SI Joint Fusion Now An Outpatient Procedure

It’s no longer major surgery. Instead, a minimally invasive  approach brings quick relief, short recovery.

After having his left SI joint fused, Timothy can do whatever he wants, without low back pain.

As a high school graduate contemplating his future, Timothy Schuller resolved to pursue a career in engineering. He applied and was accepted into the prestigious Georgia Institute of Technology College of Engineering in Atlanta.

“I chose engineering because I was almost guaranteed employment upon graduation,” shares Timothy, 64. “I picked Georgia Tech because it’s a good engineering school.”

Timothy chose wisely. After completing his education, he immediately caught on with a business in Orlando that builds roads and bridges. The civil engineer stayed with the company 35 years before retiring in 2019.

Now living in Vero Beach, Timothy spends most of his free time golfing and working out at the gym. Two years ago, however, his active lifestyle became compromised when he developed chronic pain in his lower back.

“There are several issues going on with my back,” Timothy offers. “I have several herniated discs as well as arthritis back there. None of that is a result of an injury or anything like that. It’s all just degenerative.

“But for years the pain was very annoying and sometimes severe, an eight on a scale of one to 10. Some of the worst pain I experienced was in my left buttock. Sometimes it was so bad that my wife had to put on my shoes for me.”

However, Timothy never abandoned his active lifestyle. He chose instead to fight through the pain while trying to alleviate it through a variety of treatments, included physical therapy, massage therapy, pain medications and chiropractic care.

None provided lasting relief.

Then, last March, a knee injury resulted in Timothy receiving a referral to Michael F. Esposito, MD, a board-certified anesthesiologist and pain management specialist at Interventional Spine & Pain Institute in Vero Beach.

Arthritic Joints

“Mr. Schuller presented to us with low back pain that had been present for more than two years,” Dr. Esposito recalls. “Previous treatment approaches failed to ease his pain long term, so our first goal was to properly diagnose his pain.”

By taking a thorough history and performing a physical exam, Dr. Esposito suspected the source of Timothy’s pain was his left sacroiliac (SI) joint.

The human body has two SI joints, one on each side of the lower back. They join the top of the pelvis (ilium) to the sacrum, the triangular bony structure at the base of the spine. The joints serve as shock absorbers for the spine and transfer torque forces from the legs to the spine. They are supported by several ligaments.

“Like any weight-bearing joint, the SI joints can become arthritic with age,” Dr. Esposito contends. “They can also be injured in traumas such as falls or motor vehicle accidents. Ligamentous loosening during pregnancy can also cause instability and SI joint pain.

“They can become sources of pain after hip replacement or spinal fusion surgery, as they must then contend with the durability and strength of the metal. People who undergo those surgeries are at increased risk for SI joint dysfunction.”

Dr. Esposito next injected a numbing medication into Timothy’s left SI joint. The medicine immediately relieved the pain, confirming that the joint was the source of problem.

“Mr. Schuller’s SI joint has undergone degenerative changes and was arthritic,” Dr. Esposito explains. “Unfortunately, we cannot replace the SI joint like we can the hip or knee. But we can fuse it so that it no longer causes pain.”

In the past, SI joint fusion was a major surgery performed in an inpatient hospital setting, typically using large screws. It posed a significant risk to the sciatic nerve and blood vessels in approaching the joint and required a long recovery. Dr. Esposito, however, offers an innovative, minimally invasive approach to fusing the SI joint and stabilizing it.

“The approach is similar to that of an SI joint injection,” the doctor reveals. “Under fluoroscopic guidance, we insert a small pin into the joint. Over top of that pin, we place a tool that serves as a working cannula, or tube.

“Through that tube we prepare the joint and then place two bone grafts and a material called demineralized bone matrix, or DBM. The DBM acts as a scaffold of sorts for the bone grafts and the bones of the SI joint to grow together. This allows for immediate joint stability and an ideal environment for fusion and less pain.”

Because the procedure is performed using a posterior approach, through two small incisions in the lower back utilizing the shortest and safest access to the SI joint, this results in less surgical trauma, reduced blood loss, shorter surgery times and faster recovery.

Minimally invasive SI fusion is an outpatient procedure that takes about 30 minutes. The recovery time is short. Patients are instructed to take it easy for about two weeks.

“Typically, patients undergoing this procedure realize upwards of 75 to 80 percent pain relief,” Dr. Esposito reports. “Mr. Schuller experienced a fantastic response. He achieved almost complete resolution of his low back pain.”

“Immediate” Relief

Dr. Esposito performed Timothy’s SI joint fusion at an outpatient surgery center in Vero Beach in October. Timothy says the outcome was “100 percent successful.”

“It was the easiest procedure I’ve ever had,” Timothy declares. “Dr. Esposito fused the joint, and I walked out of the surgery center that day. It was almost like I didn’t have a procedure it was so easy.

“The relief was immediate. I noticed a difference as soon as I woke up from the anesthesia. I wasn’t in pain the next day, either. Dr. Esposito gave me pain pills, but I never took one.

“The procedure totally fixed all the pain in my left buttock — and fixed it immediately. My pain level now is zero. Not only can I put on my own shoes without help, I can do whatever I want — without pain.”

Timothy is thrilled with the outcome of his SI joint fusion. He’s just as impressed by the physician who performed the procedure.

“Dr. Esposito is great. He’s young and very into what he’s doing,” Timothy raves. “He’s incredibly nice. He has a great bedside manner, and he really tries to help people. He’s also incredibly intelligent and a very good doctor who really cares about his work.

“I recommend Dr. Esposito to anyone in pain. He’s one of my favorite doctors. Even his office staff is great. I had a really good experience at Interventional Spine & Pain Institute.”

© FHCN article by Patti DiPanfilo. Photo by Jordan Pysz. mkb
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