SpinelessWench

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

I, too, am hesitant to reveal the name of the practice or my surgeon here, if only out of professional courtesy and ethics.

S.W., NC

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