SI Joint Surgical Options - Need analytical help please

[Santorini]

Hello,
After many consultations with Orthopedic surgeons, images, injections and countless PT sessions, it's been determined that my gross pelvic instability is a result of SI joint dysfunction. I am completely unable to walk any appreciable distance without dragging my legs, limping or loosing the feeling in both feet. I rely on the compression of a sacroiliac joint belt in order to stay upright and move around. Most days I have to hold my hips just to get down stairs and that is even with the support of the belt. I continue to work on pelvic stability through physical therapy but it is clear that this is not addressing the main problem which is damaged and/or lax ligaments. The damage is too severe at this point.

I have been researching the surgical options for SI joint dysfunction and have come to the conclusion that my best options are either pedicle screw fixation or iFuse implants. Both methods have pros and cons and I am having hard time deciding which is the safest and most effective in correcting my gross pelvic instability. My main concern with pedicle screw fixation only (no fusion of the joint) is the possibility of the screws loosening or backing out over time. I've read many accounts of this happening in spinal fusions so wouldn't it stand to reason that this could also happen in the pelvis? So my question to the group is: what is the likelihood that the screws will stay in place and secure the pelvis for the next 30+ years?


Here are some of the Pros and Cons to both procedures:
iFuse Pros: Minimally invasive procedure. The triangular titanium rods "are also coated with a titanium plasma spray that creates a rough latticed structure on the surface of the implants, which is designed to create an interference fit to bone" which is supposed to create a stronger hold than pedicle screw fixation. No need to clean out SI joint and insert cage for fusion. If it is done correctly, it appears to be a very good solution over the traditional open SI joint fusions.
iFuse Cons: New procedure with no long term data. If for any reason the implants need to be removed, the removal procedure would be difficult at best and in my mind result in a significant amount of bone loss through the removal process. Not sure how many have been removed to date. I will need both joints fused and this procedure is generally done one joint at a time due to the weight beaing restrictions after implant. The big Con here is that I would have to undergo two separate surgeries.

Pedicle Screw Fixation Only Pros: Can perform bi-lateral fixation in one procedure. No need to clean out the joint and insert a cage for fusion.
Pedicle Screw Fixation Only Con: Many surgeons are against this procedure as the screws will only be fixated to the bones and no fusion achieved hence, the risk of the screws loosening over time.

[Munch1958]

Hi Santorini:

I had SI-Bone i-Fuse done on my left SI joint in Gainsville, GA on April 14th with Dr David Wise of Specialty Clinics of GA - Orthopaedics, PC and Vicki Sims (physical therapist assisting on the alignment) of Gainsville Physical Therapy and screw fixation on the right SI joint.

I've tried a bunch of other therapies but nothing has worked so I finally went in for surgery. I was fighting it because this was my 16th trip to the OR. This was kind of where I was at before the surgery:

 There is no comfortable position in which to sit, stand or lie down.
 I am most comfortable lying face down and flat with hot pack on my left SI or with my legs up on a big pillow.
 Heat makes it better; ice makes it feel worse because everything gets stiffer.
 Most nights I cry myself to sleep because the pain is so awful only to wake up
around 4 am to take pain meds then I can’t fall back to sleep.
 I read a lot while lying in bed; maybe 750+ books since the fractures and pain began. Now I’m really getting sick of the view of my bedroom ceiling.
 Most days I go from the bed to the couch then back to bed then back to the couch.
 When I stand up from lying down, my back is so stiff that I must “readjust everything” and PAUSE to shift spine before I can take a step.
 Most of the time I get stuck halfway up when going from sitting to standing and need to use my arms to push up.
 Right now I am sitting on a 75 cm ball to work on my computer. Chairs are not comfy. Sitting is awful and I refuse to take my lap top to bed with me.
 Pain is worse with movement, walking, standing, sitting, can’t roll over in bed. I feel like one of those bugs stuck on their back flaying their legs about.
 Sometimes I feel the pain in my groin but not often.
 I never have sciatica or pain running down my legs or into my thighs.
 I have a hard time standing up long enough to cook dinner then can’t eat it sitting up so I semi-lie down to eat. If I twist a bit I can keep my plate warm while eating by using my hot pack under my plate.
 Most of the time, I have no appetite due to pain except for chocolate which helps the pain. (Well not really…but that was fun to type.)
 Since the spine fractures, I have a hard time with Kegel exercises and have tried several different Kegel exercise devices but have not had much luck with bladder issues (urinary frequency).
 Picking up my grandson is very difficult. He’s 2 years old. I was unable to help my daughter after he was born.
 Using my computer is difficult – I have a BS in Computer Info Systems so this is irritating.
 I enjoy taking digital pictures, scrap booking, and using social networks and want to make some web sites and a blog but can’t sit long enough.
 Grocery shopping is always a challenge to do by myself so now I have to drag my husband along which is the LAST thing he wants to do. Must use a shopping cart to lean on.
 I have not walked around any mall or store for “fun” in over 3 years.
 I enjoy gardening which is nearly impossible to do for more than 1 hour each day. I didn’t get as much as I planned done this past summer and still have mountains of mulch to spread, bulbs and plants waiting to go in the ground.
 Driving: can’t use the brakes very well, if I had to brake hard, I am in agony for days so I don’t drive much – also concerned about MVA + narcotic use.
 I can’t live like this ANYMORE.

