SI Joint Fusion - anyone?

[TripleB]

My wife has been dealing with sciatica pain (lower back, buttocks, leg) for almost a year now. Herniated L5 disc and her SI joint is extremely swollen and inflamed. She's had shots, massages, Muscle RX, chiropractor, rubs, medicines - basically she's tried everything except surgery and nothing has helped. It hurts with every step she takes and at least 3 days a week it brings her to tears. Sleeping each night is an adventure because laying down brings her pain. She feels surgery is the only possible thing that can possibly help.

She's considering SI Joint Fusion. Has anyone had this surgery, and if so, did it help with the pain?

Is there anything else she can try?

I appreciate any help you can provide!

TripleB

 

[yossarian]

Has she tried physical therapy

 

[TripleB]

Has she tried physical therapy

Yes she has.

TripleB

 

[yossarian]

Yes she has.

TripleB

Obviously it’s an extremely personal decision but if she truly has exhausted all other options and believes that surgery is the only thing that will help, then it might be the case. I don’t know the outcomes associated with that kind of surgery but it from a quick search it seems like it has pretty good success. Just find an ortho you trust and know the risks

 

[S&V-not_dead_yet]

My wife has been dealing with sciatica pain (lower back, buttocks, leg) for almost a year now. Herniated L5 disc and her SI joint is extremely swollen and inflamed. She's had shots, massages, Muscle RX, chiropractor, rubs, medicines - basically she's tried everything except surgery and nothing has helped. It hurts with every step she takes and at least 3 days a week it brings her to tears. Sleeping each night is an adventure because laying down brings her pain. She feels surgery is the only possible thing that can possibly help.

She's considering SI Joint Fusion. Has anyone had this surgery, and if so, did it help with the pain?

Is there anything else she can try?

I appreciate any help you can provide!

TripleB

I'm not doctor, just an athlete with some experience.

I've had spine problems in various spots, including L5/S1. Mine was fixed with an intensive PT regimen of not just stretching the back but also strengthening the core and loosening the hamstrings.

The back stretch was akin to what's being shown here:

except, as you get more advanced, you keep your hips on the ground and raise your chest. The wider your hand placement, the easier it is.

For a more complete stretch, my PT would plant his hands on my lower back and push down as I was pushing up. I got the impression that the point was to push the disc back in between L5 & S1.

Obviously, if it hurts, don't do it. But I actually got relief this way.

A strong core and loose hammies help to absorb shock; the weaker the core and the tighter the hammies, the more that shock will go straight to the lower back.

Before I started PT, my condition was so bad that I couldn't bend at the waist to drink from a fountain; I'd have to bend my knees and lower my entire body.

I'm pretty sure your wife has already tried these things but on the off-chance she hasn't, I hope they help.

 

[yossarian]

I'm not doctor, just an athlete with some experience.

I've had spine problems in various spots, including L5/S1. Mine was fixed with an intensive PT regimen of not just stretching the back but also strengthening the core and loosening the hamstrings.

The back stretch was akin to what's being shown here:

except, as you get more advanced, you keep your hips on the ground and raise your chest. The wider your hand placement, the easier it is.

For a more complete stretch, my PT would plant his hands on my lower back and push down as I was pushing up. I got the impression that the point was to push the disc back in between L5 & S1.

Obviously, if it hurts, don't do it. But I actually got relief this way.

A strong core and loose hammies help to absorb shock; the weaker the core and the tighter the hammies, the more that shock will go straight to the lower back.

Before I started PT, my condition was so bad that I couldn't bend at the waist to drink from a fountain; I'd have to bend my knees and lower my entire body.

