L5 S1DISC HERNIATION /NOW SI JOINT?

[marchin]

4 MONTHS AGO I  RUPTURED MY L5 S1 DISC, AT WORK.
I STOOD FROM MY CHAIR,REACHED AND THOUGH I WAS GOING TO DIE.
THE PAIN WAS HORRIBLE, BURNING, FELT LIKE SOMEONE WHACKED ME IN THE BACK WITH A SLEDGE HAMMER.

ALSO, PRIOR TO THAT I HAD FALLEN AT WORK,WHILE WALKING UP A "DEW COATED",ALUMINUM,  HANDICAPPED RAMP, ASSISTING A PERSON IN A WHEELCHAIR ( WHICH IS RELATED TO MY JOB DUTIES?).

I RECEIVED 2 EPIDURALS, THE FIRST ONE IN THE HOSPITAL, AFTER MRI CONFIRMED RUPTURED DISC. .
THIS EPIDURAL I KNOW, WAS NOT ADMINISTERED WITH THE  FLUOROSCOPIC PROCEDURE.
THE PAIN RELIEF LASTED ABOUT 2 WEEKS.

THE SECOND EPIDURAL WAS PERFORMED OVER 4 WEEKS LATER, WITH THE  FLUOROSCOPIC PROCEDURE.
THAT PROCEDURE  HELPED WITH THE PAIN, AND ALLOWED ME TO BEGIN PHYSICAL THERAPY.
WHICH I BEGAN  8 WEEKS LATER, DUE TO THE ACCOMPANYING POST DURAL HEAD-ACHE,  WHICH WAS TREATED WITH A BLOOD PATCH.

I DON'T KNOW WHAT WAS WORSE, THE DISC HERNIATION, OR THE HEAD-ACHE.

NOW, 4 MONTHS LATER, IT WAS MENTIONED THAT I MAY HAVE PAIN AND PROBLEMS RELATED TO THE SI JOINT. DOES ANYONE KNOW IF THIS COULD BE RELATED WITH THE HERNIATED DISC?
I AM  IN A PENDING DISPUTE WITH WORKER'S COMP. DUE TO SOMEONE'S IGNORANCE. AND NOW THIS...... HELP!!!!!!!!!!

[kportier]

i have 3 protruding disc in L3-L4&L5 to s1. I've had this pain for 1 yr now. my treatments have only been threw chiroprator. I've seen a nureosurgeon spine specialist and he says that i'm too young for surgery (35 yrs old) and that if i got the surgery i probably would not beable to work again and be in pain all time. chiroprator work helped for awhile although i still was getting bent over here and there. well about two weeks ago i got bent again but this time i could not walk, it was too painful. my recent MRI showed the same results as the first protrusion without hitting nerve or spinal cord. I've been trying to read and educate myself but honestly i feel like i'm lost and don't understand why the doctor refuses to help me.I feel like they are just saying, hey you know what you just have to stay like that and i'[m getting very frustrated and depressed. if anyone has had an experience like this i would appreciate any advice you could give. also my muscles in my back feel like they are getting weaker and i can't staighten by back all the way still after almost 2 and a half weeks since i couldn't walk.

[nurseaudrea]

You seem to know a lot about SIJ dysfunction. How would you know if all the pain was actually coming from the SIJ rather than some of it from there and some from your spine? Is it that easy to say it is all in your SIJ if the pain went away after an injection, or could the injection also be helping with the pain from your spine as well? I have this dilemma. I had the injections and it really helped, very short term, because I still had pain in my back. The SIJ area felt great after the injection, and so did my back for a little while, but the pain in my back came back much faster than it did in my SIJ. I am facing another fusion surgery and am scared to do it because I don't think they really know if all I need is another fusion, or if most of the pain IS coming from my SIJ. What if I do this surgery and end up with more chronic pain in my back than I already have and still have problems with my SIJ? Is there anything they can do for the pain from SIJ other than the injections? The injections are not a permenant solution, and as you stated, no more than 3 a year. That is what I thought it was, but my PM doc thinks it's okay to have 3 over 6 months time. I don't get them anymore because they never really lasted for me in that area. Is there anything long-term or permenant they can do for the pain like cauterizing (sp?) a nerve or something like that, maybe radiofrquency or something?

[Tuckamore]

Hello Marchin,

Welcome to the Pain Management Forum of MedHelp. I am glad you found us but very sorry to hear about your pain and the problems that are associated with your injury. I know very well the severe discomfort that SIJ can cause. But it would require a physician to determine if your SIJ problem is related to your disc injury. Every-one's body and how they react to an injury are different. And of course every injury can be a bit different.

