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Thread: Sacroiliac joints supposed to be fused with long fusions?

  1. #1
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    Sacroiliac joints supposed to be fused with long fusions?

    Hi,

    I haven't posted on here in years, but had T-3 to sacrum fusion in 2012. Last week I had a CT scan of sacrum area due to this chronic severe pain and an area that is swollen, very tender, even hurts for water in the shower to touch it. I've lived with chronic severe pain every since this surgery in April 2012 Well, the report from the CT scan states "there is not fusion of the sacroiliac joints. Is this area supposed to have fused? Also, the report states, "that one of the three screws in my pelvis is near a portion of the ascending colon.The Right S1 transpedicular screw extends through the anterior colon." I am so fed up with Nashville, TN surgeons!!! Is there anyone in or near this city that will REMOVE the three long iliac srews in my 5'3" petite frame.

    Thanks so much for any answers.
    Pam, age 49
    Thoracolumbar curves 80 and 40 corrected to 20 degrees
    April 20, 2012 surgery with Dr. Lenke
    T-3 to sacrum

  2. #2
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    Pam, its been a long time....

    Have you thought about travelling up to Twin Cities Scoliosis Center?
    https://www.tcspine.com/our-team/

    Also, CBD is now the craze.....
    https://northamericanspine.com/blog/...e-pain-relief/

    Ed
    49 yr old male, now 60, the new 55...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  3. #3
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    Quote Originally Posted by TwinmomTN View Post
    Hi,

    I haven't posted on here in years, but had T-3 to sacrum fusion in 2012. Last week I had a CT scan of sacrum area due to this chronic severe pain and an area that is swollen, very tender, even hurts for water in the shower to touch it. I've lived with chronic severe pain every since this surgery in April 2012 Well, the report from the CT scan states "there is not fusion of the sacroiliac joints. Is this area supposed to have fused? Also, the report states, "that one of the three screws in my pelvis is near a portion of the ascending colon.The Right S1 transpedicular screw extends through the anterior colon." I am so fed up with Nashville, TN surgeons!!! Is there anyone in or near this city that will REMOVE the three long iliac srews in my 5'3" petite frame.

    Thanks so much for any answers.
    It's pretty rare that people have their sacroiliac (SI) joint(s) fused, so not sure why the radiologist felt the need to say that they don't see fusion of yours.

    To clarify, the two statements that mention colon are actually unrelated to one another. The fact that you have a pelvic screw close to your colon probably isn't an issue of concern.

    I suspect that "Right S1 transpedicular screw extends through the anterior colon" was meant to state "Right S1 transpedicular screw extends through the anterior column". I think that if there was a screw extending INTO the colon, you probably would have died of sepsis by now.

    Any spine surgeon should be able to remove iliac screws, if that's really the problem. Iliac screw sensitivity is typically pretty far off center. Is your pain close to the middle, or is several inches or more to the right or left of center? The fact that mention that even the touch of water is painful makes me think the problem is nerve related. With that said, removal of iliac screws is a relatively benign procedure and could be worth the risk to see if it resolves your issue.

    Best of luck.

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  4. #4
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    Thanks Linda- let me clarify

    Quote Originally Posted by LindaRacine View Post
    It's pretty rare that people have their sacroiliac (SI) joint(s) fused, so not sure why the radiologist felt the need to say that they don't see fusion of yours.

    To clarify, the two statements that mention colon are actually unrelated to one another. The fact that you have a pelvic screw close to your colon probably isn't an issue of concern.

    I suspect that "Right S1 transpedicular screw extends through the anterior colon" was meant to state "Right S1 transpedicular screw extends through the anterior column". I think that if there was a screw extending INTO the colon, you probably would have died of sepsis by now.

    Any spine surgeon should be able to remove iliac screws, if that's really the problem. Iliac screw sensitivity is typically pretty far off center. Is your pain close to the middle, or is several inches or more to the right or left of center? The fact that mention that even the touch of water is painful makes me think the problem is nerve related. With that said, removal of iliac screws is a relatively benign procedure and could be worth the risk to see if it resolves your issue.

    Best of luck.

    --Linda
    Hope im posting in the correct area. I would love to get these iliac screws removed,but having a LOT of trouble finding a scoliosis surgeon to remove only iliacs and not ALL hardware as one surgeon told me, which is major. The radiology report read"the additional hardware(3rd screw) component extending to the LEFT iliac body bypassing the sacroiliac joint posteriorly. The RIGHT S1 transpedicular screw extends through the anterior cortex of the sacrum for approximately 1.7 cm. The tip of the screw is near a portion of the ascending colon without evidence of fluid collection...yada yada yada" Is any of that alarming Linda or anyone???
    Pam, age 49
    Thoracolumbar curves 80 and 40 corrected to 20 degrees
    April 20, 2012 surgery with Dr. Lenke
    T-3 to sacrum

  5. #5
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    Quote Originally Posted by TwinmomTN View Post
    Hope im posting in the correct area. I would love to get these iliac screws removed,but having a LOT of trouble finding a scoliosis surgeon to remove only iliacs and not ALL hardware as one surgeon told me, which is major. The radiology report read"the additional hardware(3rd screw) component extending to the LEFT iliac body bypassing the sacroiliac joint posteriorly. The RIGHT S1 transpedicular screw extends through the anterior cortex of the sacrum for approximately 1.7 cm. The tip of the screw is near a portion of the ascending colon without evidence of fluid collection...yada yada yada" Is any of that alarming Linda or anyone???
    I'm guessing that most surgeons would say there is nothing really alarming.

