New back op for lower back pain

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Since 2009 when the surgery was first done in Europe, it has proved highly successful in alleviating this painful and debilitating condition.

Two patients were operated on at Netcare Greenacres Hospital in Port Elizabeth by Dr Volker Fuchs of the Orthopaedic Department of the AMEOS Clinic in Germany. Dr Fuchs performed the surgery as the final part of a live training programme in the use of DIANA, organised by SXS Surgical Solutions, the local distributors of the device. Orthopaedic surgeon, Dr Hendrik de Jonge and neurosurgeon, Dr Frik van Aarde, both of whom practice at Netcare Greenacres Hospital, participated in the training.

The procedure will now be offered at the hospital. "We are delighted to be doing this highly specialised, long awaited operation right here in the Eastern Cape," says Dr De Jonge.

He explains that in addition to being load bearing, sacroiliac joints are prone to the same wear and tear and injuries as any other joints and, when damaged or deteriorated may cause a considerable amount of pain in the lower back region. Up to 25% of lower back pain is associated with problems linked to sacroiliac joints.

The sacroiliac joints fail for a number of reasons including overuse, injury from a fall or other accidents, bone malformation or damage caused by earlier surgeries. The ability to stand, walk and sit may be affected. Diagnosing whether there has been a failure of these joints can be tricky for doctors, particularly as there are other common causes of lower back pain, such as arthritis of the hip, a slipped or damaged disc or even a non-orthopaedic problem such as kidney stones. A diagnosis is usually made through considering the patient's medical history, a physical examination and the exclusion of other conditions that may be causing the pain. Using differential local anaesthesia to block off certain nerves associated with the joint is often used for confirmation.

The DIANA implant is inserted via a small incision using special instruments. It pushes the ligaments back to their regular state by separating the joints. In addition, it fixes the joints into the correct anatomical position before bone and bone replacement material are added to fuse and immobilise the joints.

Dr Van Aarde points out that the surgical fusion of the sacroiliac joint with the DIANA procedure has already been used for more than 2000 patients worldwide since it was introduced. The results achieved have been excellent and it has been shown to be a sound way to both stabilise the joint and treat pain. In follow-ups with these patients, the majority have reported reduced pain and a greatly improved quality of life.

Minimally invasive

The procedure itself is minimally invasive and there is a reduced risk of complications when compared with traditional joint fusion techniques. Depending on their general condition, patients usually have to stay in hospital for five days. They will then need to use crutches for a minimum of six weeks, as far as possible keeping the load off the affected side while it heals.

GM of Netcare Greenacres Hospital, Gloria Murison, says, "The staff and management of the hospital are honoured to be able to work with both doctors who have shown dedication and resolve in bringing this important, highly specialised service to the people of the Eastern Cape. Thanks to them, patients with sacroiliac joints conditions will now be able to access this innovative treatment in their own province."

Murison says that new technology and techniques such as DIANA are constantly being introduced at the hospital in order to ensure that it stays abreast of the latest advances in medicine. For example, the hospital recently became the first facility in Africa to acquire the Mizuho OSI proAXIS Spinal Surgery Table, which is the latest in a line of surgery tables.