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New Surgery For Back Pain

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LOS ANGELES, Calif. ( Ivanhoe Newswire) - Four out of five people will suffer back pain at some point in their lives. It can be debilitating and life altering. Now, a new procedure can ease the pain faster than ever before.

He was a surfer, a rodeo rider and a big game hunter, but when back pain struck, Jeff Pellisier was desperate for relief.

"I remember I was on the strongest opium patch you can have," Jeff Pellisier, told Ivanhoe.

So he tried a new surgery.

"I was not ready to give up any activities, much less all of them at age 50," Jeff said.

His problem along with a million others who suffer from lower back pain us the sacroiliac or SI joint.

"It's a really strong joint that keeps us standing," Dr. Neel Anand, director of spine trauma minimally invasive spine surgery at Cedars-Sinai spine Center in Los Angeles, explained.

Doctor Neel Anand is one of the first to perform a minimally invasive procedure that uses titanium implants bolted into the pelvis to stabilize the joint.

"In the past we use to open up and go down. Today we have three pins through a small incision of about an inch," Dr. Anand said.

Another difference is recovery time. For traditional fusion surgery it's 6 months, for the minimally invasive procedure it's two weeks. In fact with the new technique patients can go home the next day.

"We basically put in three pins right through the pelvis and lock it into place," Dr. Anand said.

The pins are covered with a plasma spray to help the bone grow around and into the implant for more stability. The day after surgery, Jeff was up and walking. One year out from his operation and he's moving on to more adventurous things

"I've been doing some surfing and some dog sledding," Jeff said.

The implants are not a first line of defense for SI joint sufferers. First steroid shots are used, and then radio frequency ablation then the surgery. The implants will most likely last for life.

RESEARCH SUMMARY

BACKGROUND: Low back pain is the fifth most common reason for all physician visits in the United States. The sacroiliac joint (or SI joint for short) is the second most common area where people experience back pain. Many people mistakenly refer to it as their "hip", but the SI joint is part of the spine. The joints form the connection between the spine and the pelvis. The pain forms if the Sacroiliac joint is rotated or tilted out of place causing the back to become less stable. This can lead to pain higher up in the back due to compensation. (Source:acatoday.org)

CAUSES: As with most other joints in the body, the SI joints have a cartilage layer covering the bone. The cartilage allows for some movement and acts as a shock absorber between the bones. When this cartilage is damaged or worn away, the bones begin to rub on each other, and degenerative arthritis (osteoarthritis) occurs. This is the most common cause of SI joint dysfunction. Another common cause of SI joint dysfunction is pregnancy. During pregnancy, hormones are released in the woman's body that allows ligaments to relax. This prepares the body for childbirth. Relaxation of the ligaments holding the SI joints together allows for increased motion in the joints and can lead to increased stresses and abnormal wear. The additional weight and walking pattern associated with pregnancy also places additional stress on the SI joints. Really, any condition that alters the normal walking pattern places increased stress on the SI joints. (Source: http://www.medicinenet.com)

TREATMENT: Surgery for SI dysfunction involves a fusion of the SI joints. In this invasive surgery, the cartilage covering the surfaces of the SI joints is removed and the bones are held together with plates and screws until they grow together (fuse). This eliminates all motion at the SI joints and typically relieves the pain. The recovery time for this type of surgery is generally around 6 months. (Source: http://www.medicinenet.com)

NEW TECHNOLOGY: Dr. Neel Anand, Director of Spine Trauma at Cedars-Sinai Spine Center in Los Angeles is breaking ground on a new surgery to ease back pain. The procedure is called iFuse. This MIS procedure requires a smaller incision and uses a guide pin to place the titanium implants across the sacroiliac joint. These small implants are designed to fix the sacroiliac (SI) joint and allow stable healing through minimization of micromotion. Typically three iFuse implants are used in an iFuse procedure. (Source: http://si-bone.com and http://www.infospine.net)

INTERVIEW

Dr. Neel Anand, Director of Spine Trauma, Minimally Invasive Spine Surgery at Cedars-Sinai Spine Center in Los Angeles, talks about a new procedure that can ease pain faster than ever before.

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.

FOR MORE INFORMATION, PLEASE CONTACT:

Cece Bruce
Administrative Manager
(310) 423-9209
Cecilia.Bruce@cshs.org

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