So that's why I finally went in for surgery after suffering for 3 years, 1 month, 3 weeks and 8 days. So far, I am glad I did it because that gnawing, burning, stinging, horrible pain in the SI joint is gone. I have lots of bruises and itching from the 2" incision on the left. No problems other than 2 punctures on the right side. I got 3 titanium rods on the left providing immediate fixation and fusion in a month and 2 screws on the right providing immediate fixation.

There is a SIJD group on Facebook where quite a few have had the procedure done:

SACRO-ILIAC JOINT SYNDROME / SI JOINT DYSFUNCTION - SIJD | Facebook

I'm not trying to steal anyone from this board, just providing another resource for some answers to your questions.

The reason I went with GPT & Dr Weiss is that he's done several thousand of these surgeries and trained with Dr Lippet. He's new to SI-Bone i-Fuse product and had been doing the traditional fusion surgery for many years. Vicki Sims has been working with SI patients for 28 years and has aligned about 4,000 people prior to surgery. I am not aware of anyone having Steinmann pins backing out of their SI joints. Check with Vicki Sims on this point.

[azennaro]

Hi contact DrPimenta on www.patologiadacoluna.com.br I have personally discussed and had surgery with him,on both procedures he does not agree with, He is involved in a new SI j PROCEDURE I dosuggest speaking or emailing him.I travelled across the world to see him.
Cheers

[Justin]

Hi contact DrPimenta on www.patologiadacoluna.com.br I have personally discussed and had surgery with him,on both procedures he does not agree with, He is involved in a new SI j PROCEDURE I dosuggest speaking or emailing him.I travelled across the world to see him.
Cheers

Anna, thanks for sharing your experience with others here at SPS! Your help is most appreciated and I wish you the very best.

[Santorini]

Munch, thanks so much for all the information. I am still in search of some data on the pedicle screws but have found none. How is the healing process going? I am curious about the mix of iFuse and pedicle screw fixation. Do you notice any imbalance or differences between the two sides or is it just too early to know for sure?

Anna, thanks for responding. Would you clarify what you are saying though. Are you saying Dr. Pimenta does not agree with SI joint fusion or just the methods that I was describing? I'd say most do not believe in fusing or fixating the joint but this is not a matter of pain in my case. I have severe dysfunction and inability to walk outside of my house. I too would prefer not having to go down this path but as Munch has stated, there is a clinical need for pelvic stabilization for many, many people out there.

[azennaro]

Hi Sorry I wasnt very clear. I too have been struggling and unable to walk more than a few metres for several years. I had 2 level Charite disk in 2001 in Aust, with very little relief,severe degenerated facet joints and severe SI J dysfunction. After consulting many surgeons in Aust regarding fusions of 1 level and fusing SI J both or one at a time.I flew to San Paolo and had surgery with Dr Pimenta after my assessment and indepth discussion of The current SIJ SURGERGIES available, I agreed with him that both surgeries you mention had significant problems, but he explained that there was a current new technique in development.In my case he decided to fuse L5S1 first and resurface the facet joint L/4/5 then access my SIJ once I had stabilized at least this area first.Ihave the utmost confidence in this surgeon he is one of the worlds leading disk revision and leads several clinical trials,His age and experience with spines his incredible, he told me things about my spine from a Ct scan via a phone call before seeing me, that not a single surgeon here in Aust had told me.
Unfortunately Im only 6 week post op but I can definetly still say I have a problem and its pain source is still again my SIJ'''''''''''''''
t is well worth getting in contact with Dr Pimenta, he is very easy to talk too and will speak to you immeditely if you ring his clinic and if he is there.
Cheers

[Katie]

I highly recommend Dr. Pimenta as well. I had three level surgery with him last March, a year ago, and have had significant success. But I am not familiar with your type of situation so will have to defer to Anna and her experience for that. Overall, he is an amazing surgeon, easy to talk to and discuss details and is, as she said, one of the best in the world.

