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| Considering Surgery back |
| Before considering surgery you need to considers these 5 categories
1. Educate yourself and learn what questions to ask the Surgeon. The Surgeon's answers and concerns about your questions
can be an indicator for you to use to estimate his knowledge and experience.
2. Find an experienced Surgeon. Ask around or even ring the Surgeon's room and enquire if he
specializes in pelvic surgery.
3. Do you need a second opinion? This is an individual's choice.
4. Planning ahead. Look into the financial aspects and what you can afford. If you can estimate the total
costs, such as; hospital stay, surgery costs, medication, rehabilitation, etc. You might be able to negotiate the cost
between the Surgeon and Hospital.
5.Gain perspective. Weigh up the pro's and con's of the surgery you might need. Will it improve on your
current situation? Is there a chance that the surgery could make you feel the same or maybe worse off? If the surgery
is risky seriously think is it worth the risk! Ask the Surgeon if he knows of other people he has treated with the same
complaint, see how they faired? Ask if you could talk to them?
If you decide on surgery start visualizing the whole event. Think about how the surgery will be successful,
how well it will work, feel encouraged and have a positive attitude and face each recovery day with a belief that
you will be better than before. Preparing for surgery begins several weeks ahead of the actual surgery date.
Maintaining good physical health before your operation is important. Activities which will increase upper body
strength will improve your ability to use a walker or crutches after the operation.
Begin good nutrition and if you drink alcohol or smoke think about cutting back. Smoking and drinking may
increase the time it takes for you to recover from the anaesthesia and may lengthen the healing process. Never
lose sight of your goals. The surgeon and surgical team do their work - the rest is up to you. Be inspired and work
hard during the rehabilitation phase of your recovery. Make a commitment to do your part to ensure a positive
outcome. Actively participate in the process and assume responsibility for your own care.
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| Preparing for Surgery back |
| Some time prior to your surgery, you might like to visit the hospital and organize a tour.
This is a good time to ask what you are allowed to bring with you. Things like your own pillows, woollen under
blanket etc. Ask your Surgeon if you can donate our own blood. Blood can be deposited up to 42 days before
surgery, but is needed at least 14 days before surgery.
Eat a nourishing meal two to four hours prior to donation, and avoid strenuous exercise for twelve hours
following the procedure. Begin packing your bag and if you have children don't forget to pack things for them to do
whilst visiting you in hospital. Things to pack for the children are books, quiet games, dolls, puzzles etc, consider
packing stamps and stationary so you can write letters to your children, even send them pictures to colour in and
give to you so you can hang them in your room. If you enjoy playing cards or reading, include these items as well
because you will probably be spending some times waiting before the surgery.
Try to have the house prepared for your arrival back home. Things like having frozen meals on stand-bye,
pre-arranging to have a wheelchair, shower chair etc. Your Surgeon, Hospital or Physiotherapist will be able to
advise you on what you will require.
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| The Night Before Surgery back |
| You are usually required to fast. Your bags are ready to go; the house is prepared now all
you need to do is rest and try to get some sleep. View Hospital List
to get ideas of
what you might need to take; especially if you have children.
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| Day of Surgery back |
| The nurse will spend a few minutes again making sure that you are still in
good health and ready for surgery. Ask the nurses to try and to give you a good estimation of what time
your surgery is.
Taking a shower
The nurse will ask you to shower; you will be given some type of antiseptic scrub brushes to use. The
brushes contain a special soap which will reduce the risk of infection. You will be asked to put on surgical gown
and panties.
The Anaesthesiologist
The Anaesthetist will come to discuss how you will be put to sleep. Talk to him about pain control options.
Operating Room
In the operating room, you will be connected to equipment that will be used to monitor your heart rate and
blood pressure. These devices will be used by your Anaesthesiologist to manage your condition during surgery.
If you fell anxious don't be afraid to ask questions at anytime. The amount of time you spend in surgery will
depend on the type of procedure you are having done.
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| After Surgery back |
| After surgery you will be taken to the Recovery Room for a period of close observation,
usually one to three hours. Your blood pressure, pulse, respiration and temperature will be checked frequently.
Close attention will be paid to the circulation and sensation in your legs and feet. It is important to tell your nurse
if you experience numbness, tingling, or pain in your legs or feet. When you awaken and your condition is stabilized,
you will be transferred to your room. One side effect of anaesthesia is often a difficulty in urinating after surgery.
For this reason, a sterile tube called a catheter may be inserted into your bladder to insure a passageway for urine.
This may remain in place until the first day after surgery.
Post-operatively you may have temporary nausea and vomiting due to anaesthesia or medications.
