Lower Back, Hip Pain? It May Be Your SI Joints

Jordan Pysz / ifoundmydoctor.com Since her SI joint fusion procedure, Marjorie is walking more than 2,500 “pain-free steps” each day.

In one of her earliest and most fond memories, Marjorie Van Vliet can remember sitting on her grandfather’s lap at age 4 and briefly taking the wheel of the family boat as it sped around the small Michigan lake she grew up on.

It was moments like those that kindled a passion in Marjorie that has never died.
“I was a water baby who at 8 years old was already driving boats while my brothers skied behind me,” Marjorie recalls. “I earned my first Coast Guard license when I was 12 and eventually went through all the Red Cross water safety and lifeguard programs.
“I also did some sailing, and after living in Chicago for many years and doing a lot of boating there on Lake Michigan, my husband and I moved to Florida. He wanted to come here for the golf; I came to be near the water.”
Marjorie, 66, spent several years touring Florida’s waters in two yachts, a 38-foot Cruisers Express and a 45-foot Sea Ray Sundancer. Those days ended abruptly four years ago, when Marjorie was suddenly struck down by intense back pain.
“One day I was walking on the beach enjoying myself, and the next day I woke up in excruciating pain,” Marjorie recalls. “The pain was so bad that my husband took me to the emergency room, where I wound up having emergency surgery.”
The surgery was deemed an emergency because a fractured vertebrae was putting pressure on Marjorie’s spinal cord. In terms of relieving that pressure, the surgery was a success. In terms of relieving Marjorie’s pain, it was not.
“The pain remained, and it eventually affected everything in my life,” Marjorie laments. “It forced me to spend most of my time sitting in a recliner or lying in a reclining bed because that’s the only place where I could get any relief.
“I could not get up and walk around because if I did I would get this shooting pain that was like fireworks going off. From the point where it started, the pain would move through the rest of my body like fireworks. It was awful.
“There was only one very brief time when I actually felt better for a while, but then my husband and I got T-boned in our new car. Some guy ran a stop sign and that put me right back where I was with the pain.”

“That’s My Guy”

That brief respite from pain that Marjorie enjoyed was achieved in part through the use of a pain pump, a device implanted beneath the skin and allows for relieving medication to be delivered to the painful area whenever necessary.
The device was implanted by a pain physician recommended by Marjorie’s daughter, but when a problem with the pump forced Marjorie to consider making a switch, she switched providers instead.
“I was talking to a doctor at the University of Florida who said, I’ve got a solution for all of this and suggested I go see Dr. Hanes,” Marjorie confirms. “After doing some research on Dr. Hanes, I decided, Yep, that’s my guy.”
Michael Hanes, MD, is a board-certified anesthesiologist and interventional pain medicine specialist with Centurion Spine & Pain Centers, an affiliate of Jax Spine & Pain Centers. Both practices specialize in the use of progressive interventional treatment options to address chronic joint, neck and back pain.
Dr. Hanes began caring for Marjorie by trying to rectify the issues with her pain pump. When the fixes he made failed to adequately alleviate her pain, Dr. Hanes decided to take a deeper dive into the cause of her pain.
That clinical investigation revealed that the bulk of Marjorie’s issue stemmed from damage to her sacroiliac joints, which connect each ilium of the pelvis to the sacrum of the lower spine. It’s the area between the waist and the top of the buttocks on each side.
Sacroiliac, or SI, joint pain is often caused by inflammation in the joint, which has a very limited range of motion (about 4 degrees) and can become inflamed through hypermobility, which is too much movement, or hypomobility, which is too little movement.
SI joint pain can also develop because of degeneration of the joint through arthritis, which can force the bones to rub against each another and produce pain in other areas of the back.
“Most of the people who present to my office with sacroiliac dysfunction, or sacroiliitis, come in complaining of lower back or hip pain,” Dr. Hanes reports. “Many think it’s a hip problem, but it’s SI joint dysfunction.
“It often goes undiagnosed because it’s not something that shows up on an MRI or x-ray. The only way to determine if a person’s pain is from the SI joint is to inject the joint with a numbing medication and see if that makes it better.”

In With the New

Marjorie Van Vliet

Dr. Hanes did just that in diagnosing Marjorie’s SI joint pain. When the numbing agent temporarily alleviated the pain, Dr. Hanes recommended a more permanent fix – a minimally invasive procedure known as SI joint fusion.
SI joint pain can also be treated with ablation, during which heat generated by radiofrequency is delivered through a probe to specific nerves in the joint. The heat creates a lesion on the nerve tissue that halts the pain signals to the brain.
“But the SI joint is the largest in the body, so it’s hard to ablate all the nerves in it,” Dr. Hanes points out.
“Another thing is that most insurers don’t cover the ablation procedure. But almost all insurers cover the fusion procedure, so I lean more toward the fusion procedures, of which there are two that are more commonly performed.”
One is a lateral procedure, which calls for the physician to enter the body from the side near the hip. Through that opening the physician inserts plates, screws and three titanium rods that are pieced together to fuse the joint, which alleviates the pain.
A newer version of the procedure, which has been around for about five years and is the one Dr. Hanes recommended for Marjorie, is less invasive and is performed while the patient lies face-down under light sedation.
Once the patient is sedated, the physician creates a 2-inch incision near the top of the buttocks. Through that incision the physician first delivers a pair of dilators that are used to create an opening in the joint.
Once the joint has been dilated, the physician then uses x-ray guidance to deliver an allograft, or piece of cadaver bone, into the opening. Over time, the existing bone fuses with the graft and secures the joint, which alleviates the pain.
“What we’re doing is fusing the sacrum to the ilium,” Dr. Hanes educates. “It’s a short same-day procedure, and patients typically go home right afterward and start walking right away.
“With the lateral version, patients can’t walk for several weeks. That is one of the reasons I don’t do the lateral procedure. With this procedure, all we ask is that you don’t do a lot of heavy lifting for a month or two. Other than that, patients can resume normal activities.”
Marjorie was in pain for so long she forgot what normal activities were. She was so inactive that she counted a “good day” as one in which she took 500 painful steps. Now, since having one SI joint fusion in May and another in August, she’s taking 2,500 “pain-free steps” each day.
“And building toward more,” Marjorie enthuses. “I’m working toward 3,000 steps a day, and it’s all because I no longer have that shooting pain throughout my body, so I definitely recommend this SI joint fusion procedure. Absolutely.
“And I absolutely recommend Dr. Hanes. He is fabulous. Thanks to him, I can sit comfortably again, I can walk again, and I can get out and socialize and ride in a car. These are all things I had not been able to do for almost four years.
“I don’t know that I’ll ever get back on a boat again, but I’m getting closer to walking on the beach again, and I’m excited to do that. The bottom line is that I’m feeling a lot better and doing a lot more since I had these fusion procedures. They were just what I needed.”