I wish you the very best in your search for a proper procedure. It took me several years of almost full time research to come up with my solution.

[mshedgehog]

Sanatorini~
What have you decided to do? I have SIJD not anywhere as bad as you. I can walk without holding my hips in place, can walk in a store with use of cart, can somewhat take care of my adopted 3.5 yr old, everything else my wonderful husband has to do... Cooking, cleaning, grocery shopping, transporting kids to/from school. I attend 2 counseling sessions a week, take my 6 yr old adopted daughter to counseling weekly, take the 3.5 yr old to therapy weekly and that wipes me out. I spend most of my days laying on a heating pd on my home hospital bed. I do have moderate to severe pain. I am on 2 forms of morphine (Kadian and MSIR-Morphine IR -Morphine immediate release). I take a total of 280 mg Kadian a day and recently taking 30-90 mg of MSIR daily. I am also on gabbapantin for nerve damage at L5/S1, antidepressants, mood stabalizer, anxiety med, and I am diabetic. I believe from all the meds i take causing my pancreas and kidneys to not filter meds and sugar correctly. I have a failed APILF from September 8/10, 2008. I have bilateral pain in my low back, butt, groin, bacl of leggs, hips, and pain to the sides of the spine from lowback down to tail bone. I have been examined by two different doctors, one in March 2010 and one July 2011 and both agree thawt I have SIJD. I had a SI joint injection in May 2010. Of three the first one was the only one that helped, but I got significant relief. In fact I did things I hadn't done in years. The doctor I saw in July is a doctor that has been trained in the iFuse technique. He has not dong any surgeries on a living person. I am possibly his first. Although this might scare most people he did tell me that in each iFuse surgery there are 2-4 surgeons who work for iFuse who come to the surgery to supervise and make sure that the surgery is correctly done as well as sucessful. Im sure you know that in order to get an iFuse you have to be carefully screened. I was told that I am a good candidate for iFuse. I had a CT done last week of my pelvis and SIJ area. It came back showing that my SIJ is fine and stable . Now I'm scared that I won't be able to get the surgery and that the SIJ is not the source of my pain. I am basically out of options other than a spinal cord stimulatior, but I feel at peace with the iFuse and that this is the answer, finally, but my dr is on vacation for 3 weeks now. So I have to wait....... Did you have a CT scan done, what did it show? How are you feeling now?

[mshedgehog]

Unfortunately Im only 6 week post op but I can definetly still say I have a problem and its pain source is still again my SIJ'''''''''''''''

Were you 6 weeks post fusion at this time and noticing that your SIJ was the pain generator? What is your status now. How are you feeling? what type of SIJ surgery did you or will you be having? If you have had surgery for SIJ what has your experience been? I hope you are doing good no matter where you are in the process.

[Munch1958]

A CT scan, X-Ray and MRI of the pelvis does NOT usually show problems with the SI joint. The best indicator is how you responded to the SI diagnostic joint injection. If you get pain relief from that injection better than 75% the SI joint IS THE PAIN GENERATOR.

I had 3 i-Fuse rods installed on my left SI joint and 2 screws to fixate the right side in place in mid-April. I have NO SI joint pain now but am now having pain issues in my thoracic area and still have a lumpy bumpy area in my left hip/thigh (saddle bag area.) Almost EVERYONE that I know with the i-Fuse implants has this problem.

My physical therapist says it's the glut min and glut mead muscles that are inflamed. It feels almost like some kind of bursitis to her as the muscles are very rigid. It's still better than dealing with the SI pain that I had BEFORE the surgery. That was BRUTAL and I could never find a comfortable position EVER. I am sleeping much better and no longer wake up with pain or toss and turn all night.

As for the thoracic pain around T8 - T12, my muscles are all screaming up there. Now that the bottom on my spine (pelvis) has been fixated and fused the top part of the spine needs to readjust to a different pattern of movement. This is the reason that recovery from SI surgery takes about 6 - 9 months and in some cases up to one year. I have scoliosis and a short leg which seems to be a common denominator with people requiring SI surgery.