SI Joint Dysfunction

Patient Support For Recovery From Low Back Pain

Continued Pain After Sacroiliac Surgery?

QUESTION: I had bilateral ifuse fusion and am worried it was a big mistake to do it both sides for me as the vast majority of my pain was on my left. I am having difficulty walking medium to long distances without developing serious pain now. I was fine at walking before the surgery. I can sit and lie down more comfortably than before but it still builds up pain, just slower. Standing used to be okay but now I get a sore pelvis and minor back pain. I am almost 5 months post op now. How are you now, really? Based on your own post-op recovery from SI Surgery, do you have any advice?

MY ANSWER: I am so sorry to hear of the continued pain your body is still battling with…I have been familiar with this too, more than I’d like to remember! I will answer your questions as best as I can and share from my journey, hopefully it can help bring some insight to yours.
Now that you are 5 mos post-op, I would personally tend to agree with you that you are not likely to be able to have the  ifuse implants removed…I have been told by SI Bone that there was one case where the implants were removed 3mos post-op. Nevertheless, I cannot say that you need to have them removed or that the ifuse system isn’t a success. The ifuse implant is great new technology, as long as good surgical protocols were followed (see my blog post called “What To Look For With SI Surgery”).

In my opinion, here’s what I would investigate as the top 2 categories of common problems for Sacroiliac Surgery patients post-op:

1) Structural:
a. Are you fully fused?
b. Were your SI Joints placed in.
correct ALIGNMENT?
2) Soft Tissue related problems due to:
Problematic, unaddressed conditions such as-
a. Piriformis Syndrome
b. Lumbar Radiculitis
And/or specific muscle rehab via therapy and retraining..muscles affect nerves…nerves and muscled contribute to radiating pain!

To explain…

1) Structural-

Did your surgeon tell you if there is a way to check if you have fused yet? (CT Scan is how traditional SI fusion is monitored). Full fusion can take anywhere from weeks to 6mos, even up to a 1yr…rarely some people don’t fuse.
Correct SI alignment can sometimes be detected via your post-op imaging but would need physical examination to confirm (by a trained SI expert who recognizes the issue-these are rare!).
However, your continued pain could be due to lack of a good post-op rehab program which targets the damaged muscles and nerves affected as a result of your prior SI instability…

2) Soft Tissue related problems-

Your SI surgery gave you the STRUCTURAL stability that you needed but it has NOT addressed your SOFT TISSUE conditions (which are very real and necessary to treat). This is a necessary 2nd step involved in overcoming SIJD and is a common problem for Sacroiliac Joint Dysfunction patients post-op! It is not as common to locate a sacroiliac surgeon who also tests for and addresses the specific soft tissue problems common to SIJD.
2. Common SOFT TISSUE conditions associated with SIJD are:

1) PIRIFORMIS SYNDROME (the 2nd strongest muscle in the body). This muscle if often the culprit for continued pain for SIJD patients post-op and mimics Sciatica symptoms because the muscle crosses over the Sciatic nerve.
The Piriformis Muscle is often responsible for:
-buttocks pain…all the 3 gluteus muscle pains (glut.medius/glut.minimus and glut.maximus)
-pain radiating down the legs
-hip pain
-pain w walking
-pain w sitting…
A simple test can determine if you have the Syndrome by undergoing a “EMG with Fair testing” aimed at testing this muscle specifically.
Even if u don’t have the actual Syndrome, addressing this muscle specifically should ALWAYS be included as necessary post-op rehab!

2) LUMBAR RADICULITIS (nerve damage radiating from the Lumbar Spine). Lumbar pain radiates and can mimic the same pathway as SIJD did!
-buttocks pain
-pain radiating down the legs

Because of sustaining years of damage from SI Joint instability, many SIJD patient’s also have a bulged disc at L4,L5 and/or at L5,S1.
A lumbar EMG Nerve conduction test (around the Lumbar spine) can determine if this is involved or not. It is good to test these nerves because a person can actually have a bulged L-spine disc(s) w/out it damaging the surrounding nerves… Having imaging like an MRI can show a bulged disc BUT imaging alone cannot tell you if it is contributing to the pain pathway you are experiencing, this is why a nerve conduction test is necessary to rule this in or out.
3) Sacral Nerve root interaction/injury can occur during the insertion of the Implants!
IF your surgeon did NOT have a technician perform inter operative nerve monitoring DURING and AFTER implant insertion (only some do this) than your continued pain could possibly be due to your the implant(s) interacting with the nerves in that area…

Well, my spare time is up for now as my kids are needing my attention! I hope this helps as a good starting point for you. We’ll ‘talk’ more later, pls. tell me what your thoughts are in response to this…




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