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SI injections success?

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Posted 12/18/2013 10:21 PM (GMT 0)
I had injections in the right hip bursa and in the right SI joint by flouroscopy on Friday. I can say it has helped some, but I'm still left with the gnawing pain. I return to my doctor on Dec 30 for recheck.

My ortho man said if the injections did not help (which can be diagnostic tools) that I probably needed an MRI of the lower back. In 2011 I had a double fusion at L4 and L5 which was successful. I'm wondering if pain which I started having about a year ago in differing degrees - has anything to do with that particular surgery.

So...for those of you familiar with this did you really have back problems that were hurting your hip and SI joints? I have an appt with the neurosurgeon who performed the 2011 surgery in about 3 weeks - wondering if I need to go or not? Should I get a second injection and see how that works? Were any of you referred for back MRI when your shots did not work - was a back problem found?
Posted 12/18/2013 10:33 PM (GMT 0)
I have only had the 3 fusion surgeries, (two-level each time), in my cervical area but have a history of back pain and have some herniations in the lumbar area but avoiding surgery as long as possible.

I've also had numerous injections in both areas of my spine.

To me, there is nothing to lose if you have insurance to go the Neurosurgeon appt. and see what he has to say as they will probably do the MRI to just see how things are doing.

It happens many times that the area above and below a fusion site can start to have problems...

In many other cases though, a surgery can be successful for a very long time and you can just have muscle spasms or even some neuropathy from time to time and even arthritis which is very common to develop. So there are many non-surgical reasons for some pain.

A few questions:

Are you on a muscle relaxer as well as a nerve pain medication? How about a topical NSAID like a Flector patch or Voltaren gel?

Do you also do daily exercises and things that you learned in PT after the surgery? To make sure that you are stretching properly each day and keeping core and overall strength good?

And then another quick question on what you wrote...you say you had a "double fusion" in the area of L4 and L5.....but that is just one disc as the disc is in between the two vertebrae. So was there another level done?

Just sharing some thoughts of what has worked for me:)
Posted 12/18/2013 11:06 PM (GMT 0)
Thanks Snow - very helpful. I have been to therapy, had meds (no patch) and 3 bursa shots, but only this recent one was guided by x-ray. I've tried the tens unit. My trainer is a recent chiropractor assistant so knows the body and how to handle it. He's well aware of the problem and for that reason, we've been trying to strengthen the area around the bursa. Maybe the pain would be worse had I not been exercising, but I can only hope that what I'm doing is helping. I go 2 days a week and exercise about 4 days a week in some form. Stretching is done religiously before and after exercise. He knows what he's doing.

For the most part I have pain when I stand too long, walk over about 10 minutes or exhaust that right hip. I do stop when the pain comes and a stretch will temporarily help the pain but not for long.

I'd say I'm in pretty good shape for a 64 year old - not overweight, active, etc. I'm on the healthy side. The fusion was 2 level and it must have been between L 3-4 and 4-5.
Posted 12/19/2013 1:39 AM (GMT 0)
Ahh...thanks for more info!!! You are doing great for 64 then!!! I am 45 and started having my first fusion at 33:(

Anyway, I think getting the MRI is good to see what is going on and evaluate that way to make sure there isn't anything that needs immediate attention.

The other part I forgot to mention is that even a successful fusion can fail down the road. I'm HOPING that is not your case! Just saying that it's a slim possibility.

My mom had a lumbar fusion back in '85 and only started having some pain issue again a few years ago and she is 72.

So it's very random with spines...

I will pray for those non-surgical options for you:)
Posted 12/19/2013 9:10 AM (GMT 0)
I have a pars defect at L4-5,SSD at S1 and have multiple days with pain in my hip. I've also had multiple knee problems for years and of course limped post surgical procedures and my Rheumy swears that anytime you change your weight bearing you put added stress on those joints that pick up the slack?

As for injections? I've had numerous and various kinds and have had the same in results! Numerous and varying! Some worked, some didn't, some asap, some in a week, some worked for months, others weeks!

