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View Full Version : What is the difference between fused to the sacrum and fused to the pelvis?



susancook
01-09-2013, 09:39 PM
In humans, the sacrum (plural: sacrums or sacra) is a large, triangular bone at the base of the spine and at the upper and back part of the pelvic cavity, where it is inserted like a wedge between the two hip bones. Its upper part connects with the last lumbar vertebra, and bottom part with the coccyx (tailbone). It consists of usually five initially unfused vertebrae which begin to fuse between ages 16–18 and are usually completely fused into a single bone by age 34.

It is curved upon itself and placed obliquely (that is, tilted forward). It is kyphotic — that is, concave facing forwards. The base projects forward as the sacral promontory internally, and articulates with the last lumbar vertebra to form the prominent sacrovertebral angle. The central part is curved outward towards the posterior, allowing greater room for the pelvic cavity. The two lateral projections of the sacrum are called ala (wings), and articulate with the ilium at the L-shaped sacroiliac joints.

The above quote comes from wikipedia. It shows a picture of the sacrum as part of the pelvis. I tried to copy the picture to the blog, but pictures don't copy.

So, what is the difference of fusion to the PELVIS vs fusion to the SACRUM? Can you have fixation in the sacrum like you have in the pelvis?
Call me confused....Susan

leahdragonfly
01-09-2013, 09:54 PM
Hi Susan,

fusion to the sacrum almost always includes pelvic fixation, which means that the rods and screws go all the way down to the sacrum, with an additional long screw extending across one or both sacroiliac joints into the ilium. Pelvic fixation is done to protect against fracture of the sacrum due to the pressure/stress transmitted down through the newly-fused area of the spine, while the fusion is healing.

Functionally there would be no difference at all in mobility or lack thereof between fusion to the sacrum only and fusion with pelvic fixation. Only problem with the iliac screws is that sometimes they can be a source of pain. I have read that there are newer techniques now to try and prevent pain from the iliac screws. Nonetheless, some people do suffer pain or discomfort from them. Some people, myself included, go on to have the iliac screw(s) removed after one or two years time due to pain. Apparently once fusion has occurred, the iliac screws are no longer needed.

I am glad that you had such a good consult with Dr Hu, and I hope you are finding your peace.

Take care,

susancook
01-09-2013, 10:28 PM
Hi Susan,

fusion to the sacrum almost always includes pelvic fixation, which means that the rods and screws go all the way down to the sacrum, with an additional long screw extending across one or both sacroiliac joints into the ilium. Pelvic fixation is done to protect against fracture of the sacrum due to the pressure/stress transmitted down through the newly-fused area of the spine, while the fusion is healing.

Functionally there would be no difference at all in mobility or lack thereof between fusion to the sacrum only and fusion with pelvic fixation. Only problem with the iliac screws is that sometimes they can be a source of pain. I have read that there are newer techniques now to try and prevent pain from the iliac screws. Nonetheless, some people do suffer pain or discomfort from them. Some people, myself included, go on to have the iliac screw(s) removed after one or two years time due to pain. Apparently once fusion has occurred, the iliac screws are no longer needed.

You can visit my care page at www.carepages.com/GayleKalman . You have to create a free carepages account and password, then you can view my photo album. I have my x-rays posted which clearly show the iliac screw extending into the left ilium. The right side did not receive an iliac screw. You can see the difference between the right and left sides on my post-op x-rays. There is also a photo of the large iliac screw once it was removed during my revision for broken rods.

I am glad that you had such a good consult with Dr Hu, and I hope you are finding your peace.

Take care,

Thanks, Gayle! You have been supportive from the beginning of my journey when I had my first appointment and we talked in the waiting room. My Gratitude, Susan

Confusedmom
01-09-2013, 11:08 PM
Gayle,

Did you have to have new iliac screws with your revision, and will they be removed?

Also, how could you be sure it was the iliac screws causing discomfort?

Also, why does the risk of fracture of the sacrum go away after you are fused?

Dr. Lenke's staff members have said they think that's what's causing my hip/sacrum pain while exercising, so I might need them out at two years if it's still bothering me.

Thanks, Gayle. You must be coming up on the one-year anniversary of your revision, huh? Hope you're feeling well!

Evelyn

leahdragonfly
01-10-2013, 08:28 AM
Hi Evelyn,

I had just a left iliac screw with my initial fusion, and I consistently had pain over it and in the left SI joint area. It was worse with exercise or weight-bearing activities like stairs or walking. Since there was no other hardware in that area, and all the spinal pathology was addressed during the first surgery, it seemed very likely that the iliac screw was the source of pain. My surgeon agreed but at one year post-op said to give it some time. Then when I broke my rods at 15 months I asked if he could remove it during the revision and he said sure.