I'm pretty sure your wife has already tried these things but on the off-chance she hasn't, I hope they help.

that's just a typical McKenzie extension exercise. People tend to respond well to extension. Theoretically it is supposed to displace the disc anteriorly and reduce the herniation, though I think imaging studies have shown that doesn't actually happen. Still works, though

Agree on the core stabilization. Pretty much anyone could benefit from it and it plays a big role in SI stabilization as well. In my experience, people with tight hips also compensate for limited hip ROM with increased motion through the spine, which can also cause back issues

 

[S&V-not_dead_yet]

that's just a typical McKenzie extension exercise. People tend to respond well to extension. Theoretically it is supposed to displace the disc anteriorly and reduce the herniation, though I think imaging studies have shown that doesn't actually happen. Still works, though

Agree on the core stabilization. Pretty much anyone could benefit from it and it plays a big role in SI stabilization as well. In my experience, people with tight hips also compensate for limited hip ROM with increased motion through the spine, which can also cause back issues

Right, forgot about the hip. Basically, my PT's approach was to address the entire body rather than just L5/S1, on the theory that where the pain is isn't necessarily the where the root cause is.

 

[Dartagnan64]

Surgery for isolated mechanical back pain is tiger territory. In general 1/3 get better, 1/3 get worse and 1/3 stay the same. If your wife is young and active, fusing one joint will just accelerate degeneration in other joints and likely cause more issues.

She should see a rheumatologist and see if the SI joint inflammation is related to HLA B27 Spondyloarthropathy or ankylosing spondylitis. That may respond ot very different treatments than what she's been doing.

 

[yossarian]

Surgery for isolated mechanical back pain is tiger territory. In general 1/3 get better, 1/3 get worse and 1/3 stay the same. If your wife is young and active, fusing one joint will just accelerate degeneration in other joints and likely cause more issues.

The SI joint barely has any motion anyway. Would fusion really have the same kind of negative outcomes associated with something like lumbar fusion?

ankylosing spondylitis

I'd think that any ortho would have included this in their differential dx?

 

[RogueFLIP]

My wife has been dealing with sciatica pain (lower back, buttocks, leg) for almost a year now. Herniated L5 disc and her SI joint is extremely swollen and inflamed. She's had shots, massages, Muscle RX, chiropractor, rubs, medicines - basically she's tried everything except surgery and nothing has helped. It hurts with every step she takes and at least 3 days a week it brings her to tears. Sleeping each night is an adventure because laying down brings her pain. She feels surgery is the only possible thing that can possibly help.

She's considering SI Joint Fusion. Has anyone had this surgery, and if so, did it help with the pain?

Is there anything else she can try?

I appreciate any help you can provide!

TripleB

Sorry to hear about your wife's struggles.

At this point in her chronic illness I'd try to find someone who will treat a little more wholistically, meaning looking for and treating other areas that may be impacting the SI joint and lower back. Pelvic upslips and/or rotations are possible culprits for SI pain/inflammation. If that's not addressed and they're just trying to treat the symptoms, it'll be an uphill battle. Also at this point in time, she's probably developed compensation patterns that may need to be corrected first before tackling the root issues.

A good postural evaluation and a gait analysis can give clues to where there may be restrictions in the soft tissues.

Trigger points esp just medial to the anterior superior iliac spine are common for SI/LBP. I find with a lot of pelvic rotation issues, restrictions in the quads esp the vastus lateralis are common as well.

I use blocks like these to aid in addressing rotations along with other manual techniques including but not limited to leg pulls, sacral gapping, etc:

https://www.amazon.com/3B-Scientific-Dejarnette-Length-Height/dp/B008N3HZE0/ref=sr_1_6?dchild=1&keywords=chiropractic+blocks&qid=1624585343&sr=8-6

Also use the Sacro Wedgie:

https://www.youtube.com/results?search_query=sacral+wedgie

There will be no miracle cure and it will take time, work and energy but surgery should be the absolute last option.

Good luck.

 

[mmk]

My wife has had nerve ablation on her SI joint, and it is supposed to provide relief for about a year. It did work well for about 6 months, but the effect has dwindled. But, she has lots of other issues that probably contributed to the reduced efficacy, having had her right hip and both knees replaced twice and both shoulders replaced once, and walks way out of kilter.

 

[ollinger]

My wife had lower spine fusion at NYU about 10 years ago, having had a disk dissection about 15 years before that. She's done quite well with no further prominent pain. (Surgeon told me I'd get a balance bill but don't worry about it, no need to pay it. The balance bill was $40,000 after the insurance company paid him $55,000 for his few hours work -- his third case of the day)