Like SB said if your covered, you've nothing to lose and possibly may get some relief!
Posted 12/19/2013 3:52 PM (GMT 0)
I think SB and Vickie are right on the money. If you can get in to have it looked at, you have nothing to lose, and it's always helpful to get a fresh set of eyes on the situation.

I've got lumbar fusions and two THR's, and I can tell you, there are days when the SI pain (it'll waiver back and forth between left and right) can get quite intense. So I definitely understand. The biggest trigger is standing.

It's great that you're physically active. I think my PT is a blessing, and I'm always so excited to go. If I weren't able to work my body out, to stretch,...but in particular, to strengthen,....I think I'd be a limp noodle.

When we start shifting our weight-bearing, (everything from how we sit, stand and walk), it's cumulative. Nipping it in the bud as early as we can is great. Plus, I've found, at least for me, my PT can "catch me" if I slack off or go back into the old ways of shifting my weight off balance and stressing my joints. He's like my little reminder with a verbal cattle prod to keep me focused!



M.
Posted 12/20/2013 1:13 AM (GMT 0)
Hi Sorpio

I too had lumbar fusion at L4/5 and went on to develop SI problems. It began about two years after the fusion, I began having nagging buttock pain, pain sitting, standing and walking. In fact the only time I was comfortable was lying down. I had injections and RFA, which didn't work and ended up having bilateral SI fusions. One side has been 100% successful, the other I still have pain in but it is much improved.

I was told that SI problems can be as a result of lumbar fusion, something to do with different loading. In fact many people I have heard of that have SI problems, have mostly all had lumbar fusions at some point. RFA might be worth considering, it will give longer lasting relief than injections.

Please near in mind that SI problems often do not show up on x rays and MRI scans. Many people are diagnosed by physical testing by a doctor. I know my SI issues didn't show up on X-ray but I'm in no doubt that I did the right thing by having surgery.

If I can be of any help to you, please ask. SI problems are by no means rare but there aren't too many of us around. Good luck on getting your problems resolved.

Jane
Posted 12/20/2013 11:58 PM (GMT 0)
Jane, I'm not familiar with RFA or anything about an SI fusions. My symptoms are very similar to yours except lying down is my worse pain that many times wakes me up. I will say since the bursa and SI joint injections a week ago, the problem is better - but it does not feel that good. If anything, it has worsened since the shots.

I have an appt the 30th with the PM and I know he's going to suggest another injection to "follow up" with what he's done. I've had 3 in the bursa so far, none of them working. Is it good for your system to have so many steroid injections? Should I try another injection?

I also have an appt with the back neurosurgeon on Jan 6 and I'm hoping he'll do an MRI. I'm on the fence about going --don't know whether to have another shot and give it one more stab, or should I just go to the January appt. This neuro man is extremely hard to get into - very well known and used in Houston, so I hate to cancel and have to wait for 2-3 months for another appt. He is the one who operated on me in 2011, and his popularity is what is worrying me - the difficulty of getting in.

Your comments were very helpful!
Posted 12/21/2013 12:10 AM (GMT 0)
Out of curiosity, since the January appointment is so close,....is it reasonable to keep your appointment with the neuro and ask him his opinion before committing to another injection?

If he suggests an alternative, then you've avoided an injection and will have new information.

If he agrees with the injection, then you've got another confirmation that this would be a reasonable course of action.

I do understand how hard it can be to get in to see some of our doctors, so when we do manage to get an appointment, the last thing we want to do is cancel. At least if you see the neuro first, you'll have that "second opinion" to help you out where you're feeling confused and uncertain.

What do you think about that?



M.
Posted 12/21/2013 3:12 AM (GMT 0)
Great thought Merrida...I had thought of that -- needed the encouragement from someone. I like the idea of getting the 2nd opinion from someone from whom I really value their opinion. I want to ask him also how these injections work concerning the amount you receive and the time interval between each.

Hope you are doing well :)
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