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SI joint pain after fusion

smartenssmarten Posts: 8
edited 06/11/2012 - 8:51 AM in Sacroiliac (SI) Joint Problems
Ongoing pain after fusion surgery is an important topic in our patient community.

Here's a question about ongoing pain related to the SI joint:

"I have heard SI joint inflammation can happen after fusion surgery, what causes this?"
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13

Comments

  • The level or levels thats fused has no more movement. Which will cause the level above and bellow the fusion a lot more stress which ends up with si joint ainflamation. With each movement after fusion the other levels are taking much more of a beating then before being fused. I haven symptoms i never had after fusion at my l4l5. Without having the cushion of the removed disc where fusion took place will put much more stress on the si joint i am sure. Kind of like removing the shocks and springs off your car. It will still run but wont drive like a new car that has new springs and shocks

    Alex"
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • According to a study by Ha, et al, lumbar fusion patients have been shown to have a higher incidence of SI joint degeneration than non-fusion patients.5

    •The incidence of SI joint degeneration in patients was 75% at 5 years post-fusion, which was significantly higher than in the non-fusion group, 38.2%.
    •Among patients with one-segment fusion, 91% developed SI joint degeneration.
    •Regardless of whether the fusion includes the sacrum, the SI joint is influenced by increased mechanical stress arising from lumbar/lumbosacral fusion.
    •Posterolateral lumbar/lumbosacral fusion can be a cause of SI joint degeneration.

    These data may imply that:

    •Patients who are still symptomatic after lumbar spine surgery may have actually had SI joint problems instead of or in addition to another spinal problem
    •Patients who have had prior lumbar spine surgery may develop issues with their SI joint
    •The increasing incidence of SI joint problems supports the inclusion of the SI joint in a differential diagnostic work-up of patients with low back pain.


    5 Ha, et al. Degeneration of Sacroiliac Joint After Instrumented Lumbar or Lumbosacral Fusion: A Prospective Cohort Study Over Five-Years Follow-Up. Spine (Phila Pa 1976). 2008 May 15;33(11):1192-8.

  • hmmm...I wonder if that is what could be happening to my left hip.
  • Something I did not see is that, I have screws very low close to my SI joints and feel this irritates the nerve roots close to the SI joints.

    I also had misalignment of my SI joint by pressing on the brake trying to avoid hitting a car in the car accident I had.

    I did not find this out, until seven months after my fusion and by a physical therapist (myofascial) and it took one month to adjust.

    My physical therapist states you can do this by stepping off a curb.

    Your SI joint is close to your piriformis muscle, sciatic muscle and how they relate when you walk or do
    anything physical.

    I wear a sacral iliac belt to immobilize my si joint and it is a simple method to prevent pain.

    I would like to see the difference of surgery with and without instrumentation as I believe instrumentation causes a unnatural curvature of the spine placing stress on the SI joint. If you do not have strong abdominal muscles, you place more stress on your trunk.

    So, yes, I believe the instrumentation of the fusion causes the pressure on the SI joints causing a SI syndrome that involves the piriformis muscle, sciatic, and SI joint.

    So that's my opinion from my experience and medical records. BJ
  • All fusion rods by now should have spring loaded at least to take the shock and allow some movement. If you ask me this is a no brainer and i dont know why the medical field has not come up with anything as such. Even the adr does not handle the load even if it does allow movement. With the rate of disability in the usa. You would think the brain power would kick in and they would have developed much beter way to fix the spine then sticking screws and rods or adr when neither acts as the disc they took out.

    Look at the technology going in to cars and iphones and computers but nothing for humans for beter life and less suffering. I dont mind having screws drilled in my spine if its something that you know will help by replacing the bad disc and you live pain free. But how can anyone be pain free by these surgeries when none of this hardware is anywhere close to acting as the natural replacement for a human disc?

    You go in to surgery with 1 type of pain and you come out of surgery with 50 types of pain they cant explain. Or they tell you whell surgery went great you are fused perfect. In my view a surgery is not a success as they like to think unless person came out of surgery and has slight normal pain expected as from any other surgery.

    Only a dr can have this kind of thinking that he did a good job and gets paid for it. That would be like me building a house but the roof caved in but i still want to get paid because the walls are still standing. Alex
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • After my fusion, I have lots of SI joint pain now, particularly in cold wet weather.

