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sacroiliac inflammation post-fusion

livingforwardsllivingforwards Posts: 29
edited 06/11/2012 - 9:02 AM in Back Surgery and Neck Surgery
I am 13 weeks post surgery (360 fusion L4-5, L5-S1) and have only had a few days of being pain free. With increased effort in walking and PT, I have developed more back pain plus tingling and burning down both legs into my feet.

Saw the neurosurgeon today and he said it's probably inflammation of the sacroiliac joint because of increased load now that the two levels don't move. He said about 50% of patients with my type of fusion develop some sacroiliac pain.

Has anyone else here developed this pain? I'm supposed to just chill out back on lortab which I've been off for weeks now until I get a diagnostic and steroid shot into the joint next week.


  • I did develop SI joint problems soon after my L2-S1 360 fusion. I had the same symptoms you are describing and there are multiple injections and tests to determine if the problem is coming from your si joint. You are also early in your recovery and there will be strange sensations and pain from the surgery as nerves and muscle etc are healing. Sounds like your NS is looking out for you and I would just chill out as you say until they do an si injection. Kevin
  • Thanks for responding, Kevin.

    This whole thing is so frustrating as I'm normally very active. I know it's early days, but... GAH! From where I am right now, it certainly doesn't look like a great recovery is gonna happen no matter whether I put in enormous effort or take it slowly and carefully. My body is just not happy. I have 4 bulging disks in my neck that are hampering PT too.

    I have a great Neuro team for my lumbar work. Neck is workers comp which scares me to death.

    Did you experience any significant foot/ankle pain trying to walk with the SI instability?
  • I did have a lot of pain (a burning pain) in both feet. My main complaint was sharp pain on both sides of my low back on both sides. About the same place that we have that dimple in our low back. I hope you get your problem resolved soon. I know it is no fun. Kevin
  • I have SI joint pain after being fused L1-S1. Like xMAR said the stress of a block of bone sitting on the SI joint causes problems.

    The gold standard for determing if it is the SI joint is cortisone injections. If you have 2 that successfully eliminate the pain then it is the SI joint. I had my 2 last summer. That is all you can have as then it becomes destructive.

    I also was very active. I started walking soon after my surgeries and was able to walk long distances. I also swim and got back into the pool when the incision healed.

    It is a long recovery tho and often goes slowly. You think you will never get better and then one day you do.

    I have always done core strengthening and i know that helped me in my recovery. I still do.

    It took me 3 years to be able to ride my time trial bike. But I never gave up hope. Now I can't even ride my road bike or commute bike because of the SI problems.

    You are still early in your recovery. I had unusual pain after one of my fusions that I had not had on others and the doctor said a ligament was stretched when they had to replace the disc and would take some time to heal.

    Good luck and please let me know how you are doing and what you decide to do. I see my spine surgeon on wed to talk about SI joint fusion which gives me nightmares just thinking about it!!! Thankfully I have a wonderful surgeon.

    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.
  • Hi all,

    I see so many of you have had so many problems that are far worse than mine. My heart goes out to you - hopefully one day you will be able to at least walk for a mile, ride a bike, pick a flower, and other things you may have enjoyed at one time.

    My question is about my surgery that I had 11/3/11 by a well-known surgeon in south florida. After about 4 weeks the surgical pain began to subside, and I actually had a day here and there with little pain.
    2 years prior to the surgery I had been experiencing a high degree of pain in the hips, around the SI joint area. Unfortunately, those symptoms returned after about 5 weeks so i saw my surgeon. He thought I kept returning for the surgical symptoms and kept telling me give it time to heal (at first it was 4-6 months, then he said up to a year) ... I said I'm not here for the back but my hips. He said well, I can't help you with that. See the pain doc for injections. He made me feel like I was being such a "pain" (pun intended) by asking about these symptoms, and possibly a problem with the surgery. And of course, now 6 mos. post surgery, the same pains have all returned with a vengeance!

    How have you all dealt with the return of your symptoms? What type of doctor performed your surgery? I am so over this! sick of all the pain, all the time. As I'm sure many of you are. Positive outlook sure helps make it through the day, doesn't it? Well, thanks to anyone who wants to reply.
  • If you think you are having SI joint problems then you need to find a pain management doctor who can give you cortisone injections. If your pain is successfully reduced or eliminated (only for a short time, they don't last forever) then that is considered the test for SI joint dysfunction. You have to have 2 different injections with good results before it is considered SI joint dysfunction

    From there I would suggest a spine specialist. SI joint fusions are not common so you may need to do some research.

    I believe an MRI is next as x-rays are supposedly not good at showing SI joint problems.

