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SI fusion

perfectcarepperfectcare Posts: 3
edited 06/11/2012 - 6:03 PM in Sacroiliac (SI) Joint Problems
I had an SI joint fusion and I am still experiencing the same pain. How can I find out what went wrong and can the surgery be redone?


  • Asking your dr would be a good place to start, Good luck. Let us know what you find out,
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • This is very interesting. So you had an interbody fusion at L4-5 with removal of hardware but the artificial disc is still in place. What symptoms did you have prior to the interbody fusion? More pain from the buttock down the leg or above the buttock region along the low back region?

    If the pain is along the low back and leg more specifically the buttock and down the leg. Which area is more intense the low back or the buttock down. If it appears that the low back pain is lower like along the belt/waist line it is possible that the artificial disc is placing extreme stress along the L5-S1 zygapophyseal joint causing a painful syndrome call facetogenic pain syndrome. The method to help delineate whether this structure at L5-S1 could be the source of the pain is to have a diagnostic lumbar medial branch block at L5-S1 under xray using no more than 0.3 to 0.5 ml of anesthetic in the form of lidocaine or bupivicaine demonstrating greater than a 75 percent reduction of your symptoms with activities that typically exacerbate the symptoms (standing, walking more than sitting). If this diagnostic injection is positive then it should be repeated a few days later for consistency of results. If positive again then a radiofrequency ablation of the medial branches at L5-S1 would be the next step. However if the low back pain is higher then perform the diagnostic lumbar medial branch block at L3-4 (above the artificial disc).

    Now if the pain is more buttock down the leg what are the findings seen at L5-S1 on your imaging studies? A herniated disc, formaminal narrowing that moderate to severe, synovial cyst? If none of the above then is the artifical disc displacement posteriorly causing spinal canal stenosis at L4-5? If yes maybe you are suffering from radicular pain from the L5 vs S1 nerve root distribution.

    However if there are no findings seen at L5-S1 or L4-5 like I mentioned earlier then maybe you have sacroiliac joint pain syndrome. Did you have a diagnostic sacroiliac joint injection under fluoroscopic guidance using contrast to confirm needle placement with just anesthetic injected into the joint demonstrating greater than a 75 percent reduction of your painful symptoms with provocative movements? If yes was it repeated again to look for consistency of results. If yes then the sacroilaic joint fusion using Ifuse was an excellent choice if you failed conservative treatment like pelvic stabilization, sacroiliac joint belt, and/or cortisone into the sacroiliac joint. If all of the aformentioned has been done I would get an updated imaging study of the pelvis to see if there is any evidence of a sacral insufficiency fracture. Depending on your bone mineral density (osteopenia vs osteoporosis) it is possible that you may have this finding secondary to lack of motion of the pelvis. Hope this helps. Best
    Amish R Patel DO, MPH
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