    There seems to be a lot of inflammation in that area, scar tissue or perhaps what some of your mentioned above when I look at the MRI.

    I just did a spinal injection, oh what great fun.. but seems to calm things down for about 3 months. I also do pilates stretching and my neuro stimulator seems to help. I also did Feldenkreis which for some reason make a big difference in lots of ways. Just started it, so we will see.

    Australia actually seems to be doing more research on chronic pain and back issues so you might want consider looking at research from there.

    It is scary how little they understand about chronic pain and/or back issues.


    Yet, what can you do, suffer and grin and bear it, or do the surgery and hope for the best? I am not sure what the best choice is, for everyone it is different.

    I am working hard to come up with a defined tracked pain management plan that records every treatment, alternative treatment ie non Western medicine or otherwise so I can create a tangible Action Plan around my back. It is hard for me at least, to keep track of what is working and what is not!

    Wendy

  • In dec 2010 I had my right si joint fused using ifuse, my own bone shavings and 2 screws, 3 1/2 inches long. I was non-weight bearing for 3 months. Once I recovered from the surgical pain, I had more painfree days than I had in 6 yrs. Then on day it all came back, plus some. The fusing is ongoing and is within good margins for 5 mths. Yesterday my dr told me he wants to remove the screws because he believes they are causing nerve irritation, this being the cause of my terrible si pain and pain down my leg. My question is this; is this surgery just minor surgery and I can just get up and go afterwards, or will there be a long recovery and non weightbearing again? Any information would be appreciated. I only thought of these questions after I left!
  • In dec 2010 I had my right si joint fused using ifuse, my own bone shavings and 2 screws, 3 1/2 inches long. I was non-weight bearing for 3 months. Once I recovered from the surgical pain, I had more painfree days than I had in 6 yrs. Then on day it all came back, plus some. The fusing is ongoing and is within good margins for 5 mths. Yesterday my dr told me he wants to remove the screws because he believes they are causing nerve irritation, this being the cause of my terrible si pain and pain down my leg. My question is this; is this surgery just minor surgery and I can just get up and go afterwards, or will there be a long recovery and non weightbearing again? Any information would be appreciated. I only thought of these questions after I left!
  • My SI joint pain showed it ugly face after my double spinal fusion. It is really hard to cope with particularly when there is a weather change.

    Do you find that to be the case, I am a pain weather barometer? I have had to move because I can't stand cold rainy weather, it was so painful.

    Wendy
  • For some reason they are more progressive in OZ than in the USA particularly around back pain. I am always looking for the latest and greatest. Of course I would have to pay for it out of pocket, but if I really think it would work, what is the price of a more pain free life?

    Wendy
  • After years of every treatment imaginable and a lumbar fusion that I probably did not need, I had SI fusion surgery with SI Bone technology. I still have the same pain as prior to surgery and would like to know if anyone else has had this experience. I am going to be working to find out why the surgery was not successful and have some ideas, but would like to hear if there are others.
  • Perfectcare, that's my experience exactly. I posted my story above. It would be great to hear from you, and find out who did your surgery.
  • I had SI joint surgery on August 18 on the left side, no weight bearing for six weeks. After the six weeks the doctor said I could walk and since then I have had just as much pain as I did before the surgery and keep wondering if this will improve. Originally after the surgery there was no pain going down my leg but that has returned. I also had a lumbar fusion several years ago.
  • I just had a si joint injection yesterday. I have not had back surgery, but I have DDD in L3 through S1 with many other issues which translates into a very a back that doesnt have normal movement.

    It was explained by my physical therapist that when you have decreased mobility in your lower back, and also in your hip (I have a very tight hip), then the only other place for this energy to go is to your si joint. Evidently your si joint is a very strong joint, but once it starts to go can cause some serious pain. I will vouch for the pain and horrible spasms this can cause.

