Toblerone pegs in my pelvis banished my back PAIN

AROUND 10 per cent of Britons have lower back pain caused by problems with the sacroiliac joint. Natalie Taylor, 30, a team administrator from Watford had a new procedure to treat it, as she tells CAROL DAVIS.

THE PATIENT

ON HOLIDAY in Spain with my boyfriend Adam in June 2015, I woke with an agonising pain in the left side of my lower back, just hours after Adam had proposed.

Over the next two weeks it came and went, but the pain, like a hot poker in my left butttock, got steadily worse and I could hardly move. I thought a strange bed might have caused it and wasn’t particularly worried at that stage.

I saw my GP when I got back, still in agony: she thought it might have been a bulging disc in my spine, and referred me to hospital.

I’d had lower back pain when I was younger, but had always been very active — I rode horses, ran 10km twice a week, did a half marathon and visited the gym regularly. But this was agony: I’d take painkillers after work, since they made me too woozy to drive or work properly, and couldn’t exercise.

Even pushing a supermarket trolley hurt. I had to lie down a lot.

Instead of waiting for an NHS referral, I used my private health insurance to see Robert Lee at Spire Bushey. The scans didn’t show what was causing the pain, so Mr Lee sent me for physio.

But over six weeks of physio, I was getting worse and couldn’t walk to the end of the street without having to cling on to lamp posts.

So I went back to see him and had another, more sophisticated scan using a radioactive dye, which showed there was a problem around my sacroiliac joint, which is right at the bottom of the spine where it joins the pelvis. The joint was inflamed and painful.

Apparently this could have been caused by trauma — I’d fallen off a horse a couple of times, and had spent hours running on hard roads. The pain was because the joint was pinching a nerve running through the middle.

I took lots of painkillers, and had a steroid injection in the joint, which stopped the pain, but only for a day.

Mr Lee explained that he could fuse the joint to the pelvis using three titanium pins so it wouldn’t move and cause pain.

Although it would mean a recovery of up to 12 weeks I was prepared to put up with it if it would stop the pain. As well as living on painkillers, because I hadn’t been able to exercise and was comfort eating, I’d put on three stone over six months.

I had the half-hour operation under general anaesthetic on the private patients’ wing at the Royal National Orthopaedic Hospital in London in mid December.

THE

pain afterwards was horrendous at first but got better with painkillers. Four days later I could put a little weight on that side — I left hospital after five days on crutches.

For six weeks, I lived in my bedroom as I’d been told to use the stairs just once a day while the joint healed; it was awful.

But by March, I was off crutches and could spend the summer building my fitness again — I lost three and a half stone in time for our wedding in France in October 2016 which was wonderful.

And in May this year we finally had an amazing honeymoon, visiting Las Vegas and galloping along the beach on horseback with a cowboy in Hawaii. Finally I’m my usual active self again, and so grateful to Mr Lee for giving me my life back.

THE SURGEON ROBERT LEE is a consultant spinal surgeon at the Royal National Orthopaedic Hospital NHS Trust and Spire Bushey Hospital.

AROUND 80 to 90 per cent of us have lower back pain at some point, often caused by the sacroiliac joint, which is where the spine joins the pelvis (there are two sacroiliac joints, one on each side of the spine).

Although exact figures are not available, sacroiliac joint pain probably affects 10 per cent of Britons. This pain can be caused by a number of factors, including osteoarthritis, trauma, spinal fusion for other back problems which then puts extra strain on the joints, scoliosis or curvature of the spine.

The sacroiliac is usually a fairly rigid joint which doesn’t move very much, so another risk factor is pregnancy (hormones make ligaments that surround the joint relax).

In Natalie’s case, the pain was caused by inflammation of the joint because it had moved too much, which can be caused by an accident. Sometimes pain on one side is a sign that it’s the sacroiliac joint. But in many cases the cause is not diagnosed correctly, so patients have years of pain. The first line of treatment is usually physio.

We can also try a cortisone injection into the joint to reduce inflammation, which gives short term relief from the pain.

BUT

when conservative measures fail — 80 per cent of cases will settle down in six months, but in 20 per cent there’s too much movement in the joint (essentially the joint hasn’t recovered or because it was always like that) or there’s too much inflammation — we can fuse the joint.

For most patients this ends the problem permanently, and because this joint doesn’t move much anyway, the patient won’t notice any stiffness.

To fuse the joint we use three titanium pegs to fix the sacrum, the triangular bone at the bottom of the spine, to the pelvis. It used to be done as open surgery, but now it’s all done via keyhole.

Minimally invasive surgical fusion of the sacroiliac joint has recently been approved by NICE as being safe and effective. We most commonly use iFuse, which are triangular Tobleroneshaped pegs made from titanium, either 4 or 7mm in diameter and 30-70mm long.

The operation takes around 30 minutes under general anaesthetic. We use X-rays to locate the bony anatomical landmarks around the sacrum, though I now use 3D imaging throughout the operation, too, as a live guide.

First I make an incision of under 1cm in the buttock, and feed in a guidewire into the sacroiliac joint. Once I am satisfied it’s in the right place in the joint, I drill three holes into the joint, three into the sacrum and three into the iliac bone, which is part of the pelvis itself.

I drive the pegs into position using a hammer so that they go through the joint, the sacrum and into the iliac bone on the other side. The ‘hammer’ — which is twice the size of the hammer you would find in a home toolbox — is outside the patient’s body, but the force is carried through a punch with a long handle that’s inserted via the keyhole incision.

The iFuse implants are rough and so grab bone for a secure fit — bone will grow into them in time, strengthening the joint and fusing it permanently.

Recovery usually takes six to eight weeks, though can take up to 12. This should end the pain for good, though if the patient develops pain on the other side we may need to treat that side, too.

THE operation costs the NHS around £4,500-7,000, and £6,500 to 9,000 privately.