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Si Joint Surgery Success Rate

Diagnosing The Sacroiliac Joint

Sacroiliac Joint Fusion with The iFuse Implant – Dr. Duffner

SI joint pain can be difficult to diagnose as the pain syndrome may present similarly to other lumbar spinal conditions. Patients with SI joint pain typically report pain in the low back and buttocks, sometimes with radiation into the groin or upper legs. An algorithm consisting of medical history, physical examination, imaging studies and confirmatory intra-articular joint injections is typically used to diagnose SI joint disorders.

SI joint pain primary affects women over the age of 40.21 History may include mild trauma, pain during single leg stance on the affected side, difficulty sleeping, pain in the peri- or post-partum period or pain after lumbar spinal fusion. Specific physical examination tests that stress the SI joint test, Gaenslens maneuver, sacral sulcus tenderness) are performed in the physicians office. In combination, these tests are thought to be predictive of SI joint pain.22 Apart from ankylosing spondylitis, in which the diagnosis can be made based on imaging of the SI joint typically does not provide valuable diagnostic information.23 Rather, imaging is used to ensure that the patient does not have alternative diagnoses that could mimic SI joint pain .

Know When Si Joint Fusion Is Necessary

A common cause of SI dysfunction is prior lumbar fusion. An SI injury is also the result of a fall, work injury, or a car accident. Pregnancy can also cause added stress to this joint. Other causes of SI joint pain include sacroiliac joint arthritis, traumatic birth, leg length discrepancy, and gait abnormalities. Anything that causes the ligaments in the pelvis to become too loose or too tight often results in SI joint strain.

Besides chronic pain in the lower back, people who have trouble with their SI joint may also feel pain in the buttocks or groin. This pain might radiate to the lower hip or upper thigh. Numbness or tingling in the leg is also a symptom of SI joint dysfunction.

Many people try pain medications, physical therapy, or injection therapy to treat their SI pain. These types of treatments are effective for some people. However, when pain caused by an SI injury begins to interfere with walking, climbing stairs, sitting, or sleeping, its time to consider SI joint fusion.

Diagnosing Si Joint Pain Before Surgery

Identifying the sacroiliac joint as the primary pain generator can be difficult due to the complex, interconnected nature of the lower spine, pelvis, and hips. For this reason, the diagnostic process for sacroiliac joint pain can be extensive, and typically includes the following process:

  • Collected medical history, including information on recent or past injuries that may be causing pain, as well as when pain began and a description of symptoms. A medical history also includes information on sleep habits, exercise and activity, and diet.
  • Physical exam, including movement tests designed to provoke or improve symptoms. For example, applying pressure to the sacrum or hips in various directions may cause pain to temporarily alleviate or get worse, indicating that the SI joint is the source of pain. A single movement test is usually inadequate for diagnosis, but a combination of tests can provide an accurate indication of the SI joint as the pain generator.

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How Do You Fix A Sacroiliac Joint

At the Centeno-Schultz Clinic, we are experts in the treatment of Si joint injuries. We have extensive experience evaluating and successfully treating SI joint injuries that failed other therapies. Conservative care is always first-line therapy. This may include physical therapy, manual manipulation, SI belts, and gluteal strengthening. Steroid injections are very effective anti-inflammatory agents that must be avoided as they are toxic to the SI joint cartilage and can weaken ligaments .

There are three important components in the successful evaluation and treatment of SI joint injuries.

  • Evaluating and treating the SI joint cartilage. This is accomplished by injecting directly into the joint itself. The SI joint can be very difficult to inject. At the Centeno-Schultz Clinic, we have mastered and published a successful injection technique . To confirm accurate needle placement contrast is used and needs to be seen within the joint itself as demonstrated in the x-ray to the right.
  • Evaluating and treating the SI joint ligaments. Ligaments are thick bands of connective tissue that connect one bone to another. They provide important stability for the joint. At the Centeno-Schultz Clinic ligament, evaluation and treatment are the standard of care. Ligaments are easily identified and injected under ultrasound.
  • Evaluating and treating the muscles which support and stabilize the Si joint. Muscle strength and function is critical for optimal SI joint function.

