SI Joint (continued)







MANAGEMENT:

After a firm diagnosis is established, sacroiliac joint disorder is treated initially conservatively with a focused programme of physiotherapy and rehabilitation aided by anti-inflammatory and other medications.  Other modalities of treatment like acupuncture, prolotherapy and chiropractic therapy along with manipulation have also been advocated for this condition.  






SURGICAL TREATMENT:

Open operation and fusion of the sacroiliac joint is not very popular.  The historical studies have shown high rates of wound complication, infection and operation related morbidity due to the location of the joint.  Over the last five to six years there is an impetus on percutaneous stabilisation/fusion of the sacroiliac joints.  The percutaneous fusion is done through a keyhole method under image guidance and patients typically spend one night in hospital.  Mr Mohanty has pioneered percutaneous sacroiliac joint stabilisation for various sacroiliac joint conditions in the UK (see Clinical Practice and Publication section).  







POST-OPERATIVE MANAGEMENT:

Patients are discharged from hospital the day after the percutaneous keyhole sacroiliac joint stabilisation.  Patients are allowed to walk partial weight bearing with the help of crutches for up to four to six weeks.  In approximately six weeks from the date of the operation patients are allowed to mobilise independently.  A course of post-operative physiotherapy is included in the care package.







RESULT:

In a carefully chosen patient’s group, where a firm diagnosis of sacroiliac joint dysfunction has been established, keyhole stabilisation of the sacroiliac joint has been shown to produce effective and sustained pain relief and relief of symptoms.  Mr Mohanty has presented his results in various peer reviewed society and also published his results in peer reviewed journals such as Journal of Bone and Joint Surgery and European Spine Journal (see Publication).   Mr Mohanty continues to carry out prospective research study on all patients having this novel but revolutionary procedure.







COMPLICATIONS:

Although this procedure is generally safe and the majority of people do very well there is the potential for nerve injury particularly to the sacral nerve root following this percutaneous procedure.  A minority of patients also complain of persistent pain in their lower back following this procedure.