from staff
The world’s first surgery using a new minimally invasive procedure to treat chronic back pain from both of the sacroiliac joints was performed at Baptist Medical Center South in September.
Dr. Arnold Graham Smith, FRCS, FACS, is the only physician performing the procedure in Jacksonville and one of the few in the United States.
The sacroiliac joints connect the sacrum at the bottom of the spine with the pelvic bones. These joints are responsible for the transfer of the weight of the upper body to the pelvis and lower limbs.
“Pain generated from these joints is poorly understood by the medical profession and few procedures have been available to satisfactorily treat it,” said Dr. Graham Smith. “The sacroiliac joints can be a significant source of pain because they contain many nerves that can send pain signals to the brain when inflamed or injured. Although the joints have very little movement, they can cause pain with walking, sitting and even rolling over in bed.”
Graham Smith has been performing surgery on the sacroiliac joints for the past 15 years, and in 2003 he invented a new procedure that resulted in patients healing much quicker than they had with past procedures. He has performed about 100 procedures using the technique he developed. Patients with chronic SIJ pain are referred from across the United States.
In March 2009, San Francisco-based SI-Bone Inc. asked Graham Smith to train in the use of a minimally-invasive implant that the company had developed. The iFuse Implant is an FDA-cleared device for treatment of pelvic fractures due to joint inflammation and traumatic disruptions of the sacroiliac joints.
The procedure uses a minimal incision to insert small, titanium implants that are coated with a porous plasma spray to help bone cells grow in and grip the rods, providing stability. The physician makes a short incision under X-ray control and pushes a guide wire followed by a drill from the outer side of the pelvis across the sacroiliac joint and into the sacrum. Next, the physician cuts a slot for a rod, and then inserts the rod into sacrum. There are three rods used for every joint, which prevents swiveling movement.
Graham Smith received training in March 2009, and on Sept. 10, he became the first surgeon in the world to perform a bilateral procedure, treating both of a patient’s joints. Dr. Leonard Rudolf, the New Hampshire surgeon who was the first to use the implant in a single joint procedure, visited Jacksonville and advised Graham Smith during the surgery. The patient went home in 36 hours — significantly better than the typical five-day hospital stay for a traditional sacroiliac joint procedure. Graham Smith also performed a single-joint procedure on a second patient the same day.
“I let patients choose between this new procedure, which has only been available for two years, and the procedure with which we have longer follow-up,” said Graham Smith. “Many patients say they like the idea of a shorter hospital stay, and the results of a two-year follow-up from other centers looks promising. Less than 50 of these new sacroiliac implants have been done, and to date they seem to be working well.”
Patients are typically able to put their full weight on the leg affected by the surgery eight weeks after their procedure. Graham Smith has now performed nine of these minimally invasive procedures.