    Mitch
  • Hang in there Unacorns, you've had very serious surgery and there will still be a lot of inflammation and swelling, sometimes it gets worse before it gets better. They say one year is how long it will take before you know if it was successful. Have they said whether or not you are fusing? I had right si fusion on dec 29 2010, and I was non weight bearing for 3 mths, with the pain I was still in I couldn't imagine trying to walk at 6 wks. Unfortunately, mine started to fuse but didn't bridge the joint, so I'm going through it all over again in november. The pain I'm in is unbearable, and I'm on fentynal patches and hydrocodiene (sometimes they switch the hydos out for oxys), my life has completely changed from this. From being a high energetic type A personality to having to rest every 30 mins to help the pain. There's a mental and emotional toll which no one talks about. Good luck with everything.
  • I just had a ALIF on oct. 17 th on two levels L4-5 and L5-S1 with 4 screws and 2 spacers well after a week I started having non stop pain on my right side buttocks area. Now I went to my post op and told my surgeon my pain meds were not controlling my pain, I also told him about the painful area on the right side. So anyway he upped my pain meds then told me it sounds like my SI joint and is sending me with a referral for a SI joint injection. I go for my consult this ztuesday. Anyway I can't believe right after y fusion I am having more pain in this area and now have to have this injection. For those who have had it is it painful?.. If so how painful? Do they put you to sleep? I am also wondering if this is the problem what will happen will I now have injections for the. Rest of my life or what. I had bad pain in that area before the surgery with nerve shocks down my leg. Well the fusion fixed my legs so far but I still have back pain and of course this pain on the right side. Just need some input or advice from others who have been through this thanks.
  • With sedation the injections are not bad at all, I have had two in the last two months and they have helped me a ton. SI joint issues can be very painful if not treated.
    Best of luck to you, keep us informed on how you are doing.

    Mitch
  • The SI injections do help-----I was put to sleep,so I didn't feel anything.I have had 2 spinal fusions- one 4 years ago,and one 2 years ago.I am having trouble with my bootie and leg,and fear it is the si joint again
  • The SI injections do help-----I was put to sleep,so I didn't feel anything.I have had 2 spinal fusions- one 4 years ago,and one 2 years ago.I am having trouble with my bootie and leg,and fear it is the si joint again
  • I have had 3 fusions and am fused L1 to S1. Shortly after recovering from the L5-S1 I began to have more pain in the SI joint area. My surgeon said there is a block of bone on top of the SI joint and it is putting too much pressure on it. It was already weak.

    I have had 2 successful cortisone injections in each SI joint. They lasted 3 months. There is a limit to how many cortisone injections you can have. After so much time they do more harm than good.

    The next step is RFA radio frequency ablation (burning the nerves). I had several years ago in another part of my back that didn't work but some people have much success with them and when the time comes for my SI joint I will try it. It is supposed to be less painful than when I had them years ago.

    Good luck and stay in touch.

    L4/L5 laminectomy, L4/L5 360 fusion with instrumentation, L1 to L5 fusion, L5/S1 fusion w/ disc replacement, left and right SI joints fused.
  • I have been posting in the "recovering from surgery" forum. Guess I will be posting here for a while. I had lumbar fusion in March. The surgery cured my sciatica, but after about six weeks, I developed major pain on the outside of my right hip. This was diagnosed as hip bursitis. Got two cortisone shots that did nothing. Tried physical therapy and it helped.

    Had to stop the PT for my two-week vacation, and re-start it after I came back. The pain was becoming more pronounced in my lower back, hip, buttocks, and thigh. After more therapy, my PT told me that the bursitis was better, and my problem was really with the SI joint. Am praying that PT will get me back to normal. Does anyone know about prolotherapy?
  • I had prolotherapy years ago for SI joint issues. I never had much success. My surgeon says it has changed since then but my pain management doctor says its not worth doing.

    I have SI joint pain (2 cortisone shots verified that as I got relief) from the mass of bone from my fusions that are bolted to my pelvis and putting pressure on the SI joint.

    Next in my pain management, since this was my last cortisone, will be RFA. That used to be known as rhyzotomy, where they burn the nerves to get rid of the pain. I have had this in my spine with limited success. I know of people who get long time relief and others like me get nothing. I will be trying it as I have not done it in the SI joint and it might just work. Anything to avoid another fusion!!

    To be sure it is your SI joint you have to have 2 successful cortisone injections that give you pain relief. Then they know its the SI joint.

    Good luck!!
    L4/L5 laminectomy, L4/L5 360 fusion with instrumentation, L1 to L5 fusion, L5/S1 fusion w/ disc replacement, left and right SI joints fused.
  • Now that my PT has identified the SI joint as my real problem, I am discouraged about finding a long-term solution to my back pain.