From Losses To Opportunities

Sacroiliac Joint Fusion Using Triangular Titanium Implants vs. Non ...

SI problems arent common in someone as young as Ulland , but she had suffered traumatic injuries, including breaking her tailbone in a sledding accident. I landed on my bottom and felt it all through my spine, she said.

As time went on, Ulland tried many different therapies, but continued to lose function and experienced increased pain. By 2014 she was no longer able to work or drive, and she had to use a walker to maintain her balance. Doctors in Norway were unable to accurately diagnose the root cause of her chronic, debilitating pain.

Before the surgery, Ullands life had been a series of lossesloss of mobility, career goals, independence. Now she sees her life in terms of opportunities that await herand shes grateful to Dr. Szentirmai.

In time, as her body continues to heal and her spine and legs regain strength, Ulland envisions being able to hold her two young nephews. True success will be holding them and twirling them around, she said.

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Benefits Of The Linq Procedure

The SI fusion procedure provides a number of benefits. They include:

  • Sacroiliac joint stabilization
  • Reduction in or alleviation of low back and pelvic pain
  • Improved movement when walking, standing, climbing stairs or rising from or lowering into a chair
  • Minimally invasive
  • Faster healing time in many cases, compared to SI fusions that use multiple metal implants
  • Does not involve large blood vessels or major nerves
  • No metal implants
  • Faster recovery time than conventional sacroiliac fusions
  • High success rate for qualified patients
  • Offers pain relief when other treatments have failed
  • Able to resume normal activities sooner than possible with the conventional SI fusion

How Much Does Si Joint Fusion Cost

According to the Healthcare Bluebook, the cost of a spinal fusion is between $28,463 and $85,956 . However, in one study, the more specific cost of SI joint fusion was lower and quoted at $21,696 . However, these are medicare prices which are often lower than out of pocket costs. That quote also doesnt include hospital or surgical center fees, so expect to pay for these as well. This study quoted $10,224 for those costs. The costs could be less if the procedure is performed in a physicians office.

The above price also didnt include pre-operative workup for a sacroiliac joint diagnostic injection, which when performed in an office can run as little as $650. However, many of these procedures are performed in a surgery center where costs can run $1-2,000 in total as the surgery center fee is often at least that much. The above study on SI joint fusion also quoted 7-11 sessions of physical therapy after the procedure at a cost of approximately an additional $1,000.

Hence, the average total cost for an SI joint fusion is likely to be in the $34,000 range. That could go as low as $16,000, or even higher, if the patient has complications or needs to be hospitalized.

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How Do You Prepare For Ifuse Implant System Surgery

The road to an iFuse Implant System starts at the initial exam. If a patient is experiencing lower back symptoms predominately below the L5 vertebra and the physician is able to determine pain originates in the SI joint, the doctor will request X-rays or a CT scan to look for signs of degeneration of the joint.

A common test to determine whether a patient may be a candidate for SI surgery is to do a selective injection of Lidocaine or an anesthetic agent in the sacroiliac joint, says Dr. McBride. If the sacroiliac pain is completely relieved for several hours, then that would indicate the source of the pain and suggest they may benefit from the iFuse Implant System.

Before surgery is considered, all conservative measures of treatment are attempted. Only after these measures have failed will a patient be considered for surgery.

What Is Si Joint Dysfunction

High Rate of SI Joint Dysfunction after Lumbar Fusion

When the SI joint becomes inflamed it can cause pain in one or both joints. Pain may be confined to the right or left buttock, or radiate to other areas.