    I'm surprised that you can't find someone to remove the iliac screws. I don't think I know anyone in TN, but have you tried Leatherman in KY? Steve Glassman might be a good choice.

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  6. #6
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    Pam, there is going to be someone.....

    For Nashville, you could talk to Brett Babat. I mentioned him before, because I know his father.
    https://www.nashvilleneurosurgery.co...rett-babat-md/

    He went to Yale and Brown....He does complex revision and deformity surgeries

    Ed
    49 yr old male, now 60, the new 55...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  7. #7
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    Quote Originally Posted by titaniumed View Post
    Pam, there is going to be someone.....

    For Nashville, you could talk to Brett Babat. I mentioned him before, because I know his father.
    https://www.nashvilleneurosurgery.co...rett-babat-md/

    He went to Yale and Brown....He does complex revision and deformity surgeries

    Ed
    Thanks Ed! I do appreciate it. Ironic that a dr I just saw Friday
    mentioned his name to me.
    Pam, age 49
    Thoracolumbar curves 80 and 40 corrected to 20 degrees
    April 20, 2012 surgery with Dr. Lenke
    T-3 to sacrum

  8. #8
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    Pam, my lawyer Al went to Yale, and of course he suggested Brett at the time I was making my decision. He worked with Brett's father. I used to spend time on Al's island in Canada years ago, so he had plenty of time to lecture me on the Yale alumni excellence thing. They do have their high standards...

    Since insurance can get tricky leaving your home state, and my surgeon trained at Twin Cities Scoliosis Center, I chose him. Twin was where the SRS was founded and they train scoliosis surgeons there, its a special place in the scoliosis world. Several members here have been operated on there.

    I wouldn't hold too much weight on the radiology report since the surgeon will be calling the shots. Radiologists can and do make mistakes, and report "everything they see" since a surgeon can come back and say "You didn't see this?" Scoliosis screws can look like they are overhanging sometimes when they are not. Just because the Radiologist states something, doesn't mean that's the problem. I have all sorts of lovely stuff in my reports and I am still here.... They thought I had cancer.... they were looking on my ALIF, and I fooled them.

    I don't know if you can blame it on the hardware.....but it would be a shame "if" it was just one screw which if they do remove, chances are it would be one at a time. (And then wait) Pulling one of the base legs on the Eiffel tower doesn't mean its going to topple, but these decisions are never easy.

    It will be best not to say anything about the reports. Don't sway your surgeon, let him ask the questions. Just tell him about your pain. Your exact description of your pain is EXTREMELY important.

    I hope that someone finds an answer. You have to realize that these surgeries that we do are extremely complicated, there are things that can happen that even the best have no control over. I know you know this. When things don't happen just right, there is an unbelievable amount of burden that a surgeon has to carry. And they don't forget. There is a British neurosurgeon (Henry Marsh) that did brain surgeries in England in which the odds were not good..... He had experienced incredible amounts of depression over things he had no control of and had to resign himself to the fragility of human nature....I myself have seen this in the faces of my surgeons and other surgeons, there is a look, and there is no rush because they also worry. (I am excellent at reading faces)

    Just go in, calm blue ocean, take a deep breath and try to relax....no negativity on Nashville or anyone or anything, the past is the past, only positive feelings with a new turned page. It hard sometimes, when my neck herniated and my hand went numb a few years after my surgeries, I blew off some steam, but it didn't help matters, it only established that I was emotionally upset.

    Be sure to let us know what happens....we have seen miracles happen on this forum.

    Ed
    49 yr old male, now 60, the new 55...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  9. #9
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    Thank you Ed for responding. I know you are a veteran on here and extremely knowledgeable. Have you had your iliacs removed? Just curious since a friend that has had several spinal fusion surgeries says that pretty much all fusion patients she knows has had theirs removed. I wonder what the actual percentage is? Anyone have a ballpark??

    I actually spoke with Dr. O'Shaughnessey this morning on the phone,(he did my revision and placed the 3rd iliac screw), who's explanation to me stated that more often than not there are ramifications of removing the screws and he's had to replace screws after removal due to breaks in the sacrum. Now whether all of that is an accurate statement or just a way of trying to get me, as a liability, off his hands, I don't know. He seemed to think the screw would remain in that position and possibility or probably never cause me any issues (other than this severe chronic horrific pain). He also stated that he did not believe it would help alleviate my pain to have it removed.


    Any feedback, and as much as possible, would be greatly appreciated!

