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Annoyed & Confused!!

durrrrddurrrr Posts: 10
edited 06/11/2012 - 8:58 AM in Sacroiliac (SI) Joint Problems
Hello all.. I have posted before regarding my problems, yet now I am more confused than ever.. I have had a l5-s1 TLIF 1 yr ago and achieved some relief in my low mid back and about 70% in sciatica in my left leg. I had DDD, and severe annular tear at that level and it was confirmed as a pian generator through discogram. Jump forward to July of this year. Met with neurosurgeon and explained yet again the increased pain in my left low back to the side of my spine and into my buttocks and groin. He said well I will send u back to PM I believe u may have had SI Joint issues all along and we under estimated the severity. But u also needed the fusion at the l5-s1 level due to the severity of the pain u were having and all looks well as far as union at that level. I return to PM and they do the initial injection with lidocaine and I got immediate relief for 6 hrs and the pain gradually returned. 2 weeks later another injection this time with cortisone. Immediate relief and within 2 weeks the severe pain had returned. Next a diagnostic nerve block was done with lidocaine on the lateral branch nerves. This was painful and eased when numbed and the pain returned. The PM said I am confident this is your problem and a RFA will help since those nerves responded to the block. So 4 weeks ago I do the ablation. Despite the pain after I assume it will get better.. Well now I am in just as much pain as before and have an even tougher time rising from sitting, turning over in bed. So here's why I am so confused and really annoyed. I have had relief with all the injections etc but short term and was told the RFA would ease the pain. Well since it's been over 1 month since the ablation the PM has sent me back to a neurosurgeon in the same group who specializes in SI Joint fusions. 1st of all how is it possible to get the relief I have gotten yet to only return if they are so positive this is my prominent pain source? Is this common? They are gonna run tests for HLA-B27 to see if some of it's auto immune? Okay why hadn't this been done before now? If it's positive and they think that's one issue will the fusion help the pain there yet get worse somewhere else? The fusion would be with SI_Bone I fuse which I have had a friend have and gotten good results 1.5 yr post op. I meet the surgeon tomorrow and really don't know what to say. What ?? to ask etc. Can anyone help with all this boggled up anger and lack of answers? Any one had the IFuse done and had negative results? Any advise or answers would be appreciated. Thank You!!


  • Its always very complicated for them to realy know what is realy the pain generator if you ask me, I had similar situation where injection helped but the rfa made it worse,

    This is why surgery is such a gamble because from what i read most failed surgery is actualy from having surgery which was realy not the main cause of the pain to begin with,
    Many times the biger issue was elsewhere all along so when they fuse the spine the other issue becomes now greater,

    In my view is when injection is done for testing the medication they inject reaches other areas also and thats rhe reason person gets releif and makes them think its where they acfualy intended to inject is where the main problem is when it actualy is not always true,

    Best thing is always get more then one opinion to make sure at least more then 1 dr agrees on the findings to have a beter chance i think,

    Unless its a situarion where a persons mri clearly shows a level has got totaly unstable from some form of accident and its very clear it needs to be fused to make it right, i think sometimes other situations become a guessing game on what surgery to do if any,

    I was told once the 1 st surgery did not help a person because it did not do what they thought it would acomplish then its now much more complicated to figure out what will help the patient,

    This is why you see many times a person posibly has that 1 surgery and recovers and does ok with only some minor mechanical pain which is normal and move on in life without posible further complicarions,

    While some of us just keep going back for more surgery and get more damage left behind with each surgery with more scar tissue build up that now they cant do anything about,

    I am not saying this is also in your case but i feel its something to keep in mind,
    We many times have to call the dr out and question his or her reason for the surgery if we think they might be wrong because its us who will have to deal with there failure and suffer if surgery was not called for or the wrong surgery is what was offered up without all the confirmation to show where it was realy needed,

    Good luck. And dont rush in to anything unless you are convinced with other opinions from diferent specialists,
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • I agree this can get very complicated. It appears you are fused along the lumbar spine to L5-S1. These models to diagnose painful symptoms are not perfect. It would be reasonable to assume the sacroiliac is the most likely pain generator. The reason for this is the concept of adjacent painful syndrome. As long as the fusion at L5-S1 is solid based on CT then here is the appropriate algorithm toward diagnosing pan emanating from the sacroiliac joint. Tyoically when the diagnostic sacroiliac joint injection is performed it should be performed twice under xray guidance where the needle into in confirmed using contrast. You should then feel at least a 75 percent reduction of your symptoms with certain activities that provoke your symptoms. If this is true then a steroid injection is the next appropriate step. However I would agree a 2 week response is a minimal response. However it is worth noting that steroid injections in patients with previous spine surgery have not done particularly long term and this is why additional technologies have been proposed as the new treatment for pain emanating from the sacroiliac joint. The IFUSE product which minimally invasive sacroiliac joint fusion by SIBONE is something I would consider if the repeat diagnostic sacroiliac joint injection using just anesthetic is positive again in the presence of the solid L5-S1 fusion. I hope this helps. Best of luck.
    Amish R Patel DO, MPH
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