Symptoms of SI joint dysfunction include:

  • Hip, and or/groin pain
  • Pain when shifting weight from one leg to another
  • Sitting difficulties, such as unable to sit for long periods or leaning toward one side
  • Sleep disturbances related to the pain. Pain when rolling over side to side in bed

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Si Joint Surgery: Hope For A New Life

Winter 2020

Neurosurgeon Oszkar Szentirmai, MD and Nina Cecilie Ulland Keretzis

In March 2018, Nina Cecilie Ulland Keretzis arrived in the U.S. from her home in Norway to undergo a procedure at Tradition Medical Center in Port St. Lucie. At the time, she was using a wheelchair due to the severe and chronic back pain she had endured for more than four years.

Ulland had sought out Oszkar Szentirmai, MD, a neurosurgeon with the Back and Spine Center at Martin Health, after learning he was familiar with a highly effective sacroiliac joint implant. Her long-time physical therapist, who suspected Ullands problem stemmed from her SI joint, told Ulland about the implant.

On March 20, Dr. Szentirmai performed a fusion on Ullands SI Joint. She felt immediate results after the surgery.

One hour after I woke up I knew this was what I had hoped for, she said. I had never met a surgeon like Dr. Szentirmai. He was very thorough, caring and patient.

Less than two weeks after the surgery, Ullands right leg, which had lost almost all sensation in recent years, was significantly improved. Everything is much better and the shooting pain I had is gone, she said. I expect to get even stronger over time.

Dr. Szentirmai performed a fusion on Nina’s SI joint on March 20.

How Successful Is Si Joint Fusion Surgery

SI Joint Fusion surgery boasts an 88% satisfaction rate with patients. The procedure also reduces SI joint pain by 68%., improves back function by 50%, and reduces the use of opioids by 29%. Multiple clinical studies have shown that treatment with the iFuse Implant improved pain, patient function, and quality of life.

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How Does The Doctor Diagnose Si Joint Dysfunction

Determining that the SI joint is the primary cause of the pain can be challenging. A thorough history and physical exam, along with imaging and localized injections help to diagnose SI joint dysfunction. Examples of diagnostic procedures include:

  • MRI of the L-spine to rule out lumbar origin of pain
  • CT scan or x-ray of the pelvic bones, including the hips
  • Successful injections to the SI joint, either diagnostic or therapeutic . These are performed with radiology guidance.
  • Positive provocative maneuvers to the SI joint in question

Sacroiliac Joint Fusion System

Sacroiliac Fusion

The sacroiliac joint fusion system utilized in this study has been described previously . Briefly, the system uses a proprietary decortication instrument to prepare approximately 5cm2 of the ilial and sacral bone surfaces, removing cartilage and allowing placement of approximately 5cc of bone graft. A 12.5 mm threaded implant is placed through the prepared fusion bed , and an optional, secondary 6.5mm threaded implant provides additional mechanical stability during the fusion process if the surgeon considers additional fixation appropriate based upon patient anatomical and available bone stock considerations. The system is illustrated in Fig. .

SImmetry System. Panel A illustrates the decorticator instrument preparing the graft bed the decorticated region is then packed with approximately 5cc of graft material . Final implant construct , showing a 12.5mm cannulated implant with surrounding decorticated area and graft and 6.5mm anti-rotation implant .

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When Is Sacroiliac Joint Fusion An Option

When the following symptoms persist for several weeks or months and do not respond to nonsurgical treatment, sacroiliac joint fusion may be recommended:

  • Significant low back, hip, or groin pain that makes it difficult to function in everyday life and has not been effectively treated using nonsurgical methods. Sacroiliac joint pain can be felt on one or both sides of the body one-sided low back pain is an early indication that the SI joint may be the pain generator. Pain is typically confined to the lower back and pelvis, but may radiate down the back of the leg .
  • Instability in the pelvis and lower back, which may cause pain or difficulty when standing, walking, or moving from sitting to standing or vice versa. Pain may be especially bad when climbing stairs or walking up an incline.
  • Stiffness and limited mobility in the low back, hips, groin, or legs.
  • Exacerbated pain after sitting or standing for long periods of time, or from certain sleeping positions, such as lying on the affected side for too long.