    Pamela Berry
    Pam, age 49
    Thoracolumbar curves 80 and 40 corrected to 20 degrees
    April 20, 2012 surgery with Dr. Lenke
    T-3 to sacrum

  10. #10
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    Quote Originally Posted by TwinmomTN View Post
    Thank you Ed for responding. I know you are a veteran on here and extremely knowledgeable. Have you had your iliacs removed? Just curious since a friend that has had several spinal fusion surgeries says that pretty much all fusion patients she knows has had theirs removed. I wonder what the actual percentage is? Anyone have a ballpark??

    I actually spoke with Dr. O'Shaughnessey this morning on the phone,(he did my revision and placed the 3rd iliac screw), who's explanation to me stated that more often than not there are ramifications of removing the screws and he's had to replace screws after removal due to breaks in the sacrum. Now whether all of that is an accurate statement or just a way of trying to get me, as a liability, off his hands, I don't know. He seemed to think the screw would remain in that position and possibility or probably never cause me any issues (other than this severe chronic horrific pain). He also stated that he did not believe it would help alleviate my pain to have it removed.


    Any feedback, and as much as possible, would be greatly appreciated!

    Pamela Berry
    Hi Pamela...

    Hope you don't mind my responding. I'm sure Ed will as well.

    I don't know about other practices, but my estimate of the UCSF patients with long spine fusions, is that about 1-2% of patients have their iliac screws/bolts removed. Also, I can't remember hearing that any of those patients had sacrum fractures afterward. It's possible that Dr. O'Shaughnessey is using a technique that puts more stress on the sacrum or that he's removing the screws before the fusions are solid. Interestingly, he was lead author on a paper that essentially shows good outcomes on patients who had iliac screws removed:

    https://www.ncbi.nlm.nih.gov/pubmed/22146291

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  11. #11
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    Linda,

    Thank you for your feedback AND attaching the very interesting article. I find this absolutely astonishing since Dr. O'Shaughnessy himself called me at 8:00 AM this morning to attempt
    to explain why he did not think removing the screws would help my pain nor a good idea. He stated that his experience with removing iliac screws required replacement of the screws
    due to sacrum fractures. He had very little to say regarding the screw tip that is near the ascending colon. Such a disappointment when you rely on these surgeons who take an oath to "do no harm".
    I suppose that excludes helping out a patient that may have a serious issue and at the very least has an anxiety level that is through the roof regarding this issue.

    I'm left speechless after reading this article. Is this study invalid or has the medical opinion on the removal of screws changed this much in a matter of six years? Very disappointed in both
    of my prior surgeons There is no such thing as actual patient care any longer.

    Pamela B.
    Pam, age 49
    Thoracolumbar curves 80 and 40 corrected to 20 degrees
    April 20, 2012 surgery with Dr. Lenke
    T-3 to sacrum

  12. #12
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    Quote Originally Posted by TwinmomTN View Post
    Linda,

    Thank you for your feedback AND attaching the very interesting article. I find this absolutely astonishing since Dr. O'Shaughnessy himself called me at 8:00 AM this morning to attempt
    to explain why he did not think removing the screws would help my pain nor a good idea. He stated that his experience with removing iliac screws required replacement of the screws
    due to sacrum fractures. He had very little to say regarding the screw tip that is near the ascending colon. Such a disappointment when you rely on these surgeons who take an oath to "do no harm".
    I suppose that excludes helping out a patient that may have a serious issue and at the very least has an anxiety level that is through the roof regarding this issue.

    I'm left speechless after reading this article. Is this study invalid or has the medical opinion on the removal of screws changed this much in a matter of six years? Very disappointed in both
    of my prior surgeons There is no such thing as actual patient care any longer.

    Pamela B.
    Pam...

    It's not uncommon for a screw to extend outside of the spine/pelvis. I remember being alarmed when I first saw something like that, but was assured that it wasn't really an issue in terms of damage risk.

    I think one of the previous fellows I worked with at UCSF ended up in Tennessee. I just sent off an email and will update you when I hear back.

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  13. #13
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    Pam...

    I was correct. Erion Qamirani was a spine fellow at UCSF. He was well respected. I can't really judge his surgical skills, but I can tell you that he's really smart, and a very kind, caring doctor.

    http://mtbj.net/physicians/erion-qamirani-md-phd/

    --Linda
    Last edited by LindaRacine; 11-14-2018 at 05:08 PM.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  14. #14
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    Thank you very much, Linda.
    Pam, age 49
    Thoracolumbar curves 80 and 40 corrected to 20 degrees
    April 20, 2012 surgery with Dr. Lenke
    T-3 to sacrum

  15. #15
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    Quote Originally Posted by TwinmomTN View Post
    (he did my revision and placed the 3rd iliac screw)
    Pam, I still have my pelvic anchors.....

    There are not too many pelvic removal posts here on NSF. Over 10 years, maybe 2 or 3 at the most.

    I didn't know you had a 3rd pelvic anchor installed....why was that done and when?

    Ed
    49 yr old male, now 60, the new 55...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

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