    Hope that is helpful for you. Good luck and let me 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.
  • Hi Jani,

    Thanks for your reply. I actually just had si joint injections yesterday, 2 on each side. My pain doc did say what you're saying, that it is for diagnostic. He said if they are successful then a procedure can be performed to deaden the nerves involved(I had similar result early last year, but had other problems too). He mentioned the cauterization of the nerves to stop the pain for a while. I've read some posts about this procedure, and it works for some, not for others.

    Before I have this done, I suppose I need to see my spine surgeon for a 6 month follow-up. I'm not crazy about going to see him as he's probably sick of seeing my face! tough! He may want to do an mri which would be helpful in determining whether I have the procedure done or not. Take care, and thanks again for your reply. Hope you're doing ok today.
  • Glad to hear you have started with the injections. I have had the nerve endings burned (all in my spine, never SI) many times but without a lot of success. I had the procedures done years ago when it was a very painful procedure but I have heard it is much less painful these days.

    Good luck seeing your surgeon. Remember, he is supposed to be there to help you!!! I see my surgeon today to determine what the next step is for me.

    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.
  • Hi Jani - what did your surgeon say would be the next step in your treatment? Just looking at some of the surgeries you've had, oh my! and I think I have it bad...you've been through so much. And the nerve ending treatment (burning to deaden) didn't really work for you? I kind of don't like the idea of damaging my nerves like that. Kinda creeps me out, and I can imagine what the pain would be for several days (weeks? months?) afterwards while the body heals. I would be asleep during the procedure, there is no way I'd be awake!
    Phoned my surgeon's office, and I decided not to make an appt. because I'm being told that he won't do anything like xrays, etc. unless I am in pain. Well, how do I find out if the fusion really was successful, etc....not sure what I think of this doc. I hope you got some hopeful news yesterday from your doctor. The road is long, is it not? just get through today, that's all we've been given. Take care, I'd like to know what's happening with you
  • Seems strange that the doctor wouldn't do an xray. I always had xrays to determine how well my fusions went.

    And no, the rhyzotomies did not work for me. I had it done 4 times in 2001 and then again about 5 years ago, 2 or 3 times. All I got was a lot of pain during the procedure.

    I had a disappointing visit with my spine surgeon. He does not do SI joint fusions and doesnt' think I should have one. He wants me to do prolotherapy which I have had years of in the past and no relief.

    I do not think my surgeon really listened to me when I described how much pain I am in. The pain has changed recently and gotten worse. He palpated the SI joint and it was very tender.

    My pain medicine doctor here, who did my SI joint injections, does not believe in prolotherapy. She has 4 medical degrees and was named to the top 100 doctors in the US list. I have a tremendous amount of respect for her. I have made an app't to see her next thurs to see what she thinks my next step should be.

    So now I am waiting til next thurs. I need to find a surgeon who knows about SI joint dysfunction and that seems to be a hard task. I just want to know if I am a candidate for SI joint fusion. I know my body very well and know when something is not right. And since my pain level has changed and the pain pills are no longer working something is up.

    Hope you are doing ok. I know it takes several days at minimum for the injections to take effect. Hope they do for you as it is nice to have a break from pain.

    Keep me 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.
  • I've been doing a bit better painwise without physical therapy and daily walking, just a lot of slow, boring pottering around the house - can't stay in one position more than a few minutes. I know other people here have the same frustrations. Lortab is not worth the constipation - frustration upon frustration!

    The pain mgt office has my referral, so hopefully I'll get in for the diagnostic injection early next week.

  • Jani

    Sometimes the docs just don't understand the pain we have and how it directly affects our lives. I hope this other doctor you're seeing will help you. What is prolotherapy? And have you ever tried accupuncture? I have not, and just like anything else, it works for some, not for others. I think since we have actual problems like pinched nerves, disc dessication etc. all the pt, and other pain relieving treatments are temporary and cover up the real issues. On so many posts I've read, people with spine problems that have surgery, the problems get worse, but usually not better. We have to live with this for the rest of our lives? I never want another back surgery ever! But, there is one man I work with who has had 3 back surgeries. The most recent, he had rods and screws across I think 6-7 levels. And now, he feels great...he went to a teaching university hospital and his doctor comes highly recommended. Maybe next time....

    The si joint fusion seems really scary, but so do all the other surgeries, right? Do you have a full-time job? How do you do it every day? I just plug along one day at a time. Take care, and try to make it a great day!
  • the injections you had on May 2nd. Did they relieve your pain? Completely?
  • I had a fusion last year in May on L4 L5.

