Pain-free: Kerry Bentley, from Stockport, underwent the surgery and is loving life
THE PATIENT
For as long as I can remember, I’ve had back problems. A few weeks after my daughter, Mollie, now 19, was born, I fell and landed heavily on my left side.
My GP said it would settle down and although it eased, for the next ten years my left side hurt when I sat for long periods, and the pain woke me at night.
Then when I was pregnant with Oscar, now ten, I slipped a disc while getting into the car.
I was in agony and couldn’t walk but because I was pregnant, I couldn’t take painkillers — so my doctor signed me off work for six weeks.
Although the disc healed over that time, the pain on the left side of my back was worse than before; I couldn’t bend forward to tie my shoelaces, pick up my little boy, or brush my teeth without having to hold on to the basin.
When Oscar was six months old, I had a scan which showed I had lumbar spondylosis, a kind of arthritis that had caused wear and tear of the lower spine.
I had all kinds of treatment — painkillers, epidurals, spinal injections and physiotherapy to strengthen the muscles in my back — but nothing seemed to work. I couldn’t sleep properly as every time I turned over the pain would wake me; and exercising was impossible.
My husband, Will, was wonderful and the kids picked things up for me, but life was miserable; I was in constant pain and so tired.
Then in April 2015, I was referred to a specialist and given another, more sophisticated, scan — this showed that my sacroiliac joint [at the bottom of the spine where it joins the ‘wing’ bones of the pelvis] was inflamed.
The specialist said the cushioning cartilage had worn away, and the pain on my left side was the result of tiny movements in the joint, causing bone to rub against bone.
He then told me about a new procedure called iFuse, where they fix two or three titanium rods through the painful joint to stop it moving. There were risks, including that it might not work — but I was ecstatic they’d finally found the source of the pain and there was something they could do.
‘Overnight, I was virtually pain free, and after a couple of weeks day-to-day tasks such as bending over were fine,’ she says of the revolutionary 90-minute procedure
I underwent the 90-minute operation, under general anaesthetic, in January 2016. As soon as I woke up, I could feel the difference. Although the incision site was sore, there was no pain from the joint and I could move freely. I had the best night’s sleep in years and went home the next day.
Overnight, I was virtually pain free, and after a couple of weeks day-to-day tasks such as bending over were fine. I used crutches for six weeks, had lots of physiotherapy and took it easy to give me the best chance of healing.
In May 2017, I started training for a half marathon and by October, I could run 13 miles. I’ve run three more half marathons since, and am planning to run 50k next year. I’m fighting fit and have lost 15lb from exercising more. The surgery has changed my life.
THE SURGEON
Vineet Tandon is a consultant orthopaedic surgeon at Stepping Hill Hospital in Stockport, Greater Manchester.
Lower back pain is very common, affecting around 11 per cent of men and 16 per cent of women.In 15 to 30 per cent of cases, the pain is caused by a problem with the lower sacroiliac joint, which joins the spine to the pelvis.
The joint is usually fairly rigid, but for reasons we don’t fully understand it can develop micro-movements, causing pain. This can be caused by an accident or pregnancy and childbirth, when the ligaments become lax and the joint moves apart slightly.
Painkillers or steroid injections can dampen down the inflammation but these are temporary solutions and, in many cases, the pain returns as the bone moves.
Finding the source of the pain is very difficult since movement of the joint does not show up well on scans, and the sacroiliac joint is close to other structures in the back which can also cause pain.
Although the sacroiliac joint is on both sides of the body, most patients experience pain on just one side. Many just live with the pain but in around 20 per cent of cases, the pain is so severe we surgically fuse the joint.
Traditionally, this is done through a 10-15cm incision, and it takes up to six months to recover from the operation. However, we can now offer patients iFuse, a triangular titanium peg with a rough surface so bone will grow into it, which goes through the bones of the joint to fix them together so they don’t move.
Developed in the U.S. in 2009, it is less invasive than traditional surgery — the incision is a quarter of the size — with a recovery time of just six weeks.
In June, the National Institute for Health and Care Excellence (NICE) issued draft guidelines recommending iFuse for chronic sacroiliac joint pain after two trials comparing it with non-surgical treatment supported its use.
NICE concluded that iFuse improves pain, reduces disability and could save the NHS money compared with non-surgical alternatives. The procedure takes 60-90 minutes to perform under general or spinal anaesthetic.
With the patient lying on their front, we use X-rays to locate the joint. I make a 3cm incision on the side of the pelvis which needs to be treated and introduce a guidewire into the joint.
Once I’m satisfied it’s in the right place, we drill into the joint and insert two or three iFuse pegs into the iliac bone [the ‘wing’ bone on either side of the pelvis], through the joint and into the sacrum [the triangular bone at the bottom of the spine] on the other side.
Checking the position on X-ray, we tap each peg into position using a special hammer, check they are in the correct position and close the incision.
Patients spend four to six weeks on crutches (compared with six months for conventional surgery) and the smaller incision means less pain and risk of infection.
The procedure costs around £5,000 to the NHS, and £10,000 to 12,000 privately.