Sacroiliac joint fusion is always an elective procedure, meaning it is the patients decision whether or not to have surgery. There are many factors to consider when deciding to have surgery, including the effectiveness of nonsurgical treatments, if fusion surgery is likely to improve ones quality of life, and the recovery process necessary after surgery.

Most doctors or back pain specialists will recommend significant trials of nonsurgical methods before advising surgery.

Know Who To Contact About Si Joint Fusion

If you live in Southwest Florida and are experiencing sacroiliac joint pain, you need to find the best medical facility to help you with the SI joint fusion procedure.

Southwest Florida Neurosurgical & Rehab Associates. Has over 20 years of experience helping patients find relief. Our neurosurgeons perform the minimally invasive SI joint fusion using the iFuse Implant System. One of our neurosurgeons, Dr. Savage, is the first person in Lee County, Florida, to have training in the iFuse Implant System.

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What Is The Sacroiliac Joint

The sacroiliac joint is a very important joint formed by the sacrum and ilium bones and functions as a shock absorber between the spine and legs. It is a C shaped joint with the cartilage within the joint and an extensive number of supporting ligaments. Each patient has two sacroiliac joints. A left and a right. SI joint pain is common with an incidence of 15-30% of patients with low back . Patients that have undergone lumbar fusions are particularly susceptible to SI joint injury. A recent study reported that up to 75% of patients who undergo lumbar fusion will develop SI joint degeneration . Other causes of SI joint injury include trauma, degeneration, inflammation, pregnancy, ligament laxity and muscle weakness .

How Long Does It Take To Recover From Si Fusion Surgery

What Should I Expect After SI Joint Fusion Surgery?

After the minimally invasive iFuse surgery, patients should discuss post-operative care and weight bearing recommendations with their surgeon. Depending on the patient, they may progress to full weight-bearing rapidly while others may require a period of protected weight bearing due to health conditions including age, osteoporosis, altered bone health, impaired balance, or other musculoskeletal conditions.

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How Can I Get Relief From Si Joint Pain

You have many choices for treatment that could help your SI joint dysfunction. The first step your doctor may recommend is to stop the activities that may be causing the pain. Your doctor may prescribe some pain medication or physical therapy to teach you stretching and flexibility exercises to help the joints rehabilitate. Physical therapy could also teach you to overcome some of the compensating behaviors you picked up while trying to avoid the pain, such as walking with a limp or leaning to one side. Massage, heat and cold treatments, stretching, and even cortisone injections to cut down on the inflammation may be helpful. If none of these treatments work, it might be time to seek out SI joint fusion.

Additional pain treatment options may include:

  • SI joint bracing/pelvic belt
  • Ongoing therapeutic injections with steriods
  • SI joint rhizotomoy/radiofrequency ablation
  • Surgical fusion

Triangular Titanium Implants For Minimally Invasive Sacroiliac Joint Fusion: A Prospective Study

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  • Per Gunnar Brolinson and more…Encyclopedia of Sports Medicine
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How Successful Is Si Joint Fusion

SI joint fusion is a major surgery where large screws or implants are placed across the joint thereby eliminating motion. Please remember that the SI joint is a critical shock absorber between the spine and legs and as such must be able to move. Fusion prevents this function and in doing so can give rise to a number of complications. Success varies dependent upon the surgical technique used and the parameter included in the study. Complications however are significant.

In one study that followed 469 patients for 7 years. There were significant complications which included .

  • Re-operation rates after open surgery ranged from 0%-65% whereas in the minimally invasive surgery re-operation rate ranged from 0-17%.
  • Major complications ranged from 5%-20% and in one study were found to be 56%.
  • Continued pain with the need for oral narcotics
  • Adjacent Segment Disease

Another randomized controlled study followed patients for two years after SI joint fusion . Results are questionable as 55% of the patients were still taking narcotics two years after the procedure.

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