Anti-nausea medication can be given to minimize the nausea and vomiting. When you have stabilized you will be
moved from the recovery area to your room. Nurses will continue to monitor your recovery and administer pain
medication as prescribed by your Surgeon or Anaesthesiologist. At some stage during that day your Surgeon will
visit your room to discuss the surgery.
Recovery
Don't view the recovery period as time lost, but rather as time to rest and recuperate. Realize that the time
you will invest in the rehabilitation process is necessary for better health.
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| Initial Rehabilitation Activity back |
Some patients experience back discomfort after surgery. This is caused by the general
soreness and by the prolonged lack of movement required before, during, and after surgery.
Periodic change of position helps to relieve discomfort and prevents skin breakdown. The first day after surgery you
will probable need assistance to do most things. Within a few days the Physiotherapist will visit and therapy will
begin. You will gradually begin to take steps, walk, and learn to climb stairs with the aid of a walker or crutches.
This initial rehabilitation generally takes 3-4 days or more, depending on what type of surgery you had.
During this time, discomfort may be experienced while walking and exercising.
Do's and Don'ts
Do use a chair with arms.
Do grasp chair arms to help you rise safely to standing position.
Place extra pillow(s) or cushion(s) in your chair so that you do not sit to far back.
Don't sit low on toilet or chair.
Use the elevated toilet seat if we have given you one.
Don't lie without pillows supporting your legs and pelvis. So make sure you bring the pillows and/or
cushions you were using at home.
Do keep a pillow between your legs when you roll onto your side.
Do keep the bed at a height that makes it easier for you.
Do your breathing and other exercises you were instructed to do.
Don't be discouraged if things don't improve in a hurry. Following surgery, you will work with a physical
therapist to become independent in walking, going up and down stairs, getting in and out of bed, and doing
exercises to improve the range of motion. You will be instructed by your physical therapist in a specific home
exercise program to meet your needs.
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| After you Leave the Hospital back |
| Once discharged, you will be given instructions by your surgeon about what to watch
for and how much activity you will be allowed in the first few weeks. Your skin incision will generally heal in 10 to
14 days. The fusion of the bones usually takes 12 to 18 weeks to become strong enough to resume your normal
activities. Your surgeon will take X-rays after the procedure to follow your healing progress and determine when
the bones have fused. Four to six weeks later you will have a post-operative appointment with your Surgeon.
At Home
Arrange for someone to be with you, especially the first week or two. If no one is available, make
arrangements to enter a post-op inpatient rehabilitation facility until you become independent and are able to
care for yourself at home.
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| Pro's and Con's of Surgery back |
| With any surgery, there is a risk of complications. Complications could involve subsequent
pain and impairment and the need for additional surgery. You should discuss the complications associated with surgery
with your doctor before surgery. The list of complications provided here is not intended to be a complete list of
complications and is not a substitute for discussing the risks of surgery with your doctor. Only your doctor can evaluate
your condition and inform you of the risks of any medical treatment he or she may recommend.
Some of The Risks of Surgery
Bleeding
Most major surgical operations can result in unexpected blood loss. If too much blood has been lost a blood
transfusion may be required.
Nerve Injury
During the operation, the surgeon will be working close to the nerve roots that exit the spine near the SI joint.
These nerves may be damaged. In some cases, the injury to the nerves may be temporary and return to normal
over time. In other cases, the nerve damage may be permanent. If this occurs, it can result in weakness,
numbness, or pain.
Ongoing or New Pain
Some pain after surgery is expected, but if you experience chronic pain well after the operation, you should
let your doctor know. Not all operations are successful and some may even make the situation worse. If your pain
is coming from an area of the body other than the SI joint, your pain may continue. It is difficult to be absolutely
sure before surgery that the operation will cure your pain.
Hardware Breakage
If screws used for fixation of the fusion do not work, hardware removal and a repeated operation may be
required. Your doctor will have to check the status of the hardware with X-rays, implants can bend, break, loosen
or The screws may be placed in the wrong position One of the main causes of a screw breaking after surgery is
that the fusion has not healed. There is a percentage of the community that will have an allergic reaction to the
implant materials, you will experience pain around the hardware and develop a temperature.
Bone Grafting
Bone grafting is a surgical procedure where bone is taken, usually from the iliac crest of the pelvis and place
into the gap of the symphysis pubis or crushed to implant into the sacroiliac joint to create a fusion.
Non-union/Delayed Union
A certain number of bone grafts simply do not heal as planned. A graft that doesn't bond is called a
"non-union". Some bone grafts will take longer than expected to heal. This type of problem case is
called a "delayed union" A non-union may require a second operation to try to get the bones to heal.
Most surgeons do not consider an SI joint fusion to be non-union until six to eight months have passed
with no evidence of healing.
