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SI Joint pain!! Post lumbar fusion..

durrrrddurrrr Posts: 10
edited 06/11/2012 - 8:56 AM in Lower Back Pain
Hello.. I had l5-s1 TLIF in Jan 2011.. I have been back to the neurosurgeon every 3 months for xrays and he says all looks well.. Some union taking place etc.. I explain to him that the leg pain subsided about 50%-60% post op. However my back pain has only decreased maybe 30%.. He says that it will take some time and be patient.. Okay I can accept that.. I then adress the extreme pain to the left of my spine, my hip and buttocks that is more intense than before the fusion.. He looks baffled.. Said since discogram was positive for discogenic pain he attributed my pre-op pain in that area to the DDD and annular tear.. He leaves and comes back and says u may have SI Joint issues worse than 1st diagnosed and now the fusion is creating more stress on the joint. Sends me to PT to adress the pain.. The PT makes the pain excruciating, so we scratch that idea.. He then sends me back to PM doctor who did my original ESI Injections, Facet injections yet never adressed the SI Joints before.. WTF why do they not adress this at most PM clinics? All the symptoms were there. So he does a diagnostic shot and the pain virtually subsides, yet returns about 6 hrs later just as before. Shazamm that's the pain source.. So they now have done 2 sets of injections with cortisone with zero relief. Only relief is for maybe a week then it's gone.. I'm set up for a 3rd on Oct 10th. If this fails then he says I am out of options there at the PM clinic.. They do offer the ablation at the SI Joints but he admits it's rarely succesful doue to the nature of the nerves in that area. So what do to then? He said I may need to see a Ortho Spine surgeon to look at a fusion of the SI Joint.. He said even though it isn't hyper mobile a lot there is instability, worn down, and the pain can't be managed that that would be the next option.

So has anyone on here had a similar issue? If a fusion was done what was the outcome? Am I out of the norm with what has happened? I don't wanna take pain meds for life, yet I am scared of a SI Joint fusion.. Just really frustrated no one adressed this 3 years ago when I first brought up the pain indicators.. Maybe it could have been avoided now? Any advise or encouragement would be appreciated.. Thanks!!



  • I cannot believe how closely your experiences mirrors my own.

    I had a 2-level fusion in July 2010. At first, everything was going really well, but slowly, the same old back pain has crept back!

    Earlier this year, I saw the surgeon and was confused as to why I was still getting the same old back pain as I had before surgery. He decided that it could be coming from the SI joint and ordered a steroid injection. I had that done in May.

    The very first night of the injections the pain went. Amazing I thought, we've cracked it. But no, by the following day it came back and has remained with me pretty much ever since on a daily basis.

    I would also say that I'm having awful problems at work at the moment and have officially applied to reduce my working hours from full-time (37 hours per week) down to four days (29 hours p.w.). I know they will probably reject my request as it is "NOT in line with THEIR service provision". It doesn't seem to matter that working with children in both secondary and primary schools, as well as working with toddlers and babies on the floor is really making my back pain far worse. To the point that I'm always going to and fro my local doctors to try and get on top of it.

    I'm on Butrans patches as well as morphine solution as/when it's required, but now I'm dealing with a different monster - depression! It's awful and the side-effects from the first prescription were awful, I thought I was dying after having gastric pain for nearly 8 hours solid! My doctor has since changed my tablet and hopefully this new one will do the trick - but it makes me feel 'wacky' during the day and, although I do sleep at night purely because of this new tablet, I'm still waking with back pain and feeling like rubbish first thing in the morning!

    Anyway, I'm visiting my surgeon again tomorrow to discuss the results of the injections (in May). I am also confused because I was assured that the discogram I had prior to fusion surgery was 'positive' and prooved 100 per cent that my discs were pain generators - hence the fusion surgery in the first place. But now, a year later, I'm still having the same pain (and on some days even worse!). It makes me wonder if the SI joint was also a factor in the first place, but because the discogram came back positive they didn't look for anything else. And why should they? I thought the same as them at the time.

    I'm on sick leave at the moment after going back to work for the first week of the new school term!!! My employers have a lot to put up with where I am concerned, but I cannot help it. Also, the worry of losing wages because I'm on sick leave is not helping at all either.

    I don't want to have any more surgery ever again (I've already had 3 spine surgeries) and I'm beginning to resign myself to the fact that my pain will never go away. Even my doctor and Occupational Health physician have both said that the pain I feel now will be with me for life and will probably get worse as I get older. Well, it's true!!! This past year has seen me (little by little) return to the same physical/mental state I was in pre-fusion surgery, only now it seems to be getting worse as I get older (I'm 54). I'm in a quandry to know what they can do about it, but I suppose I'll find out tomorrow.

    I hope you get some more people posting their comments because it would be interesting to find out if other people are experiencing the same problems.

    I hope your professionals can help you to relieve your pain levels.
    2 x Microdiscectomy 2005 / PLIFusion 2-level 2010 / revision surgery 2011 / NEVRO Senza spinal cord stimulator implanted February 2013. I WILL NOT GIVE IN / UP !!
  • It seems that so many of our stories are very similar. Maybe it is just the nature of a degenerating spine?
    I had lumbar fusion l4 5, in May. I continue to have pain and some(thru the groin, buttock and left leg) that I didn't have before surgery.
    so now the PM doc is planning a shot in the SI joint (sound familiar?)
    I really don't have answers, but rather just offer my info to let you know you are not alone.
    take care!
  • Yes it does sound familiar. I am fused L1-S1 and as my surgeon says there is a huge mass of solid bone bolted to my pelvis, sitting on top of the SI joint. I build bone very well so I am well fused.

    I had a cortisone injection, under protest, since I had had so many in the past that did not work. It didn't work but I agreed to have another since she was unable to get in very far due to scar tissue. I had a relaxant both times but the first time they were too late in administering and I flinched even before the needle got close so was very tense. The next time I was out and it was very successful. The PM doc was able to get into the SI joint and the shot actually worked. I am going on 3 months now. Also still on pain meds and a new anti-inflammatory (voltaren) that actually seems to work. I know cortisone won't last forever and even if I have success they will stop working period.

    My spine surgeon says the next step is prolotherapy which I have had before in my upper lumbar spine. He says this is different than what I had years ago as they actually go into the SI joint. Might be worth asking your doctor about.

    I have had rhyzotomies before, again in the lumbar spine, and they have never been successful. I don't know if they are successful in the SI joint.

    For now I will continue with the cortisone and get another when this one wears off and hope it works. I cannot imagine having my SI joints pinned and being 2-3 months non weight bearing for each side. I think I would shoot myself first!!!! ~X( Not really!!

    I live day to day with my pain meds and anti-inflammatories and hope the cortisone lasts a little while longer.

    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 am almost 2 years post L5-S1 TLIF, and have had similar SI problems most of the time.You might get some relief from the Serola SI belt. I also have immediate calf pain, on sitting. I had a very painful, prolonged reaction to BMP reaching the nerve roots after surgery, but the radicular pain is getting worse again, and I will be getting some follow up scans. It sure feels like pressure on the nerves when sitting, but might be related to scarring too. Definitely seems like the changed mechanics can impact the SI joints.It sucks....
  • Yes I have the SI belt which I wear off and on.I get mixed results from it. And you are right, it sucks!!

    Good luck and let us know how you are doing.
    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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