Transcript Chronic Symptomatic Symphyseal Instability

Chronic Symptomatic
Symphyseal Instability
M.L. Chip Routt, Jr., M.D.
Patient #1
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28 yo Female
G1P1
2.5 Years after NSVD of Term Baby Son
Anterior and Posterior Chronic Pain
Unable to Walk > 100 ft
Unable to Lift/Carry Son
Dyspareunia & Stress Urinary Incontinence
Employed-Sedentary Job-Computer Work-Fulltime
“Relatively Comfortable” Sitting 45-60 Minute Intervals
Takes No Medications – “Nothing Works, Why Take Them?”
Pelvic Instability on Compression Exam, Causes Pain
Presentation Pelvic Films
• AP
Presentation Pelvic Films
• Alternating LE Standing Films
Pelvic CT Scan
• In Binder
Pelvic CT Scan
• Axials @ S1 & S2
• SI Joints
Surgery
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Supine
Pfannenstiel
Unstable Symphysis
Compressive Reduction Clamped
Symphyseal Plating – Frail Bone
Perc Upper and 2nd Sacral Segment IS Screws
Postop CT Imaging
Postop CT Imaging
• Axials @ S1 & S2 Levels
Rehabilitation
• 1st 6 Weeks - Bed or Chair Restricted and
Isometrics
• “Marginally Compliant” Due to “Comfort”
• 2nd 6 Weeks - Tandem Bilateral Protected WB,
Stretching, Strengthening Program, Aquatic
Program
• Non-Compliant Due to “Comfort”
4 Months After Surgery
• Plain Films
• Notable Plate Segmental Breakage
4 Months After Surgery
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No Pain Complaints
Normal Gait without Distance Limit
Lifts/Carries Son
“Normal” Sexual Activity
No GU Complaints
Still Working FT
Patient #2
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51yo Male
Was D1 College Baseball Player “back in the day”
Remained Fit & Active
Executive - Employed FT
8-12+ Years Progressive Pelvic-Groin-Back Pain
Anterior Pelvic “Grinding”
Bilateral Posterior Pelvic Pain
Worsened By Essentially Any Activities
Antalgic Gait
Dyspareunia (But Fights Thru It!)
Has Had Spinal Injections Without Relief – Body MRI In Hand
? Pelvic Instability on Exam
Plain Films
• Inlet-Outlet
Initial Plain Films
• Single LE Alternating Stance Films
Pelvic CT Imaging
• SI Joints
Surgery
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Supine
Pfannenstiel
Fluid Filled “Cyst” Around Unstable Symphysis
Compressive Reduction Clamped
Symphyseal Plating
Perc Bilat IS Screws at Upper Sacral Segment
Postop Imaging
• CT Scan
Rehabilitation
• 1st 6 Weeks - Bed or Chair Restricted and
Isometrics
• 2nd 6 Weeks - Tandem Bilateral Protected WB,
Stretching, Strengthening Program, Aquatic
Program
• “Very” Compliant Due to “Fear of Pain Return”
3 Months After Surgery
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Left Adductor Sporadic “Cramping”
No Prior Pelvic & Low Back Symptoms
“Slowly Evolving Normal-Pareunia”
“Scared and Cautious Recoverer”
Back to Work
Durable Implants Thus Far
3 Months After Surgery
• Plain Films
• No Implant Breakage….Yet!