    Post op I initially had the "normal" pain, but then I developed searing and burning pain in the groin, low back and into the leg.
    I am also in FL at a teaching hospital and after xrays, and a myelogram the determination was that it looked like the SI joint.
    I went to pain mgmt and did have the "gold standard" with some relief, then I had the RFA but it really didn't do much for me.

    My surgeon wants to do the fusion on the SI joint. But I have a complication that is pushing it off for now. I have CRPS/RSD in my right arm. The pain and loss of strength prevent me from being non weight bearing (using the walker) for the post op time needed.
    I did finally find a great PM doc who treats the CRPS and have found a little relief.
    One day at a time...

    I hope for you that it is just early in the healing time and that your pain subsides soon.

    take care
  • Prolotherapy has been around a long time. I started with it in 1997 or 98. It is where a saline solution is injected into the inflamed ligament and the theory is that the saline irritates the ligament and it grows back stronger. I had it a lot in the late 90's and then off and on thru 2001. It never worked.

    RFA which was then called a rhyzotomy then and actually burned the nerve endings nerve worked either.

    Accupuncture didn't work.

    All my surgeries were successful in that they eliminated the pain the immediate problem was causing. But because my spine was so deteriorated it continued to deteriorate and so I needed another fusion and another fusion to stabilize it. Now I have a huge block of bone sitting on the SI joint which was the original impact site in the accident. so I have come full circle.

    I am hoping I can get some answers from my pain management doc. She has 4 medical degrees and was ranked in the top 100 doctors in the US so she is pretty damn smart.

    I have done some research and there are not many surgeons who do si joint fusion. I will have to go to a large teaching university. I live in a small town in Idaho so this is going to be a real pain. I can't imagine having a surgery and then having to get on an airplane to go home. I can barely make it home from the hospital 20 minutes from my house. I may live in a small town but we have excellent doctors since it is a ski resort.

    I have taught skiing to kids for 38 years and I did have to take a leave of absence for a few years but am back doing it. Of course I can't ski like I used to. Being on my feet and moving is probably the best thing for me. Picking up little kids is not. I work for the resort in the summer too. I have a job that does not require sitting and involves some walking so that is good. Sitting kills me.

    Anyhow enough. I am on vacation this week and going to lunch with an old friend so looking forward to that.

    Hope your day is going well.

    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.
  • been on sh lately. The injections unfortunatley didn't help my si joint pain so i was not a candidate for the nerve burning treatment. I can tell you that the SI joint fusion, if it comes to that is not that bad at all compared to spinal fusion. It's 2-3 days in the hospital, but the worst part of the surgery is the recovery. you are non weight bearing on which ever side needs to be fused, which means you are on crutches for 8 weeks. It is just a pain in the butt to use crutches for everything. I had to have both si joints fused, so it was done 6-8 months apart. You will not notice any lack of motion from the surgery, which is what my surgeon said and I didn't. There are not many surgeons that do SI fusions, but I had them done in Minnesota and if you want to pm me, I can give you his name. Maybe i already did. Anyway I thought it wasn't that bad at all, but that's comparing it to a huge fusion that I and Jani had. I hope whatever you decide to do works out great for you. It's no fun being in pain and only us spineys can relate to each other about that. God Bless Kevin
  • The injections relieved the pain I had in my hips for about 24 hours. After that it started coming back but it isn't quite as bad as it's been. So no, the pain was not relieved completely, but I think the diagnostic question is answered, confirming I do have si joint issues. The "pulling" in the lumbar area is from the surgery and it is painful and uncomfortable. Yikes! Thanks for asking. How are you doing?
  • When you had your SI joints fused was it the traditional method and take bone from your hip or did your surgeon use IFuse?

    I live in Idaho so probably a trip to Minnesota is out of the question. I am looking for a surgeon a little closer to home.

    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.
  • The surgeon used BMP which is mixed with your bone marrow. I would check with your insurance company first to see if it is covered. BMP is a contraversional way to fuse, and is very expensive and not covered by most insurance companies. It cost about 8,000 dollars per side for you si joints and they used it for my 4 level lumbar fusion, which didn't fuse at l5-S1 and that was 38,000 for the BMP. Be sure and check on that. Kevin
  • I have never heard of BMP. IFuse is a new minimally invasive fusion that very few surgeons are trained it. I would assume the surgery with BMP is like a traditional fusion with your own (or other) bone grafts.

    I will remember that tho. Thanks.

    I am still trying to find a doctor close by. I see my pm doc and thurs and then I am going to start calling some of the university teaching hospitals to find out if they have a SI joint specialist on staff. Unless she knows of anyone.

    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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