How many people do you see that have SI joint problems?
Dr. Anand: We probably under diagnose it more than we actually see it. We’re seeing more and more today than we saw before only because we’re more aware.
Is it because it presents itself as lower back pain?
Dr. Anand: Yes, it presents itself just like any other lower back pain.
What are the symptoms that would say it is not a disc problem but it’s a joint problem?
Dr. Anand: The pain is actually pretty similar, but it may be in a different location, maybe closer to the SI joint. You can get back pain that also causes pain near the SI joint. There are tests we do that may confirm or not confirm the problem.
What kind of tests?
Dr. Anand: Most tests are designed to stress the SI joint and produce pain We rotate the hips and do a figure of four crossover test. We stress the SI joint applying vertical pressure to see if that’s producing pain, tenderness directly on the SI joint is also a sign.
Where is the SI joint?
Dr. Anand: It’s actually the joint that articulates your spine to your pelvis. The SI joint is the joint between the end of the tail bone and the wings of your pelvis and there is one on each side.
It’s probably not uncommon that they wear out?
Dr. Anand: It’s different in that it doesn’t move as much. It moves very little compared to a hip or a knee or a shoulder. The range of motion is extremely limited but it does move. It is a regular joint and is a synovial joint and we can develop arthritis like any other joint can.
What was traditional treatment for this?
Dr. Anand: Traditionally it was injections, physical therapy and eventually if it ever came to a point you do an open fusion of the SI joint.
What’s the difference now with the iFuse Implant System?
Dr. Anand: What the iFuse Implant System does is it helps us do the fusion of the SI joint and stabilize it in a totally minimally invasive way. In the past we used to open up the entire pelvis go down the inside and do open surgery. Today, literally three triangular rods are placed across the joint through a small incision about an inch in size. We can literally go in and stabilize the joint and fix it. It’s made the entire procedure minimally invasive and totally tolerable and acceptable.
How long is the traditional incision?
Dr. Anand: Six to eight inches.
What is the recovery time?
Dr. Anand: With the iFuse Implant System, recovery time is a lot less.
Can you explain the difference?
Dr. Anand: Open surgery is big and it pretty much became out of vogue, which is why SI joint problems were never diagnosed. Now that we have a solution we are looking at it more easily, today we can make them go home in about six hours. The next day they can get up and start ambulating. They may not be able to put full weight on their leg but we’ve got different people do differently. Some people walk right away some people take some time to put weight on it. The open surgery took about six weeks.
What are the risks?
Dr. Anand: With any procedure there are risks, there’s always risks. It’s way less risky than the open procedure that we did.
With a lot of implants they wear out, will these be for life for most people?
Dr. Anand: It stabilizes the joint and hopefully fuses around it. So yes it could be there for life without any problem.
Is there a risk of fusing it in the wrong area?
Dr. Anand: If you don’t put it in the right spot then yeah the implant will be in the wrong place.
What would happen?
Dr. Anand: The implant can get loose and will have to be taken out.
Is it hard to get it in the right place?
Dr. Anand: Normally it’s all done under Xray control. If you know the anatomy and study the x-rays it’s not difficult at all. It takes about an hour to do.
Can you tell me about the implant?
Dr. Anand: The reason you do plasma spray coating is to allow ingrowth of bone. That’s again been shown from hips and knee technologies where if you plasma spray coat the implant, the bone has an affinity to grow towards it and bond to it. That’s the idea behind it. By putting the implant in we can allow bone to grow and fuse the joint.
Tell me about Jeff.
Dr. Anand: He was a really interesting patient. He was in agony for years and could not do anything he wanted to do. He had seen many doctors. He had gone through the whole sequence of treatments including different shoes, back doctors, pain management and actually by the time he saw me he already had I believe two or three SI injections. Each one of them had given him relief. I also believe he had radio frequency oblation that had given him relief but just came back. After three or four months it will come right back. So he was getting to a point he was getting tired of getting these injections. I examined him and he really fit the criteria clinically and his history and with all the successful injections it really proved it was the SI joint. He did spectacularly well, post surgery and recovered really well and he is very pleased. It’s a great technology it’s been definitely proven to work in selective patients and its helped us a lot.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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