I am not sure why the risk of fracture goes away after a certain period of time. I did some reading in PubMed about iliac fixation and sacral fracture and come upon it, but I don't recall now. I did not need a new iliac screw with the revision.

My one-year appt is coming up on Jan 29th. Overall I am doing very well, although it is hard now to not worry about breaking a rod again right at this point. I am looking forward to additional healing/improvement in soft tissues this coming year. I think there is definitely some improvement to be had still for me!

gardenia
06-13-2013, 10:02 AM
I am at 7 months post op and showing a lot of pain below my waist towards the sacrum. I recently (last month) bought a treadmill as per the Physical therapist that was new with Dr. Bridwell ( 6 months visit May 2013) and walking at higher speed that he recommended. After a month, I pain almost constantly here and there.

I must have over done it and possibly (iliac screw pain) is the cause. Answers to problems makes me not wonder WHY? What am I doing wrong? Am I hurting the surgery work?

I was painless for the first 6 months. Hope Bernie (Dr Bridwell's nurse) returns my call and tells me what I am possibly doing to cause the pains.

jrnyc
06-13-2013, 12:31 PM
Gardenia...did you discuss the treadmill with your surgeon before
you started using it...???????????

when i was going to go thru with surgery some years ago, surgeon
told me he would NOT ALLOW me on a treadmill for a looong time...
he said i should consider surgery during spring or summer,
as walking naturally was what he would allow, indoors or out...
this was in Manhattan, where weather wouldn't allow walking outdoors in winter months...

jess

jackieg412
06-13-2013, 05:11 PM
Dear Gardenia,
Please stop the treadmill---it is harder on you than walking normally. I can make myself hurt on it{fusion 2 years old}. Yet I can walk on sidewalks and not hurt. Please be careful!

golfnut
06-13-2013, 09:56 PM
Yes, stop the treadmill. I was about 6 or 7 months post op and thought I needed to kick it up a few notches and walked some steep hills. I had new pains and finally called Dr. Lenke's office after a week or so and was allowed to take Aleve which helped with the inflammation that I had caused by overdoing it. It really will pay off in the long term to be conservative for the first year. I walked miles and miles and did several exercises with weights for my arms while laying on my back on the bed. It is all you need for now. There is plenty of time to do more after a year.

Confusedmom
06-13-2013, 10:11 PM
Umm...guess it's just me, but I have less pain from the treadmill (3.2 mph max) than sidewalk walking. Unevenness of sidewalk can irritate my iliac screw on left side. But I definitely agree you should not go so fast that it causes pain. And yes, take Aleve at six months!! :-)

golfnut
06-14-2013, 07:44 AM
I was just thinking about my own Treadmill which is manual and at an incline. I'm sure a treadmill would be fine as long as it's flat.

gardenia
06-14-2013, 10:52 AM
Actually I had asked the nurse before m 6-mos visit with Dr Bridwell, she said OK. I was at an apartment complex and would do slow speeds at 1.2 and about less than .5 miles. It was good.

Then on my visit beginning of May, I spent almost 45 minutes with a PT (the last PT Janet had retired). This PT was young and likely very optimistic. He pointed out that I was walking with hip swinging more to the left so I should tighten my butts to avoid swing - something I constantly forget. Taught me some good exercises by leaning on the wall and scooting down (I was terrified) Then he ask me to get up on the exam table and told me lean back: WHAT?!!! I said I don't do that like that anymore, so he told me to just do it he would guide me with his big great arms. He is 6'5". What I did not hear but my daughter did was that for my one year check up I should be walking at 1.8

Reality is that I live in San Felipe, Baja California on an American gated community in the desert with great weather, an eyefull of the Sea of Cortez, and lots of mountain ranges behind in a U shape. But, the property totals 35,000 acres and individual lots are all spread out into communities. There are no streets but dirt roads although well maintained they are not smooth. Summer has started getting to be 110 degrees later.

During the visit in May to St Louis, I went to the bathroom at night, close the door, and did not turn on the light I fell back onto the toilet breaking the tank midway up from the seat. No damage but sore body for several days and fortunately the weekend before seeing Dr. B. so no damage showed on the xrays.

I've been doing the treadmill at 1 -1.2 miles/h very slow and walked until I got too tired. After the visit I convinced my husband that I could no longer walk the roads so we got the cheapest treadmill at Sears. His thought was as in my entire life, it would be money wasted as I would lose interest when there is pain and no gain, pre-surgery.

Back in Baja, I started at 1.2 increasing in stages (slowly but within 5 days I was up to 1.8). I started feeling the pains and back muscles no longer stiff would be felt. I have not taken any med for the pain as it is tolerable compared to pre-surgery.

But, Thanks my friends!!! I know it is hard to not want to recover faster but I just need to really slow down much more than my brain is up and ready.

Thanks again!!!