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SI Joint Fusion Patient is Now Pain Free

Pullen has spent years dealing with chronic pain. A fiercely independent woman from Advance, Mo., Pullen was successfully working in a predominantly man's world as a heavy equipment hauler and dump truck driver when an accident changed everything. "I had been driving for years, since I was about 22 years old," Pullen says. "My dad was a truck driver his entire life and he took us kids on road with him every summer. I loved it."

But in 1998, when she was on a job hauling and spreading gravel on wet clay, her truck was filled almost to overflowing. Top heavy, the load shifted and the truck flipped as Pullen went around a curve. She says, "The gear shifters hit my hip and I knew right away it was bad."

Unable to walk well, do housework or relax and ride her family's beloved horses, Pullen finally was placed on full disability leave. For the next 17 years, she was in and out of doctors' offices trying to find the source of her pain and to alleviate it.
"I must have gone to more than 20 doctors over the years," she says. "Last year, it got so bad, I could hardly do anything. My back hurt. My legs would tingle and hurt and I'd just lie in bed and cry sometimes."

Her doctor suggested a referral to Kyle Colle, DO, a neurosurgeon at Regional Brain and Spine in Cape Girardeau. In the initial X-rays, Dr. Colle noted that Pullen's pelvic bone had been broken previously. "No one had ever told me that before," says Pullen.

He also noted that the sacroiliac joint was dysfunctional on one side and that she had a leg length discrepancy. Instead of pain radiating from Pullen's back, Dr. Colle suspected the pain had a different source – the sacroiliac joint.

Shock Absorbers for the Body

The sacroiliac joint lies near where you put your hands on your hips. That's where larger, butterfly-shaped bones in the pelvis, called the ilium, can be felt. Between the ilium and the bottom of the spine is the sacrum. Connecting the ilium and the sacrum on each side is the sacroiliac joint. Strong ligaments hold the two bones together and the system functions much like a shock absorber for the body, stabilizing it while you move. However, when the joint becomes inflamed or the ligaments are injured or stretched, it can cause abnormal motion, weakness and pain in the low back, hips or buttocks. Sometimes pain radiates down into one or both legs and causes difficulty in sitting or lying down.

Patients can go for years without a confirmed diagnosis because the symptoms often mimic the symptoms for chronic low back pain. There are, however, specific physical tests that can be performed by a trained healthcare practitioner to zero in on the sacroiliac joint.

"One of the tests is to see if I can reproduce the pain if I take my thumb or finger and push on the posterior/superior iliac spine while the patient is standing or sitting," says Dr. Colle. "We also look for leg length discrepancy to indicate that the pelvis is out of alignment."

If several different tests reproduce the same pain symptoms, the sacroiliac joint is suspected as the root cause. "We have to rule out back pain and other potential causes, of course," says Dr. Colle.

"Research has shown, though, that up to 25 percent of all chronic low back pain is due to SI joint dysfunction or inflammation, so it's wise to take a look at that as the source of chronic pain."

Step One

Dr. Colle says the first step is to manage sacroiliac pain conservatively. Physical therapy or chiropractic care to restore the balance of the pelvis is often recommended. Specific exercises to put the SI joint back into place also can be taught. Braces and orthotics are other options.

When the pain is persistent and patients have failed physical therapy, diagnostic and therapeutic injections may offer temporary relief. "We can successfully manage up to 80 percent of SI joint pain patients with non-surgical treatment options," says Dr. Colle.

When pain remains after six months of conservative treatment, Dr. Colle offers another, more advanced option.

Great Results

In the past year, Dr. Colle has been one of only a few doctors in the region trained to perform minimally invasive SI joint fusion. Much more advanced than just fixation with screws embedded into the joint to keep it from shifting, SI joint fusion adds a bone graft material that is placed directly into the joint. Titanium screws are then precisely angled and placed to hold the joint together so that the bones can fuse together over time. The procedure is done through a small, two-centimeter incision and takes less than an hour. Patients are kept overnight for observation and then sent home. Patients use a walker for about two weeks. Two weeks of aquatic therapy and then traditional physical therapy follow.

"It takes about three months before a patient is completely released from restrictions," says Dr. Colle. "But in our patients so far, they've noticed their pain dramatically diminish within 10 days after surgery."

Dr. Colle is tracking the results of his SI joint fusion patients as part of a clinical study. "Right now, we are seeing great results, with the overwhelming majority of our patients doing well."

Now, Dr. Colle is on a mission to have all insurance companies recognize the surgery as non-experimental. "This works," he says. "Medicare covers it, but we're still having to convince other insurance companies that this is a real, viable, successful option for patients."

Pain Free

Pullen was one of Dr. Colle's first SI joint fusion patients. "I remember when I came out of surgery," she says. "I couldn't believe it. There was some discomfort, but the pain was gone. It was just shocking after being in pain for years."

Since her surgery in April 2016, Pullen is walking and getting in and out of her bathtub without pain. "I can vacuum my house now and reach up and dust my ceiling fan," she says.

She also takes her dog Sophie for regular walks around her home. As she continues to regain strength and balance, she's focused on her favorite outdoor activity and anticipates riding horses within the next several months. In the meantime, she's grateful for her family and close friends, who helped her during the recovery process, and for Dr. Colle, who kept searching for the cause of her pain.

"Dr. Colle didn't give up like other doctors had with me," she says. "He told me, 'we're not quitting until we find out what is wrong.' After years of being in pain, I'm so thankful I found him."