You do not have to have a disc problems to have SIJ problems. My discs are fine. You may have injured your SIJ when you fell, especially if you handed on your buttocks. SIJ pain and injury can result from bending, sitting, lifting, arching or twisting movements of the spine, or, from running or jumping. Injury to the sacroiliac joint may occur traumatically or due to repetitive or prolonged use over time. Unfortunately there are no good, long lasting treatments for chronic, long standing SIJ dysfunction, in my opinion and many other SIJ patients. However if caught early and treated properly the outcome is very good.

An injection of lidocaine into the joint under guided fluoroscopy will determine if your pain is coming from your SIJ. Most practitioners will inject a steroid compound at the same time. I have had this procedure preformed. The PMP that I dealt with (along with my DO) agree that only three injections per year are safe. I have done many years of research into this condition and the treatments for it. I highly disagree five of more injections, but this is my opinion. Once you reach that magic third number your risks for complications increase greatly and often outweigh the long term benefits.  

SIJ pain and disc pain can mimic one another. It takes a very good practitioner and the proper tests to determine which one is actually causing the pain. My SIJ Dysfunction causes pain in my hip, one side of my lower back, buttocks, leg, knee, groin and sometimes my foot. Most, if not all, SIJ pain sufferers can point to the exact spot in their buttocks that the pain originates. That "test" is part of a good clinical assessment.  

Good luck to you. I am hopeful you will follow-up with SIJ diagnosis and treatment. Please let us know how you are doing. I will look forward to your updates with interest. Take Care, Tuck

[nurseaudrea]

I also have had SI joint problems due to a fusion at L4-L5-S1. I had SI joint injections done with the same medications they use for epidural steroid injection. You have to be careful with those injections because you are only supposed to have 3 within a given amount of time. I think it is 3 every 6 months. I had a doctor who told me 3 in a year, but my PM doctor says you can have 3 in 6 months. If you have reached your limit, or for diagnostic purposes, you can have your doctor inject lidocaine ( a numbing medication ) into your SI joint(s) to see if that gives you any immediate relief. If it does then you know it is your SI joint. You would know instantly if the pain goes away in that area. It really helped me and the steroid helped the inflammation go down. But, as I stated, only 3 steroid injections over a course of 6 months because it can cause avascular necrosis of the hip joint. It disrupts the vascular components at the hip joint for some reason. I knew a woman who had these injections done and went to a new doctor who did more steroid injections in another area of her spine but neglected to let her doctor know about the previous injection, she had completely forgotten about them.She did not know how critical it was to disclose all of her medical history to this doctor and had more injections done to her detriment. In the following years her hip started to hurt and she eventually had to have hip replacements done. She was only in her 30's at the time.

Back to the SI joint problems, I had the injections done and found a lot of relief. Of course the pain always came back after time passed. Knowing I could not keep getting these injections, my doctor decided he would try to do something permenant to help with the pain. He referred me to a physiatrist, a doctor that specializes with the movements of the body,concetrating on  bone, and muscles. This doctor thought it would be good for me to have prolotherapy, or schlerotherapy some would call it, in the SI joint. What they do is inject some schlerosing agents into the SI joint area. When they inject this type of stuff it is very painful, more so than the original pain, and it causes scar tissue to build up to try to fuse the joint to make it immobile. My doctors thought the movement in my SI joint was causing me all the pain. When I had the fusion at the L4-S1 level the thought was that it put more pressure on the SI joints and it made them hypermobile causing the increased pain. If they could immobilize it then maybe the pain would get better. Well, they were wrong. The therapy was supposed to be a course of 10 injections, getting one in both SI joints every two weeks or so. I had 5 injections done treatments done. It did not get better, only worse. Now my SI joints are severely scarred and inflamed all the time. The doctors have actually learned that when you do have your spine fused at the L5-S1 level you NEED your SI joint to be able to move freely because the L5-S1 can't, something needs to give. When the spine is fused it puts more pressure on the level above and below that area, it only stands to reason. I wish I had known that before, I would have never agreed to go through that.

As patients, we always look up to our doctors to know the answers. Some of us go in with blind faith that they KNOW what they are doing, when in fact, many times it is a big guessing game. I wish you all the luck and hopefully your doctors can find the answers that you need.            Audrea