Joint Maneuvers
It’s so important to have faith in the people who treat you, and I have faith in everyone at Florida Pain Management Associates. – Gail

It’s so important to have faith in the people who treat you, and I have faith in everyone at Florida Pain Management Associates. – Gail

Minimally invasive fusion technique alleviates low back pain.

Gail Harmon is the first person in her family to graduate from college, and she did so with honors. She completed her higher education later in life, though, earning a degree in social science at age 46. She then began her career as a psychiatric social worker.

“My job involved meeting with clients out in the community and accompanying them to their psychiatrist’s office,” Gail describes. “I informed the doctors if I thought the clients were about to have a psychotic break, so the job required a lot of observation skills.” 

To Gail, now 67, psychiatric social work is a noble profession. She especially cherished interacting with colleagues, sharing stories and improving strategies for achieving their common goal: helping people with mental health issues live optimally within the community. She also valued her colleagues’ suggestions for dealing with problem situations.

“Sometimes, the clients were difficult to work with. They tended to be a difficult population,” Gail elaborates. “I appreciated the camaraderie and partnership with other people in my field.”

A Cleveland native, Gail moved to Florida in the 1980s before she established her career. Committed to finishing college, she ultimately returned to school in Ohio. It took her 30 years to get back to the Sunshine State. 

Gail’s been living out her retirement in Vero Beach for the past three years. But her laid-back lifestyle was interrupted by terrible hip pain.

“I have horrible arthritis in my hips, and it was extremely painful,” Gail confirms. “The pain made it difficult to get out of a car and stand up from a seated position. Last year, the situation came to a head.”

Gail visited Florida Pain Management Associates, the practice of Harold J. Cordner, MD, a board-certified pain management specialist. Dr. Cordner employs an extensive arsenal of services for relieving pain. 

“In the spring of 2020, Dr. Cordner performed a nerve block in my hips, and it successfully eased the pain,” Gail recalls. “But then in November, I started to feel intense pain in my lower back. It was really bad, definitely a 10 on a scale of one to 10. It felt like a hatchet was being thrust into my back. The pain was so extreme that I had to use a walker to get around, which was very discouraging.”

Hoping to find relief, Gail returned to Florida Pain Management Associates.

“We determined through diagnostic injections that Ms. Harmon’s back pain was coming from her sacroiliac (SI) joints, which link the pelvis and lower spine,” Dr. Cordner reports. “She received nearly 100 percent pain relief from the joint injections, but that was only temporary. 

“We discussed other treatment options including radiofrequency ablation, where we burn the nerves going to the SI joint. But Ms. Harmon had undergone ablation in the past and wanted something more permanent. So, we suggested an SI joint fusion, where the joint is fused into an immobile unit. She elected to move forward with that procedure.” 

Improved Technique

In the past, SI joint fusions were major surgeries with many potential complications, Dr. Cordner asserts. They were open procedures performed from the patient’s side and involved drilling three large holes, removing cartilage and placing screws across the joint to fuse it. They typically required a multiple-day hospital stay.

“More recently, a less invasive way to perform the procedure was developed,” the doctor informs. “It uses a posterior approach, from the patient’s back. We place a guide pin into the SI joint under x-ray guidance and create a small and precise channel using a unique and proprietary method of SI joint site preparation. 

We fill the site with a precision-machined allograft of cadaver bone, immediately fixating the SI joint. The patient’s existing bone then grows through a large window in the center of the graft, spanning the joint, to permanently fuse the joint so that it no longer moves. There are no screws in this procedure, just pain relief for the patient.

“This technique is a much simpler procedure than the traditional lateral fusion approach. It is an outpatient surgery typically done in less than an hour. The incision we use is very small, less than one inch, so it is a minimally invasive way to perform an SI fusion.”

Potential complications of traditional SI fusion surgery include bleeding, infection, escalation of pain, and nerve and muscle damage. The minimally invasive approach involves no muscle cutting, so the risk for complications is significantly decreased. It also requires less operating time and consequently, less recovery time. The procedure is done under sedation rather than general anesthesia.

“Studies show that the success rate for minimally invasive SI fusion is very high,” Dr. Cordner observes. “The most recent studies show a success rate between 77 and 85 percent, which is very good.”

Dr. Cordner performed a minimally invasive SI joint fusion on Gail’s left side first. He was quite pleased with her response.

“Ms. Harmon achieved complete pain relief from the procedure on her left side, so she elected to proceed with treatment on her right side,” the doctor reports. “She did remarkably well with almost complete resolution of her pain, and she was able to come off of her pain medication. She told me, I feel like a little kid again.”

“Michelangelo of Medicine”

Dr. Cordner performed Gail’s SI joint fusion in April, and it stabilized her lower back. It resulted in a significant decrease in her pain level.

“I’ve made a lot of progress,” Gail enthuses. “I received great relief, so instead of a 10, my pain is minimal, and I’m active again. I’m taking my dog Smiley to the dog park and jumping back into life in full.

“I thank God every day that I no longer have the extreme pain I had before. I’m so glad I live in an age when these treatments for pain are available.”

Gail reveals the three things she likes best about Florida Pain Management Associates.

“I have ultimate faith in Dr. Cordner,” she discloses. “He’s the Michelangelo of medicine. He really knows what he’s doing, and that’s important when you’re getting a procedure. And it’s a bonus that he’s very gentle when he’s inserting needles. That’s the second thing.

“The third thing I like about the practice is the staff. Dr. Cordner has the absolute best staff. They’re very friendly, so when I go to the office it’s a very pleasant experience. It’s so important to have faith in the people who treat you, and I have faith in everyone at Florida Pain Management Associates.”

© FHCN article by Patti DiPanfilo. Main photo courtesy of Pinnacle Surgical Partners. Graphic courtesy of Dr. Yu Chao Lee. mkb
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