next-day partial weight-bearing, to partial weight-bearing for 3-6 weeks, and I’ve read non weight-bearing for up to 12 weeks. What’s the truth on this? Will I need someone with me constantly for the first few days, or weeks, or not at all?

Thanks for your help, and time…

S.W., NC

Thank you Dr. Corenman for this invaluable website for people like me thats been suffering for years of debilitating back pain. Been lurking around here and finally posted something . Not a stranger to back problems, having it for the last 25 years off and on. Seven years ago, I was diagnosed with a DDD. Epidural injections are the only thing that works for me. I get it about once a year (series of 3 shot), it gives me about 10 months to about a years worth of pain relief. I got 2 MRIs total, heres the latest.
MRI FINDINGS
Degenerative disc disc is present at L4-5. L4-5 contains a small posterior annular high intensity zone. Disc height loss is most prominent at L5-S1 whre discogenic endplate changes are present. the vertebral bodies are maintained in height and allignment. The conus is normal caliber and signal.

At L2-3,L3-4 and L4-5, there is no significant central canal or neural foraminal narrowing.

At L5-S1, a 5-6 mm right paracentral disc protrusion causes narrowing of the subarticular right lateral recess and probably abuts the traversing right S1 nerve root. There is no significant neural foraminal narrowing.

Doctor Corenman in your experience, would it be the size alone be indicative of a microdiscectomy?. The reason I ask is, the ortho that i saw 7 years ago did not want to operate because it was a small herniation(5-6 mm). In hindsight I’m kinda happy he didn’t operate on me right away. Secondly, How safe is epidural to your spine? I’ve been doing this for the last 7 years (21 total shots to the back) so far been lucky that it’s still working and the only thing that works. I get the L5-S1 transforaminal epidural to the right and sometimes bilateral.Thirdly I’m considering surgery (microdiscectomy) , The thing that stop from having one is that I read somewhere that microdiscectomy is not indicative for back pain but for leg pain. Is this true compared to your experience? My pain is in mainly the buttocks, lateral to my sacrum. I also lean to my left side about 25 degrees and and bend forward . Recently, I’m having a very little foot numbness. It’s the lateral side of my right foot, and sometimes when i wear socks I would feel my pinkie toe having a little spasm, very minute no pain at all, Back 100% Leg 0% (Pain distribution). Dr. do you think my L4-L5 is also a pain generator by just looking at the MRI results? When I get this episode of flare up because of the cortizone wearing off, it’s a hellish life. I’ve been very good with timing it . When I feel it coming, I’ll just call my pain management office and schedule for some shots. I can’t keep doing this forever tho. Dr. do you think I will benefit from a microdicectomy. My family, friends tell me not to have surgery because I will get worse,but there not the one living with this pain. By the way Dr., I have not seen any spine specialist since 7 years ago. Sorry for this long post, hope I don’t bore you with my life story. Thank you for your patience and thank you also for a speeedy response.