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Old 03-18-2012, 11:28 AM   #1
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RF Ablation for SI Joint Disorder

Was wondering if anyone here has had RF Ablation for SI joint disorder. I have had it for facet joint issues, but that's a different animal.

I will be having diagnostic injections on my right SI Joint soon, with the first one about a week away. I also have an appointment with an orthopedic surgeon this week who specializes in the pelvic/hip region to explore more permanent fixes for the SI Joint.

My pain management doc will want to do the RF Ablation if the SI joint proves to be a problem, and I'm just not sure about it for the SI joint. Based on symptoms and physical exam tests, we are pretty sure the SI Joint is a problem. Sure, it can take the pain away for awhile, but it isn't a permanent fix.

I will have him explain how the RFA will help with the SI Joint, and he is very thorough with his explanations, expected results, etc.

 
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Old 03-18-2012, 11:59 AM   #2
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Re: RF Ablation for SI Joint Disorder

I would be very careful moving ahead with anything like a fusion for the SI joint. After years and years of doctors thinking the SI joints could not possibly be a cause of "back" problems, now it seems like the tide is turning and people are really jumping on the bandwagon. I have really mixed feelings about the topic and feel like I have been on both sides of the issue, in a way. My feelings are slightly tempered by the fact that the new SI Bone fusions seem to be having more success than the standard way of fusing, which had a very, very long recovery without weightbearing and a low rate of success. But the "new" way doesn't have any track record, so we don't really know how patients will be five years from now...what other problems may arise as a result of having the SI joint immobilized, etc.

Many issues that people perceive to be SI joint problems are caused by or at least there are many other things that contribute to the issue. And, it is very difficult to tease them apart and know for sure it is one and not another. Even having the diagnostic injection doesn't necessarily answer the question like it does higher up in the spine.

I personally would try the ablation prior to doing anything surgical. There is no turning back once surgery is done.

 
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Old 03-18-2012, 12:13 PM   #3
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Re: RF Ablation for SI Joint Disorder

I keep bouncing back and forth between RFA and permanent. I'm sick of the fight to find even the source of the pain. I'm still thinking on it, and am waiting to see what happens before making any further decisions. The iFuse is one thing I am looking at. The short amount of time the procedure has been around gives me plenty to think about too. Not going to make any snap decisions, that's certain.

 
Old 03-18-2012, 12:32 PM   #4
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Re: RF Ablation for SI Joint Disorder

Have you looked into prolotherapy if you find it is SI joint hypermobility? it occurs to me I don't really know what types of symptoms you are having, so it might not be appropriate for your situation.

I know we all get sick of the constant rounds of going to the doctor, trying a new med or procedure, waiting to see if it helps, going back to the doctor, etc. and we all hope to find a permanent situation where we will be without pain. But always keep in mind that some people end up in more pain after surgery. Sometimes surgery is a success but it turns out what was "fixed" wasn't the only pain generator, etc. Sometimes surgery seems like the lesser of two evils, but, often it doesn't have the desired outcome.

I know you will do your homework and won't jump into anything. I just mention these things for anyone who might be reading!

 
Old 03-18-2012, 01:13 PM   #5
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Re: RF Ablation for SI Joint Disorder

[QUOTE=teteri66;4946429]Have you looked into prolotherapy if you find it is SI joint hypermobility? it occurs to me I don't really know what types of symptoms you are having, so it might not be appropriate for your situation.

I know we all get sick of the constant rounds of going to the doctor, trying a new med or procedure, waiting to see if it helps, going back to the doctor, etc. and we all hope to find a permanent situation where we will be without pain. But always keep in mind that some people end up in more pain after surgery. Sometimes surgery is a success but it turns out what was "fixed" wasn't the only pain generator, etc. Sometimes surgery seems like the lesser of two evils, but, often it doesn't have the desired outcome.

I know you will do your homework and won't jump into anything. I just mention these things for anyone who might be reading![/QUOTE]

I have tried prolotherapy. Did not react well to that, and was in major pain for several months after only one session, or whatever they call them. Doc agreed that to repeat it would be a mistake.

Mention anything you want, as we all want to help others as much as we can!

I can deal with there not being a 'fix' for my back. I've learned enough of the warning signs that things are flaring up to usually keep it on a leash. I have also learned the things not to do for the most part.

The main symptoms are pain in the SI Joint area, pain at what I have learned is the piriformis muscle, the glutes, right at the bottom of my pelvis, my hamstring gets tight, as does the muscle at the side of my hip/thigh. Sitting, walking, standing all increase my pain. Kneeling, squatting, and similar activities also increase my pain. I know that the SI joint isn't the only source of my problems. The facet joints affect some of those activities as well, but with the RFA still working for those, everything is focused on the SIJ.