Infection
With any surgery, there is a small risk of infection. An infection can be mild to severe. The infection can be
localized to the incision, or deep within the bone. A deep infection may require antibiotics and additional
operations to drain the infection. An infected incision will usually cause an increase in pain and may ooze a liquid,
or pus. You may feel ill and run a temperature.
Anaesthesia
With any surgical procedure there are risks associated with anaesthesia. Prior to anaesthesia, you will be
evaluated by the surgeon and anaesthesiologist to assess risks and make recommendations to reduce the risk as
much as possible.
Bladder and/or Bowel Problems
After having your symphysis pubis operated on there is a chance you mild notice a tingle, to a sharp pain as
you urinate due. This is due to the bladder and urethra being so close to the back of the pubic bone that supports
tissue could be disturbed or irritated due to the surgery. If you are on strong pain killers after the surgery it is
common to become constipated.
Thrombophlebitis
When blood clots form inside the veins of the legs, it is referred to as Deep Venous Thrombosis (DVT). After
pelvic surgery you usually cannot stand for a few days and will be resting a lot. This inactivity can increase your
risk of developing DVT.
Unanticipated Results
Internal fixation can improve complaints and quality of life, although some limitations may persist.
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| Types of Bone Grafts
back
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| Autograft
Autograft or bone graft transplanted from one site to another in the same individual, is considered to be the
most biologically suitable type of graft. The iliac crest is the most versatile bone graft reserve. Bone may be
removed in the form of block. Harvesting your own bone graft means you will have an additional scar, one
from the symphysis pubis and/or sacroiliac joint and the other from the graft.
Allografts
Allografts are the most frequently used alternatives to autografts. They are bones transplanted from one
individual to another. Allografts are readily available and come in a wide variety of shapes and sizes. They
can provide immediate support and minimize the use of stabilization hardware or braces. They provide
biologic scaffolding that is gradually replaced with the patient's own bone.
Synthetic Bone Substitutes
A variety of synthetic bone substitutes are commercially available. These are usually hydroxyapatite based granules formed into a coralline or trabecular structure to mimic the structure of cancellous bone. They act solely as an osteoconductive matrix. Some manufacturers have recently begun supplying these products with soluble bone-forming factors such as bone morphogenetic protein to attempt to create a synthetic product with osteoinductive properties.
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| Hardware back |
| Hardware are the screws, plates and bolts etc. that are used to stabilize the pelvic joints
until they fuse together. There are two compounds used to make the hardware one is stainless steel, the other
titanium. Both have pro's and con's for use. Ask your Surgeon if you want to know what type of screws and/or
plate he will use.
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| Surgical Treatment
back |
Surgery may become an option if all conservative methods of treatment fail.
Operative treatment consists of arthrodesis to the pubic symphysis by bone grafting supplemented by a compression
plate. Surgery on the SI joint usually consists of a fusion of the joint
(also called an " arthrodesis").
An incision is made over the SI joint in the lower back. The joints are opened so the surgeon can
see each joint surface. The articular cartilage lining the joints is removed from both surfaces. This leaves a fresh
surface of bone instead of the normal cartilage. The bone surfaces are then held together until they heal or fuse.
Without the articular cartilage of the joint, the body treats the two raw bone surfaces just like a fracture, and tries to
heal them like any broken bone.
To hold the bones together, the surgeon will usually insert several metal screws
across the joint. Bone graft may also be placed around the joint to help fuse it.
A walking program might not begin until at least 6 to 12 weeks postoperatively , and then only under the strict direction of your physical
therapist. If you experience buttocks pain, it could
be an irritation of the piriformis
muscle, you should tell your Physical Therapist who might suggest to decrease walking to a minimum.
Recommendations for First Three Weeks Postoperative Sacroiliac Fusion
Surgery
(16)
1. No driving or car riding for more than one hour.
2. No sitting for longer than one hour.
3. No standing or walking for longer than 30 minutes.
4. Avoid bending and twisting at waist.
5. Sleep with a pillow between knees.
6. Sit straight with a pillow to small of back.
7. No lifting anything over 10 lbs.
8. You may drive in approximately one week.
9. Avoid stair climbing. If you do stair climb, lead with the strong
leg and take one step at a time.
10. No single leg standing.
11. No exercise for three weeks.
Lifetime Activity Restrictions
(16)
1. No bungee jumping.
2. No parachute jumping.
3. No rock climbing.
4. No step aerobics.
5. No Stairmaster.
6. No chiropractic manipulation of the lumbar spine.
7. No heavy lifting - more than 75 lbs.
Sacroiliac Joint Dysfunction and Low Back Pain (PDF). Article discusses
recommendations for the first
3 week after SIJ Fusion Surgery. (Gainesville Physiotherapy)
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