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after si ct scan doc says I need surgery

wwlady41wwwlady41 Posts: 131
edited 06/11/2012 - 8:58 AM in Sacroiliac (SI) Joint Problems
Hi all, I am hoping for a bit of feedback. I have already had cervical and lumbar fusions. Due to ongoing pain and the results of the physical exam both my pt and neurosurgeon are both convinced the pain I am experiencing is from the si joints.
I have had the first round of injections in the si joints as well as the facet injections.

My ns requested a ct scan of the si joints. He shared the results with me and said that my low back and both si joints show extensive arthritic changes, deterioration to both si joints, the left being greater than the right. He then said that he can do the fusion surgery to repair.
Right now there is also another issue, my right arm and shoulder. Again arthritis, some small tears in the rotator cuff and what they are calling rsd in my forearm and hand.

Those arm issues would prevent me right now from doing the si joint surgery since I cannot use a walker.
Truthfully all of this has me more than a bit overwhelmed. And I really don't understand why all the docs come back with test results saying how I have much more arthritis than they expected.

if anyone has any thoughts it would be wonderful, I am just trying right now to take some time and relax the best I can. I do not believe all this stress is great for healing...


  • Hi,

    I also have SI joint issues after being fused from L1-S1. Too much solid bone on the SI joint which was injured in the original accident and then the rest of my spine slowly deteriorated.

    I have had cortisone injections successfully, which was therapeutic as well as diagnostic but have reached the limit for them. Next I am scheduled to have prolotherapy which I have had before but never in my SI joint. It is injections into the ligament with a saline or sugar solution that irritates the ligament and theoretically it is supposed to rebuild itself stronger.

    If that is unsuccessful the next step is RFA (radio frequency ablation) where the nerve endings are burned to ease the pain. I have had that before also, but both the RFA and prolotherapy were more many years ago and supposedly both have changed for the better. I am hoping for some relief from one or the other to avoid having more fusions.

    Ask your doctor about the possibility of having something else done to deal with your pain since you are not a candidate for fusion surgery.

    Good luck and let me know how it goes.

    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.
  • Just because a CT demonstrates SIJ degeneration does not mean the pain is caused from the SIJ. Your fusion is at L4-5 only. It is possible the SIJ could be the source but also the L5-S1 facet joint is also a possibility. If you are curious as to whether the SIJ is the source of your pain, the current gold standard towards diagnosis at this point is to perform a diagnostic sacroiliac joint injection under xray guidance. Contrast should be injected into the joint to confirm needle placement and the solution should only be an anesthetic (lidocaine or bupivicaine) If you demonstrate at least a 75 percent reduction of your typical symptoms with certain activities that provoke your pain then get it repeated. If positive again then I am convinced it is with a reasonable degree of medical certainty that you suffer from sacroiliac joint pain syndrome. However if these diagnostic injections are negative I would explore whether the facet joint at L5-S1 in truly the source of your pain. Hope this helps.
    Amish R Patel DO, MPH
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