I have posted on here before regarding issues I have. Short synopsis.. Extrem lbp since MVA in 2008. Had ESI, facet injection and ablation, PT and finally a neurosurgeon did a discogram in 2010 following my 3rd MRI and it was positive at l5-s1. The following month I had a TLIF fusion at that level. That was 1 yr ago. At every appointment I have brought up that though the sciatica and mid lbp had eased moderately the pain I had prior to surgery in my low back to the left of my spine has gotten unbearable and is in my buttocks and groin. He says well U made the correct decision in the TLIF, however I think that your problem secondary to the IDD at l5-s1 was SI joint pain and the fusion may be exacerbating the problem there. We may have underestimated that as a pain source. He sends me back to PM and he does a diagnostic injection in the SI Joint and immediate relief. Lasts about 6hrs then returns. 2 weeks later another injection with cortisone. Immediate relief that last about 2 weeks and here comes the pain. 3 weeks later a lateral branch block and got relief so he schedules an RFA. Well I had the RFA 4-5 weeks ago and yet ZERO relief. He says there's nothing else I can do except a pain pump, or keep u on Oxycodone and muscle relaxants which I HATE. So he sends me back to the same Neurosurgeons and 1 that specializes in SI Joint fusions. He says that he would suggest SI Joint fusion by SI Bone and would like me to consider it and get a 2nd opinion. I get the 2nd opinion and he determines I have SI Joint dysfunction and inflamation problems and would suggest a fusion and a HLA-B27 test for auto immune issues. I haven't done that yet but why wasn;t this done b4 now? If that is an issue would the fusion be a help yet the auto immune cause problems elsewhere? I am just really confused about what to do. If the diagnostic tests were positive why no relief with the RFA? I can go on and on with questions but won't. Does any one have similar issues, answers or suggestions? Have I done all I can and should I proceed with the fusion since 2 docs say yes? What idf the HLA_B27 isd positive what will that mean? Sorry for the novel just really worried.. I am a father of 3 and 1 being a toddler and want my life as normal as possible. I am only 38 and really annoyed as u can tell. Thanks in advanced to any who respond with any advise or suggestions.. Thanks XwinX
I problem almost was a mirror image of yours. I also have had a TLIF at the same level yet still had tremendous pain. I went back and had another MRI and all looked well they said. Referred back to PM and find out I have SI Joint dysfunction as well as Sacroillitis on left side. I was in tremendous pain. With the dysfunction I could literally feel a "clunk" noise when it came out of place. When this happened I was unable to do anything. I could get it back in place most of the time yet the residual pain was excruciating and it was a vicious cycle.. Had all the diagnostic and steroid injections just as u had as well as RFA. None worked. I went to CNSA in Charlotte and met with Dr. Hunter Dyer. He is a neurosurgeon but specializes in SI fusion with the I-FUSE from SI BONE. He has performed a lot of them and with relative good results. He will allow u to speak with prior patients who has signed consent to speak with you. It was not all favorable ones either. A rate of over 80% have had substantial relief and would do it again. Some not so great results. That's with any surgery as u know. Since u live 3 hrs from Charlotte maybe see CNSA or Carolina Orthopedic in Hickory, NC. Dr. Geissele. I am scheduled to have surgery on Dec. 28th and I know I will be non weight bearing for 12 weeks but then therapy and hope to do well from there. I know how frustrating it is. If they are certain it's the SI Joint, then I would see a specialist as u said u are. I would also get a few opinions and see if they are in agreement. I will post after surgery. If u wanna PM me I can get u in touch with the Dr's I mentioned. Good Luck and keep us posted..
The Following User Says Thank You to Bigphil For This Useful Post: XWINX (12-12-2011)
If you are asking why the HLA-B27 test was not done previously, I would assume it was because the neurosurgeon did not suspect anything going on such as Ankylosing Spondylitis. I imagine he thought your symptoms were coming from the disc between L5 and S1 and that the fusion would relieve the symptoms. Only after this proved not to be the case, do they start looking for other reasons.
Looks like your location in NC will be beneficial if you want SI joint fusion. The surgery is more common in some parts of the country than in others.
The Following User Says Thank You to teteri66 For This Useful Post: XWINX (12-12-2011)