Dawn's story: SI joint dysfunction

At her lowest point, Dawn had to ask her parents to drive her to and from work. When she arrived, she would lie down on the floor with her laptop, working there until she had to stand up to process an order.

"I couldn't stand for more than 10 minutes," says Dawn, a pharmacist from northwest Ohio. "I could not sit at all without excruciating pain. Walking any distance was difficult because of my situation. My life was severely altered."

Dawn, who is pain-free today thanks to surgery performed by William Tobler, MD, a neurosurgeon with Mayfield Brain & Spine, was suffering from dysfunction of the sacroiliac joint. Also known as the SI joint, it is located between the hip and the base of the spine (the tailbone). Normally the joint moves 2 to 3 millimeters when someone walks, runs, or dances. Dawn's was moving significantly more than normal.

An athletic woman who ran 5k races and performed CrossFit, Dawn had her first traumatic SI event – "a brief but powerful scare" -- in 2012. "One morning when I stepped out of bed, I felt like a jar with a crooked lid," she recalls. "It was extremely painful. Something in the middle of my body felt twisted, and I struggled to find a provider who knew what was wrong or what to do.

"I was an emotional wreck and prayed for a miracle. Thankfully, 3 months later, a physical therapist recognized that my sacroiliac joint had rotated. After a few months of therapy, I was feeling great. When I left her care, I was encouraged to strengthen my core to prevent it from happening again."

About three years later, Dawn was once again in crisis, and this time her PT could not fix the problem. Dawn was bereft. "My days were long, often spent lying on the floor or couch, and the nights felt too short," she says. "I could cry in the middle of any conversation, unprovoked."

Over the next 2 years Dawn visited various therapists, chiropractors, osteopaths, and physicians. She spent a week in Georgia "with the best therapist in the country for this condition." Still miserable, she realized that she needed surgery. She and her husband – "a rock star through all of this" -- talked about how far they were willing to travel from their small town for her treatment.

Dawn was resigned to going out west when, while searching the Internet, she opened up a link about an advanced O-arm surgical technology. "This was Lord-led," Dawn says. "I was Googling everything, and that link kept coming up. Once I finally clicked on it, the skies opened. It started a rapid domino effect. Who is Dr. Tobler? Who is Mayfield? Just like a surgeon does homework, I started doing an incredible amount of homework on Dr. Tobler. I read the articles he had written. It calmed me."

Dawn made an appointment with Dr. Tobler, and surgery was scheduled for April 2018. She also reached out to Lisa Cleveland, PT, Director of Mayfield Physical Therapy. "I interacted with her a lot prior to surgery, because I didn't have anyone here in northwest Ohio to talk about this," Dawn says. "Nobody here was in favor of this surgery. I knew no one who had had this surgery. So I really leaned on her for information."

Dr. Tobler says the physical therapist plays an important role in the treatment of SI joint dysfunction. "The PT gives us a very detailed analysis of the patient's anatomy, their SI joint dysfunction, which sometimes results in the joint actually being palpably dislocated. And when that dislocates, there's a leg length discrepancy that can be measured. The SI joint can then be manipulated back into position, which resolves the leg length discrepancy."

As Dawn prepared for her surgery at The Christ Hospital, Dr. Tobler gave her permission to bring her longtime physical therapist and friend, Nancy Siatkosky, PT. Prior to surgery, Ms. Siatkosky demonstrated to Dr. Tobler how she aligned Dawn's SI joint, which would actually protrude upward when Dawn rolled onto her stomach. The goal, Dr. Tobler says, is to ensure that "the sacrum is relaxed into its normal position and not dislocated. That way, when we put the pins and screws in the sacrum, it's fixated in its best anatomical position."

Dr. Tobler has learned how to accomplish this with the help of physical therapists. But in Dawn's case, he says, "She had a very close relationship with her therapist and felt assured with the therapist being there, which is no problem for me."

"What he did blew me away and nearly drew me to tears," Dawn says. "He looked at Nancy and said, 'Show me what I have to do.' Nancy explained to him that my sacrum would pop up and out of position. Dr. Tobler promised that he would personally roll me over on that table. He guaranteed that he would do exactly what Nancy demonstrated. I was blown away that a neurosurgeon would offer any of that. I was at complete peace."

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Mayfield on YouTube: SI joint fusion surgery >

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During the surgery, a one-hour, minimally invasive procedure, Dr. Tobler stabilized the joint with titanium rods and bone graft material. When Dawn awoke, she knew immediately that the surgery was an answer to her prayers.

"I knew something was different, even with the post-op pain," Dawn says. "The Mayfield protocol was to be on crutches for 2 weeks. And the day I was allowed to be off crutches -- after my first post-op appointment -- I came home and walked 2 miles. I had not done that since 2015."

Life is now back to normal, with a few modifications. Ms. Cleveland, the physical therapist, had recommended that Dawn behave as if she had undergone a spinal fusion and to limit bending at the waist. "Let's face it, as we age we should make some modifications anyway," Dawn says. "I'm choosing to forego running and cross-fitting. I try to walk 45 minutes each day. I'm back to working part-time, but sometimes I do 10-hour shifts. I also continue to do therapy for some soft-tissue damage I had before surgery.

Dawn is also sharing her story with others.

"I am very driven to prevent this from happening to someone else, and I think I'm in a unique position because I'm in rural Ohio where no one knows anything about this surgery," she says. "It is an uncommon surgery, and there are not a lot of surgeons who do it well.

"For me it was radically life-changing. Who would have thought this could happen to an active, healthy person? I'm not even 50. I felt like life stopped, like I had hit a brick wall. I feel I've been given a second chance at life. Not a day that goes by that I don't thank God for the ability to do something simple, something that I used to take for granted before my injury."

 

~Cindy Starr

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