    I am done with surgery. Have had 3 totally separate surgeries in the last 8 years. Knee replacement in 2003, pelvic reconstruction in 2009, and spinal fusion in 2011. I don't want any more injections or surgeries.

    Has anyone recovered from SI joint dysfunction by using PT as the only treatment?

    Thank you.
  • I went to PT for years with my SI joint problems and never found a good solution. Always worth a try tho. I am like you not wanting another surgery but nothing is working right now so it may be in the future.

    Good luck.

    L4/L5 laminectomy, L4/L5 360 fusion with instrumentation, L1 to L5 fusion, L5/S1 fusion w/ disc replacement, left and right SI joints fused.
  • In all the reading I've been doing about SIJD, it seems impossible to find a long-term solution that does not involve surgery.

    However, when I saw my PT last night, she felt that PT results worked more quickly with SIJD than hip bursitis. I hope she's right. For weeks, we thought the back pain was related to the hip bursitis.

    Darn doctor doesn't call me back. I don't even know if he is aware of my current status. The PT updates him, but I don't know how often.

    If I keep feeling like I do today, I need better meds. Any suggestions? Is Flexeril any good?
  • Asked the doctor for a different drug, because the Tramadol didn't do anything for my SI joint pain. He prescribed Naprosyn 500, twice a day. I took my first pill after dinner last night, and it gave me major GI issues this morning. Made it to work, but only stayed half a day. Couldn't deal with both the GI problems and the back pain -- oh, and the job stress!

    For now I'm taking ibuprofen alternated with tylenol, suggested by my boss, who is a nurse. She said that Naprosyn and OTC Aleve are really hard on your stomach. Wish I had thought to question the doctor about the side effects of such a high dose. Also wish he had thought of telling me about side effects. How long is it going to take for the physical therapy to really work? Thought we'd be done with it by Thanksgiving. So frustrated!!!!!!
  • The PT is finally working, and now I am much better than I was a month ago. I'm finished with PT, and can go up stairs and walk normally without pain (maybe a tiny bit of pain sometimes). It took over two months of PT to reach this point. Never really confirmed my problem was SIJD.
  • Glad the PT worked for you. My doctor changed me to neurontin and it works great on the nerve pain I was having. Still have bone pain in the SI joint but it is so nice not to have the rest of it which was really debilitating.

    Hope the PT continues to work. Keep us posted.

    L4/L5 laminectomy, L4/L5 360 fusion with instrumentation, L1 to L5 fusion, L5/S1 fusion w/ disc replacement, left and right SI joints fused.
  • L5S1 TLIF in June 2011, things got better, back to work and PT in Sept.

    About ~4 weeks ago pain came back but in the SI Joint area. Both sides.

    Pain kept going up. Now I have an SI belt and it helps but like maybe 10%.

    Neuro sent me to a PM doc after my post fusion MRI came up clean.

    SI injections this coming Tues.

    Just stopped the NSAID's Thursday and it now hurts REALLY bad.

    Tuesday can't come fast enough.

    It's an odd pain. Percs and Soma don't touch it. Only help after it cause havoc with it's neighbors.

    Was given Voltaren, but agan had to stop pre injection.

    The inflammation is pretty ugly right now.

    I am hoping injections work, but the 6 spinal I had for the L5S1 stuff prior to surgery never did.

    Fingers Crossed.

    So what's the gold standard to calmer waters for us post fusion SIJD people?

    Thanks
    -wsn
    Jun 2011 -TLIF @L5-S1
    Mar 2012 -NonUnion @L5S1
    May 2012 -Multi Level Discography
    July 2012 -XLIF 2Cages @L3L4/L4L5
    Aug 2012 -All New Hardware @L34L45/L4L5/L5S1
    Mar 2013 -FBSS = Pain Management until they figure it out.
  • I have had good success with voltaren after trying almost every other anti-iflam. I also had many cortisone injections in my spine that did not work but for some reason I got relief from the injections in my SI joint so am hoping for the same for you.

    Good luck and keep us posted on how the injections go.

    L4/L5 laminectomy, L4/L5 360 fusion with instrumentation, L1 to L5 fusion, L5/S1 fusion w/ disc replacement, left and right SI joints fused.
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