SI Joint Gone Bad Post Lumbar Fusion

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Suzy-Q

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Hello All,
I welcome any responses and I'm real hopeful of finding a "community of peers", as my new PM docs call it. I had L4-5 decompression and fusion with hardware - twice. First attempt failed(2005). Revision (with BMP) was in 2006 and finally succeeded. I've had a serious limp and constant left bum pain post-op. Docs assumed it was referred pain from lurabar spine, heck, I did too. But all the scans and a myelogram said otherwise. I've just had 2 SI joint blocks and now have a diagnosis for SI joint disease (arthritis, osteophytes evident on fluoroscope). Docs now tell me its a result of my fusion - all the stresses and forces are transferring to the SI joint and its breaking down pretty bad. OK, fine. So what to do? PM docs want to do SI radio frequency ablation (burning and killing the nerves that serve the joint). They want to do this in a 2 procedure fashion. One half of the nerves will be burned and I wait for them to die and then the other half. Why? Cuz I'd never be able to stand the pain of having them all done at once, they say. Hello! That's quite a turn off! And after nerves are dead, I will undergo targeted PT to "open" the joint and rehab it to protect it from further breakdown.
I see the logic. Anyone been through this? I don't take docs word for anything anymore. I look for my peers and see what they went thru. I saw some posts but none went thru this 2-phase approach. Why am I so special? Anyone else dealing with SI joint disease as a consequence of lurabar fusion? My spine specialist neuro agrees that the SI blocks are the definitive diagnostic and that ablation is the appropriate next treatment. But I don't know what he thinks of this phased business or the intensive rehab stuff. I'm hoping to find some folks who can talk me down from the ledge. Thanks and best of luck to you. SQ
 
Dear Suzy-Q,

Hi! I have bad arthritis in my SI joints and my lurabar facet joints. I receive ablation (nerve burning) in my lurabar areas, but just stick with periodic injections in my SI joints. I looked into ablation in my SI joints, but was told that there is only a 50% chance of improvement, whereas with the lurabar area over 90% of improvement. You might see if you can get a series of 3 injections and then re evaluate the RFA. But, if your pain is high enough, maybe you need to go straight to the nerve burning. I do know people who have gotten relief from this procedure.

When I do the lurabar area, they burn both sides at one time, so I don't see why you would have to do it two times. Ask for enough pain meRAB during the procedure-without pain meRAB it is super painful, but with meRAB, not so much. My doctor gave me fentanyl and versed during the procedure, which made it go smoothly. Good luck and let us know what you decide.......

Kera4
 
I have had RFA (nerve burning) done twice to my SI joints (S1/L5- S4). They have always done one side at a time for me in this area. I would NOT do both sides at once. It would be too painful post-procedure. At the end of each procedure they gave me some cortisone and when I felt that kick in the following day it was sweet relief. Once the nerves settled down (e.g. died) I got a lot of relief but it took about 4-6 weeks. I did not have any major complications, however, I did find that the muscles started to spasm at the point of the needle insertions. For this, I took Valium, 5 mg twice daily with good results. It is far from a perfect procedure, however, unless you can live with what you have now, it may be your only option. My SI joint problems did not come about as a result of lurabar fusion, however, many on this board have reported SI problems similar to what you have developed as a result of lurabar fusion. Best of luck to you! Lisa.
 
Hello Kera and Lisa!
Thank you both so much. It is so helpful to know your experiences. And it does calm me down. OK, so a phased process sounRAB like a good idea. And I was told, Kera, that it could take 3-6 weeks for the nerves to finally die. What I worry about is handling the pain. I am already having a hard time getting thru at work and my current meRAB are not doing the job. My decision to go ahead with this treatment plan and this new pm group will largely depend on whether they convince me they will help me thru. I am hoping to get a second opinion, too. I like the idea of rehabing the joint but I can't imagine allowing anyone to manipulate it right now. The doc poked it as part of my initial exam and I am still limping badly. He actually injured me.
I have not had RF of facet joints. My pain has been so completely in my left bum and not typical of facet joint pain that we have never gone that route. We were headed there but ... I'm told this is the standard for diagnosis so my neurosurgeon and PCP are satisfied that we've identified the cause. Complications is my middle name! I have to try to anticpate the worse. The docs never seem to do that so I must be vigilant. And I think I have very good docs but my experiences have been scary nonetheless.
Complicated? I also have a bad cervical spine situation going on. New pm docs told me there isn't any more they can do for me, sent me off for a new cervical MRI, and suggested I consult surgeon. So, part of my anxiety is how I deal with both issues at once? Can I even try or must one problem simply wait a resolution on the other? I sure can't picture myself trying to rehab from cervcial surgery and SI joint at the same time but maybe I am just plain wrong and it is doable and recommended. Maybe. Well, I am very grateful. Glad to know the procedures helped you both. That's great.
 
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