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Sacroiliac joint fusion options


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Old 01-19-2017, 10:56 PM   #1
velo77
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Sacroiliac joint fusion options

Been over 3 years since 3 level ALIF L3/S1 and fusion is solid. Issue is pain while sitting has gotten progressively worse. Therapeutic injections 95% helpful, but short lived (2 days max). RFA was not helpful, but burning 6 or 7 nerves is a crapshoot from my research (best informed crapshoot) as there are many more the 6 nerves in the area. Considered prolotherapy and PRP, but consults were less than convincing for my case.

Brings me to today, considering bilateral SI joint fusion with I-fuse (triangular dowels if that gets edited). Just found there are 12 different approaches with different instrumentation solutions??? WOW. Hoping for some others experience here as a search didn't turn up too much.

All the best,
Keith

background:
Lumbar fusion now sacroiliac (SI) joint pain. Had a three level lumbar fusion at the bottom three, L3/S1 on November 1, 2013. Had the hardware removed just under one year later as it appeared the lower sacral screw was piercing the left SI joint causing sitting pain. One diagnostic and two therapeutic injections later (SI), similar short-term relief measured at between three and five days of pain relief.

Read more: http://www.healthboards.com/boards/back-problems/1007979-lumbar-fusion-now-sacroiliac-joint-pain.html#ixzz4WHIQI3MF

 
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Old 02-01-2017, 10:36 PM   #2
velo77
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Re: Sacroiliac joint fusion options

CA BCBS denied, peer to peer review coming up. fingers crossed.

 
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Old 02-02-2017, 06:42 AM   #3
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Re: Sacroiliac joint fusion options

Sorry no one responded to your original post. I can't think of anyone currently on the board who has had any type of SI fusion who could provide experiential information. It appears you are knowledgeable about your options. The problem when considering SI fusion is that the rates of success are not impressive. And, of course, it is always so difficult to figure out if the pain generator is really the SI joints or something else.

I imagine this is one reason why your insurance carrier denied the surgery.

Are you convinced the issue is SIJ dysfunction? Do you have symptoms other than pain when sitting?

 
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Old 02-02-2017, 11:00 PM   #4
velo77
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Re: Sacroiliac joint fusion options

Thanks for the reply and 90%+ confident SI Joint is issue. 2 therapeutic injections were extremely helpful, but short acting. RFA no help and finally, 2 diagnostic injections (no steroids) 1 week apart confirmed 90%.

The next question; will fusing solve for pain? SIJ is 90%+ pain generator, but not a lot of solid data i can find to prove fusion is a high probability fix. Open fusion would not be an option, but the minimally invasive solutions seem to be a reasonable probability (risk vs reward).

Will post findings.

k

 
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Old 02-03-2017, 08:31 AM   #5
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Re: Sacroiliac joint fusion options

You won't find any long-term success rates for IFuse because it hasn't been around that long. The only person I know who had IFuse regrets her decision to have the surgery. Part of the problem with fusing the joints is that it sets up the situation for developing other muscular/soft tissue issues. In order for the legs to move there has to be some part of the lower body/back/torso that has some movements. Even though the Si joints don't have much movement, when they cannot move at all, other things have to compensate...it may spread to piriformis, multifidis, etc.

After I was fused from L3-S1 after initially fusing L4-5, I had lots of problems with the SI joint area. I was looking into PRP injections, prolotherapy etc. but was going to a bodywork guy every week at the same time. He uses acupuncture to warm up the tissue and then breaks up focal adhesions and generally realigns me when needed. I can't really explain what all he does, but it keeps me going and feeling good. Anyway, for the 2 years after surgery, when I walked or moved, my body was compensating for very weak glutes by using other muscles to move my legs. This created hip pain, etc. due to using those muscles incorrectly and putting too much demand on them.

I mention this just to indicate that there can be other ways to resolve what seems to be SI joint issues...other than the drastic step of fusion.

 
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Old 03-01-2017, 10:18 AM   #6
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Re: Sacroiliac joint fusion options

Hello. I just read your post and noticed u mentioned IFUSE as the option for your SI Joint Fusion. That word IFUSE always does catch my eye. I have had bilateral SI Joint fusions. One in 2012 with IFuse and the other in 2013 with SI-LOK. IMO the IFUSE hardware and method aren't very good. With the 2012 fusion I had 3 Implants put in across the Joint. The method used to implant them is where I ran into problems first and only partial union was the 2nd prbllem. Having to tap the implant into the Joint with a hammer type tool is very tricky even with flurospic imaging. Mine was tapped in less than a MM to far and impinged nerves which to this day still burn my legs and feet. Yes that could happen with almost any surgery but the surgeon who did mine only used IFUSE 3 more times due to the risk of it happening again. I did have to have a revision done to get the implant off the nerve. X-rays and CT showed only partial union and the 3, 6 and 12 months and again at 2 yr. There was enough thereto keep the joint in place but barely. My next fusion was done with SI-LOK which is HA (Hydoxyapatite) screw that has a graft slot to promote fusion by using BMP or whatever the doc decides to use to promote the bone growth. These are put in just like a Pericles screw and can be placed more accurately that the Implants. After the SI LOK was done I had full union across the Joint at 6-9 month Scans. IMO a lot better option than the IFUSE. I'm sure the SI LOK site has a list of surgeons in your area who use them. I know IFUSE did. That was how I found the surgeon to do the initial one. Luckily I had the option to switch hardware the 2nd go around. Now even 5 yrs out I still have pain in the side that IFUSED was used. The right side I have had no issues with. Good luck!! Hope everything goes well.

 
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Old 03-02-2017, 11:46 PM   #7
rockiemountain
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Re: Sacroiliac joint fusion options

Hello, I have 3 rods laid in across the SI Joint in each hip and honestly I'm5 years out and I am just starting to have extreme pain again. It lasted for about 5 years so yes i'd say its worth it but i'd never do back surgery again!!! Also the recovery time for this versus fusion is way way better! So much less time in the hospital andonce home easy street compared to fusion

 
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