How long is the surgery?
Depending on the amount of work to do the surgery may last from 1 to 3 hours.

How is this decided?
Among your tests, you will undergo a nerve study to look for a compression of the sciatic nerve by the piriformis muscle. The day before surgery, when all tests and evaluations are available, the amount of surgery will be decided.

What is the most frequent surgery?
Most frequently, we end up stabilizing the sacroiliac joints on both sides using screws and doing a bone fusion on the bad side. This takes about 2 hours. Decompressing the sciatic nerve by releasing the piriformis muscle usually adds another 45 minutes.

How long is the hospitalization?
Depending on the amount of work, the hospitalization is from 1 to 3 days. Piriformis surgery usually adds one day.

How soon can I get up?
We encourage you to get up as soon as possible. Many patients require a walker and a bedside commode for comfort. Often, this is needed at home for 2-3 months.

What about pain medications?
We use an intravenous pain pump while you're in the hospital and we might combine this with other medications. At the time of discharge, we decide what you will need and give you the prescriptions. If you go straight home from the hospital and have a long ride, we can give you an IM shot of pain medication for the ride. Also read our narcotic policy.

What about possible complications of surgery?
Read the consent forms under the bullet "Forms & Consents". This details (but is not exhaustive) of what might plausibly go wrong. Discuss any concern with the surgeon.

What should I do before and after surgery?
Read the page entitled "pre-operative and post-operative care". This will go over the topic.

When will I be able to go back to work?
This depends on your line of work and on how you are doing after the surgery. 1 to 3 months is the average.

What type of work will I be able to do?
The fact that you needed this type of surgery implies that you badly injured your back. You will have to avoid any activity that could cause more injury. We recommend doing sedentary clerical type work. You should avoid work that involves heavy lifting, twisting and squatting.

Will there be post-operative physical therapy?
We have a physical therapy protocol after surgery which usually starts 3 weeks after surgery.

What activities can I do?
You have to increase your activity slowly and in steps. It varies with each individual patient. Moderate walking and other activities are OK as long as they do not cause pain. Swimming the breaststroke (not competitively) is good for the back. Avoid stationary bicycling and bicycling in general. This can flare up pain in the surgical area. Walking against resistance (when in water for example) is also to be avoided. Talk to your surgeon and physical therapist about any particular concerns.

Will the sacroiliac screws send off any alarm at the airport?
The screws are made of titanium and are not magnetic. They will not send off the alarm.

Why is an enema or laxative necessary the evening before surgery?
The surgery requires many XRs to visualize the placement of the screws. Food in the bowels obscures the bone landmarks.

Why is a pregnancy test necessary before surgery?
The test is only necessary if you are in an age group when pregnancy is possible and if you didn't have any surgery that would prevent it (such as a complete hysterectomy). The amount of XR needed for the procedure would be detrimental to a foetus.

What about pregnancy after this type of surgery?
Pregnancy is possible after this type of surgery. Some women did have a normal delivery after surgery but there are significant chances that a C-section might be necessary. Make sure you notify your obstetrician that you had this procedure done.

What about smoking?
Smoking is not good when undergoing general endotracheal anesthesia. It also specifically interferes with bone fusion. This is because the nicotine causes spasm of the small blood vessels that supply blood to the bone graft. Bone fusion requires a lot of blood. The chance of a successful bone fusion drops from about 80% under the best circumstances, to less than 40%. You may want to ask yourself why you should go through so much surgery if you're not going to be able to do what is necessary to maximize the chance of success.

What about arthritis drugs (NSAIDs)?
Non-Steroidal Anti-Inflammatory Drugs (called NSAIDs) such as Ibuprofen, naproxen, etc … interfere with bone fusion. If your surgery involves a bone fusion, you must not use those drugs for a good 6 months following surgery. Discuss this with the surgeon.

What type of anesthesia is used?
Because the position is face down and because sacroiliac surgery is significant and requires a relaxed patient to make sure nothing moves until the joints are fixated, general anesthesia with a tube in the trachea is necessary.

How is the incision closed?
The incision is usually closed with skin glue which, usually, leaves better looking wounds. Deep dissolvable stitches are also used. After the surgery, the wounds should be cleaned with soap and water only (and nothing else). They can be left open to air if there is no drainage. Showers are OK. Avoid the bathtub for a couple of weeks, until the wounds are fully healed.

Why do I need to have a MRI of the lumbar spine, a CT scan of the pelvis and a nerve study prior to surgery?
Please remember that sacroiliac dysfunction is a diagnostic of exclusion. We therefore need to exclude other diseases that may mimic this problem. The MRI of the lumbar spine mainly checks for a disc herniation pinching a nerve root. The CT scan of the pelvis check for other (much rarer) diseases of the sacroiliac joint, such as infection or tumor. If your symptoms have remained the same and if you have had those tests within the last year, those would do, but we would like to see the pictures ourselves besides the report. The nerve study will check for nerves or nerve roots problems. A variation of the test (that is usually not performed in the standard test) will tell us if your sciatic nerve is pinched as it exits the pelvis."

Why is it better for me to carry the XR pictures myself (rather than sending them in the mail)?
When send by mail or other means, Murphy's law makes it that the tests' pictures never get to our office before you do. The safest way is to sign them off (you have the right to do so, don't let anyone tell you otherwise), and hand-carry them yourself. This way, you can be sure they'll be here when you are.