SOS orthopedic surgeon specializes in spine surgeries, recently completed 200th sacroiliac joint fusion surgery
By Chris Motola
Q: What kinds of conditions do you treat?
A: I am a board-certified orthopedic spine surgeon. I’ve been in practice for about nine years now and I essentially do all types of spinal surgery, from the base of the skull down to the pelvis. Most of things that I do are adult degenerative types of spinal conditions like arthritic conditions, spinal stenosis, pinched nerves, herniated discs, etc. But I also will treat things like infections, trauma to the spine, tumors, deformities, surgery, etc.
Q: Tell us about the joint fusion procedure using a new iFuse Implant System that you’re doing. I understand you’re one of only a few who are doing it.
A: SI [sacroiliac] joint fusions are something I’ve been quite familiar with but have been doing more of in the past few years. The SI joint is where the spine and the pelvis meet up. It becomes arthritic or inflamed for a number of different reasons. Essentially, if somebody is a surgical candidate, what I’ll do for them is a minimally invasive fusion of the SI joint basically using three metal bars or pegs that go across the joint and stabilize it, which hopefully eliminates motion and whatever kind of inflammatory reaction that’s causing and hopefully reducing their pain.
Q: Is this procedure usually done for older or younger patients?
A: It’s interesting, there’s a wide variety in demographics for people who have the condition. In general, what I would say it’s a younger person’s problem. I see a lot of people in their 20s, 30s and 40s with this condition. I’d say that’s the most common. Women get it more often than men, about four to one. There are a couple reasons for that. There are hormonal differences between the two genders, where women have a hormone called relaxin that makes some of the ligaments of the SI joint become a little less stable. Pregnancy can also contribute to pelvic dysfunction. I also see it in older people, people who have had spinal fusions. Some people can just develop dysfunction with the joint for really no significantly obvious reason.
Q: What is quality of life like for patients who undergo SI fusion, especially considering that many of them tend to be younger?
A: Younger and older, you can make a positive impact on their quality of life so long as they’re good candidates. A lot of patients previous to surgery had a hard time doing basic things, who couldn’t hike or walk or exercise but were otherwise healthy. I have a high number of patients who have done very well and gotten back to full activities with minimal or no pain. So you can make an enormous impact. The most important question really is whether we’re selecting the appropriate patients for this procedure.
Q: What tend to be the major causes of injury for the area?
A: For this problem, it’s the gender issues I mentioned above, people with previous fusions and a lot of the times its traumas to the area. A lot of people fall on black ice right on their tailbone. I think they can disrupt the SI joint. That’s in addition to people just developing chronic, regular lower back complaints that aren’t related to the SI joint. I think our job as providers is to pinpoint what their problem is by listening to them, examining them, doing diagnostics. My goal, for most people, is to get them by without surgery if I can. But a lot the time nonsurgical inventions may not work or only work temporarily.
Q: What makes this condition hard to diagnose?
A: It’s interesting. When we evaluate people, we obviously order imaging studies like MRIs and X-rays. Truthfully, almost every other orthopedic condition you’ll have some kind of abnormality show up, but this one doesn’t always show up. It can look normal in pictures. I think that makes it get missed a lot. Also, physical examination maneuvers are not very sensitive. So sometimes they’re positive and sometimes they’re not. You really have to put the whole picture together. Diagnostic injections are very useful here.
Q: What’s the recovery time usually? Is it an outpatient procedure?
A: It’s an outpatient procedure. It takes about 45 minutes to do each side surgically. If I can, I like to do this at our surgery center if the insurance companies will allow it. People can usually go home within three or four hours of surgery. Usually get out of bed, do some therapy, make sure their pain is controlled. If everything looks good, we let them go home. It’s not uncommon for me now to do fusions on both sides. Even those patients I usually let go home the same day even though the procedure takes a little bit longer. Overall it’s a safe, quick, efficient procedure. The recovery process can be a little bit slow though. It can take up to a year or two to completely recover from. To feel better than you did prior to the surgery might take two to six months. Some people recover faster than others. It just takes time. As the joint fuses, their pain reduces.
Q: What kinds of physical therapy do they have to do?
A: I really don’t mandate physical therapy for this. I give people exercises to do after surgery; some basic hip and hamstring exercises. I encourage people to walk around the same day as surgery. Some people need a walker, which they can transition away from in a week or two. Typically running is one of the last activities people can get back to. Low impact exercise is usually fine within 10 to 14 days.
Q: Does the fusion affect flexibility?
A: You really don’t lose any motion with this because the SI joint has a very limited range of motion to begin with that doesn’t really provide any functional motion with regard to bending or twisting. If it fuses appropriately, they really shouldn’t lose any motion at all.
Name: Aaron J. Bianco, M.D.
Position: Spinal surgeon at Syracuse Orthopedic Specialists
Hometown: Coon Rapids, Minnesota
Education: Chicago Medical School
Affiliations: St. Joseph’s Hospital Health Center; Crouse Hospital
Organizations: American Academy of Orthopedic Surgeons; North American Spine Society
Family: Married, two boys
Hobbies: Fishing, hunting, outdoor activities