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Forum LockedSacroiliac Joint Fusion or What?

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Quaver View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Quaver Quote  Post ReplyReply Direct Link To This Post Topic: Sacroiliac Joint Fusion or What?
    Posted: Oct/05/2011 at 12:49pm
Hello Dr Barone,
 
I had double level fusion L4 L5 and L5 S1 in April 2008. In November 2010 I was sitting on a shower seat which broke and I hit the ground hard (I am not especially heavy, the seat was defective) I was Xrayed but the fracture in my L2 was overlooked by A & E (Emergency Room). That healed badly and caused an L bend in my spine. I know that this has upset my saggital balance and that my sacroiliac joints are under extra pressure. My mother also had problems with these joints so I may well have a congenital problem, but my recent MRI showed nothing significant in them.
 
Recently I did an exercise which involved lying on my side and lifting both legs together, laterally. I could barely do it on the right and couldn't do it at all on the left but tried very hard. The result was agony! It has settled a bit and I have now been prescribed diazepam which helps but they are still very sore, particularly in the evening and at night. My low back is also worse than usual. I am on Transtec Patches, 70 mcg and oxynorm 10 mg 3 times a day, 4 when my back is particularly bad but I try to avoid a 4th one.
 
My neurosurgeon has suggested sacroiliac joint fusion. He has also implied that a re break and repair to L2, then fusion from there to L3 and L3 to L4 resulting in my being fused from L2 downwards is probably inevitable. He has also offered to do discography to find out whether I am still getting pain from the remnants of my L5 S1 disc which he couldn't get at during my very lengthy posterior fusion operation. If there is still significant pain which wouldn't surprise me, then an anterior fusion of L5 S1 is indicated, I have many abdominal adhesions already so that would be an unlikely operation for me to go for.
 
My neurosurgeon and I agreed that unless I am prepared to seriously consider surgery there is little point in my seeing him. I get on with him very well and respect him very highly. He is an eminent man. I will go for a consulation in a few months as I go once a year. Can you offer me any advice or suggestions? I can barely walk a quarter of a mile due to pain. I am 54 years old.
 
Best wishes,
 
Quaver
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Severe back pain since 1997. Lumbar Spinal Stenosis, Scoliosis, DDD. Hashimoto's syndrome, Depression, High Blood pressure, Fibromyalgia, Raynaud's Syndrome. Severe chronic pain in lower back, hips and knees. Osteoarthritis in spine, wrists and hands. Golfer's Elbow. Facet and Sacroiliac injections Dec. 2007, aggravated entire spinal column. L4-L5 L5-S1 spinal fusion plus cage support and titanium spacers April 2008. Facet and Sacroiliac Injections May 2009 allergic to injection medium. Radio frequency June 2009 aggravated entire spinal column. Undetected fracture in L2, Nov 2010, caused L bend in spine more pain. Bilateral trochanteric bursitis. Mobility diminishing now wheelchair user.
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tkay View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote tkay Quote  Post ReplyReply Direct Link To This Post Posted: Oct/05/2011 at 7:50pm
Hi Quaver.
 
Good question.
I am sure Dr. Barone will be along soon to answer your question and comment.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote DrBaroneDC Quote  Post ReplyReply Direct Link To This Post Posted: Oct/06/2011 at 2:30pm
Quaver

This is a little difficult to advise on, because I really feel in this situation I would need to actually evaluate a patient before I could help make a true recommendation as to whether further fusion is needed at this time. A lot has to do with the integrity of the neurologic structures, overall functional level, ligament stability, and pain generating structures.

I do not want you to use the exercise you were doing which set off the discomfort, and its subsequent pain, as a reason to have your SI joints fused. The exercise you described is one that i would not recommend for someone with back problems unless they are very advanced in terms of core strength. I see people trying this one (or instructed by a therapist to try it) and they flat out do not have the baseline strength to do it correctly. until your other core muscles are strong and can fully support the spine during such an exercise, there is no need for it. Many other exercises exist to target those muscles and you should not need to strain at all to work them. (sorry for the rant)

If you can avoid fusion (especially SI joints) I think you will probably be happier in the long run. With the lack of MRI evidence that there is any significant injury to that joint (not belittling your pain) i would try to avoid a surgery on it. As for the upper lumbar spine, without seeing x-rays to show how much shifting has taken place, its impossible for me to say whether it is reasonable to do that one either. I would say that if the neurologic structures are in tact and the spine is stable, i would stay away from surgery as long as possible because you are still young.

how much pain were you in before the incident with the exercise?
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Quaver View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Quaver Quote  Post ReplyReply Direct Link To This Post Posted: Oct/07/2011 at 4:59am
Hello Dr Barone,
 
Thank you very much for your lengthy and considered reply. My pain levels are up and down all the time but my mobility has diminshed greatly since the fracture in the L2. Your advice is basically the same as that of my own neurosurgeon and also my own preference.
 
My neurosurgeon only said that if the pain in my sacroiliacs didn't ease that fusion is the only suggestion he has. You will not know of course, that steroid injections or nerve blocks aggravate my pain hugely. The general view is that I must be allergic to the injection medium. I have also been treated with radio frequency and that led to the whole of my Summer 2009 being spent in bed.
 
In short I think I must return to my Pilates DVD once this pain has settled, leaving out any exercise which hurts or aggravates my pain and plug on!
 
Thank you for your time,
 
Quaver
PLEASE DONATE TO CHRONIC PAIN SITE! SO THAT WE CAN CONTINUE TO HELP CHRONIC PAIN SUFFERERS


Severe back pain since 1997. Lumbar Spinal Stenosis, Scoliosis, DDD. Hashimoto's syndrome, Depression, High Blood pressure, Fibromyalgia, Raynaud's Syndrome. Severe chronic pain in lower back, hips and knees. Osteoarthritis in spine, wrists and hands. Golfer's Elbow. Facet and Sacroiliac injections Dec. 2007, aggravated entire spinal column. L4-L5 L5-S1 spinal fusion plus cage support and titanium spacers April 2008. Facet and Sacroiliac Injections May 2009 allergic to injection medium. Radio frequency June 2009 aggravated entire spinal column. Undetected fracture in L2, Nov 2010, caused L bend in spine more pain. Bilateral trochanteric bursitis. Mobility diminishing now wheelchair user.
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