I would appreciate any insight you can give me. More than 40 years ago, I had a fusion [T5 to L3] with Harrington rod instrumentation. Since 2013, Iíve had pain in my lumbar back and pain down my right leg. After having read numerous posts about the realities of extending a fusion to the pelvis, I decided that I would do everything I could to avoid further surgery. To that end, Iíve researched pain management and have used a combination of Gabapentin, Diclofenac, a topical cream and cannabis based medications. I have also tried to exercise and stretching and have managed to do this more or less consistently this last year. Up until recently, I thought I could manage with these strategies.

In the last 5 or 6 weeks, Iíve developed significant pain in my left sacroiliac joint [SIJ]. Recently, the pain is so bad that at times, I canít even walk or sit. Diclofenac [a strong NSAID] has helped me with this pain but this relief is not enough. It has occurred to me that given my current limited mobility that perhaps extending my fusion to sacrum/pelvis couldnít be too much worse. I have an appointment with one of my HMOís Physical Medicine specialists. If I am lucky, they will assess this problem correctly and perhaps offer me suitable imaging and then an injection into the SIJ. However, what probably will happen is that they will elect to adopt a ďwait and seeĒ approach because that is the most "cost effective" approach. I donít know if I can handle the ďwait and seeĒ approach.

Research has shown that the SIJ is negatively impacted by spinal fusion [another form of Adjacent Segment Degeneration / ASD]. I found it interesting that harvesting bone from the Iliac crest has been shown to weaken the SIJ. Although bone was taken from my left ilium, it was probably too long ago to have an impact today. It also probably doesnít help that my right, lumbar curve goes into the sacrum/pelvis in a very asymmetrical manner.

So here are my questions I am hoping I can get answers for:
(1) If you were me, what would you do? Would you consider extending the existing fusion?
(2) If you have had pain in the SIJ, could you adequately manage it? Were you able to stay physically active? Is there any reasonable possibility that this will not become a chronic problem?
(3) If I did elect to have a fusion that extended into my pelvis/sacrum, is it likely that this procedure would help with the pain in my SIJ?

I would be most appreciative of any answer to any question. Thank you, Terry