The Agonizing Battle with Back Pain

COURTESY PHOTO

JORDAN PYSZ / iFoundMyDoctor.com
The day after he underwent the first of two SI joint fusion procedures, Gregory walked a mile for the first time in months. Now, he’s walking nearly five miles a day.

The 19-foot bay boat that Gregory Cooper has been navigating through the Florida shallows for more than 25 years is this avid fisherman’s “pride and joy.” But it’s not the boat from which Gregory made his most memorable catch. “That happened in Boca Grande, where a guide took me and my wife out for the day, and we were both catching snook and redfish left and right,” Gregory remembers. “Then we both caught fish right at the same time. “As my wife was reeling in a redfish, I caught a snook. Both of them were right at the high end of the slot limit (legal size), so we had to throw them both back, but the fact that we both caught fish that big at the same time was really special.” When he retired several years ago, Gregory was devoting the better part of four or five days a week to fishing. As time passed, though, an aggravating back problem forced him to essentially abandon that passion as well as a few others. “For years, this back problem would flare up and bother me for a while and then kind of go away,” Gregory says. “For the most part, I just fought through it because you learn to live with things like that. But then it came back and became almost impossible to live with. “I’ve always been very active, but the back pain kept me from doing anything physical. I have an acre of property here, and it’s manicured. I put a lot of time into making it look nice. But my back hurt so bad that I couldn’t even bend over and pull a weed.” Gregory’s back pain also forced him to give up daily walks and gym workouts. As a result, he gained nearly 50 pounds. He fought hard to lose that weight, but his pain persisted, and for a while, none of the medical providers he visited could alleviate it. “I tried chiropractors, but nothing they did helped,” Greg laments. “It then got to the point where the only way I could relieve the pain was through pain medication. But I didn’t want to take that stuff, so I finally asked my primary care doctor for some advice.” Gregory’s primary care physician recommended he visit Advanced Orthopedic Center. That’s where he met Lee M. James, DO, the physician who slowly whittled away at Gregory’s back issue until he found the solution Gregory had been seeking.

Hitting a “Home Run”

“Mr. Cooper first came to me in 2018, and at the time, he had a lot of generalized back pain,” Dr. James explains. “We treated that with a series of steroid injections, and those worked well for him for a while, until 2020. “That’s when Mr. Cooper came back to me with lower back and upper buttock pain. So, we once again treated the back pain with injections, but this time the buttock pain became worse. That’s when we realized that the problem was more than likely being caused by his sacroiliac joints.” Located between the waist and buttocks on each side of the spine, the sacroiliac (SI) joints connect the sacrum (the triangular bone at the base of the spine) to the ilium (the uppermost bone of the pelvis). They are designed to remain stable, with a limited range of motion (about 4 degrees), to support the body’s weight and minimize excessive movement in the pelvis. Pain in these two joints develops from inflammation (sacroiliitis) that is the byproduct of either hypermobility (too much movement), hypomobility (too little movement) or arthritis, the latter of which can force the bones to rub against each other and cause pain elsewhere in the back. The “gold standard” for diagnosing SI joint dysfunction is a steroid injection that targets the SI joints, according to Dr. James. In using this approach to diagnose Gregory’s pain, the doctor says “hit a home run.” “He absolutely nailed it,” Gregory confirms. “When I went back for my follow-up visit three days after receiving that injection, I said, Whatever you did, you hit it perfectly. After that, I had no pain for about six weeks in that area. I felt like Superman. But then, of course, the shot wore off.” It can happen, Dr. James notes. Though steroid injections can relieve pain for months, their effectiveness typically wanes with each subsequent shot. When that happened with Gregory, Dr. James recommended a more permanent fix: an SI joint fusion. “SI joint fusion is an outpatient procedure that is performed under very light sedation, so the patient is still breathing on his own,” Dr. James explains. “With the patient lying face down, we start by making an incision about half an inch long in the lower back.” Through that opening and with the aid of x-ray guidance, the physician uses a needle as another guide to drill a channel through which he delivers two screws that are then screwed into holes made in the ilium, which is fused to the sacrum by the screws. “We finish by making sure those screws are nice and flush with the bone, and that’s it,” Dr. James adds. “The last thing we do is close the incision with some skin glue, cover it with a bandage and, after spending some time in recovery, the patient is discharged. “Once they’re back home, patients are asked to avoid soaking in ponds, lakes or the ocean until the incision is healed. We also ask that they avoid any excessive bending, lifting or twisting for six weeks. Other than that, they can go about their normal activities.”

Pain-Free at Last

Before agreeing to cover the cost of an SI joint fusion, insurance companies require that physicians first attempt to alleviate the patient’s pain through more conservative measures such as steroid injections and possibly even an ablation procedure. As a result, it wasn’t until this past spring that Gregory underwent the first of his two SI joint procedures, the one targeting the left joint. The next day, Gregory did something he had not done in months. “I walked a mile feeling no pain whatsoever on the left side,” he enthuses. “It was after I took that walk that I knew this treatment was going to work out well for me. After that, I really could not wait to get the second procedure done on the right side. “I finally had that other fusion procedure done about four weeks later and the results were the same, which was such an incredible relief. My pain is pretty darn well gone now, and I’m back doing everything I normally do and want to do. “I’m walking almost five miles a day now, and I’m back exercising again and lifting some weights and without all the pain that I was suffering with before. So, I am absolutely thrilled with Dr. James and the work he did for me. I only wish that I would have gone to see him sooner. “I would definitely recommend him and this procedure to anyone who is having the kind of problems I was having. I even told my cousin about Dr. James because he’s got similar problems, and I’m sure this procedure will work for him.”

Lee James, DO

Interventional Pain

Lee M. James, DO, received his undergraduate degree from the University of South Florida. He earned his medical degree at Read more...

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