The physical exam included only two physical tests . . . the first one being they had me sitting in a chair, put my foot on the opposite knee (one leg at a time) and apply light pressure. There was response to that on the right, not on the left. Then doc had me stand, pick one foot up off the floor, and applied light pressure over the si joint on the same side as the foot still on the ground. With the left side, there was nothing, with the right side, I just about went through the ceiling.

If there is nothing that any of the docs I am talking to want to do or can do, I am just going to live with it. I know how to keep it all on a leash for the most part, it just means that I don't have much of a life. My youngest kid is 17 years old, so I don't have as many 'mom' duties as others with younger kids.

 
Old 03-18-2012, 05:21 PM   #6
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Re: RF Ablation for SI Joint Disorder

If you seemed to get such dynamic response from those tests on the right and not on the left, it would seem worthwhile to proceed with the injection to see what it helps.

There is a (in my opinion) fabulous "new" machine that performs imaging like MRI but it is for nerves. Unfortunately there aren't any facilities in this part of the country that offers them yet. I think the closest one might be in Indiana. Several years ago they were only available on the West Coast, but the inventer has started to license the technology and is opening up facilities around the country. You might be interested in checking it out in the event that you don't get your issues sorted out. It is called MR Neurography and the inventer is Aaron Filler, MD and PhD. I know there is an interesting article on the website about piriformis issues and how it is often misdiagnosed, as well as lots of other information.

 
Old 03-21-2012, 03:07 PM   #7
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Re: RF Ablation for SI Joint Disorder

Well, just got home from the appointment with the orthopedic surgeon. If the diagnostic injections show positive for the SI Joint, then I give him a call back. The CT scan that was done a couple years ago doesn't show much in the joint or with my pseudoarthrosis, but if the diagnostics show a problem, then I go back to see the doc. He was actually pretty cool, and also understands that I have been round and round with this for several years.

Murphy's Law, but the last couple of days I have been at the lowest pain level since early January. It did cooperate at least, and show him something during the physical exam, and my pain level did start increasing after the physical exam, and BEFORE I left the clinic.

At least I wasn't brushed off, and will be able to discuss some options if the diagnostic injections show the SI Joint is a problem. Kind of in a holding pattern until the first diagnostic injection at least.

 
Old 03-21-2012, 05:33 PM   #8
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Re: RF Abl**ion for SI Joint Disorder

And wh** are you supposed to do if it does not provide any relief? He doesn't want to see you again?

 
Old 03-21-2012, 06:02 PM   #9
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Re: RF Abl**ion for SI Joint Disorder

[QUOTE=teteri66;4948179]And wh** are you supposed to do if it does not provide any relief? He doesn't want to see you again?[/QUOTE]

Then we need to find the source of the pain and take it from there. Everything else has been tested, so pain management would be my only real option anyway. I have the feeling that the injections will verify the SI joint is the problem, based on positive physical tests and the symptoms. I will be shocked if the injections don't provide relief.

I've already had one positive and a partial positive diagnostic injection on the right SI Joint. The reason the second one was only partially positive is that the injections involved cortisone, and I increased my activity level too much after the first one. I felt soooooo good! I was me again. I did too many activities that I really shouldn't have. I'm glad that these upcoming diagnostic injections will only be the anesthetic. I won't over do it, as they only last about 6 to 8 hours.

 
Old 03-25-2012, 03:18 PM   #10
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Re: RF Ablation for SI Joint Disorder

I came across my pain log that I had to fill out after my second diagnostic on my right SI Joint from 2010. Interesting thing is that it shows the first 7 hours as being pain free. The 8th hour was at a 1. The following 14 days were mostly 0's, with a few 1's mixed in.

I'm still going a head with the current diagnostic injections, but it would seem to me that the second diagnostic from two years ago was just as successful as the first one, just didn't last for a month, but only about two weeks instead. How that translates into only 50% relief in comparison to the first one, I don't quite understand.

I have a request in for the pain log from the first one so I can compare them. Hopefully, I will have it early this coming week.

 
Old 03-26-2012, 04:12 PM   #11
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Re: RF Ablation for SI Joint Disorder

First of this round of diagnostic injections on the SI joint out of the way. The doc did use cortisone as well, which I wasn't expecting. So far, feeling pretty good. Still a bit out of it from the sedation, but not too bad.

I also remembered something that happened about a week and a half after the second one I had back in 2010. I slipped on a wet floor in our laundry room. Didn't fall, but caught myself before falling. A slip on ice is what started this current flare up back in January.

 
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