Three years ago, Dr. Milenko Savić, a spinal surgeon, was the first in this part of Europe to install an implant in the Atlas General Hospital, which achieves fixation of the sacroiliac joint. The sacroiliac joint functions as the transition between the spine and the pelvis. This advanced method is included in the regular program of Atlas General Hospital and has made life easier for many patients and relieved them of the unbearable pain that also occurs in younger people.
Dr. Milenko Savić: ” This is a young patient who is 38 years old and was previously operated due to a spinal disease.” Stabilization and fusion were performed in 2 levels in the lumbar region. Although the operation, technically speaking, was done perfectly without any need for correction, after the intervention, after some time, he started to feel pain in the lower back again, which intensified over time. Of course, we conducted all the tests, which showed that everything that was done in the previous operation was perfect. Practically everything is fine with the treated region, and the patient still feels pain. The patient, of course, wondered what to do next. Some general conclusion was that there was nothing to fix and that the patient was doomed to suffer pain, which is of course the worst option. ”
The patient was lucky. Pain that occurs from the sacroiliac joint has already been recognized in medicine. A clinical trial was performed because radiological tests for this disease do not exist.
Dr. Milenko Savić: ” It is not possible to see on the X-ray whether the sacroiliac joint is damaged. In clinical tests, we suspected that it was a sacroiliac joint. A blockade or infiltration of that joint was done, under the control of X-rays, after which the pain completely stopped. It is almost one hundred percent proof and confirmation that the problem is in that overlap. ”
What is a sacroiliac joint, how and when is it damaged?
Dr. Milenko Savić: “The sacroiliac joint has no visible movements. It is not like a hip or knee joint, but it is still a joint. The sacroiliac joint joints spine and the pelvis. Although the movements in that joint are minimal, it can be damaged or diseased, like any other joint, and produce pain that is not typical. Not every patient has the same pain intensity, distribution, or spread, nor the character of the pain. It is especially difficult to predict or recognize, if the patient has already been operated. This sacroiliac joint can suffer on its own and occur like any other disease. However, it is very common and now we, surgeons, are becoming more and more convinced that it can occurs after operations that were performed in the upper part of the spine, such as stabilization, fusion in one or more segments. ”
The essence of the operation is to fix the damaged joint. In this case, two special screws are placed, in order to prevent any movement in that joint. The intervention is minimally invasive.
Dr. Milenko Savić: “ There is no classic opening of the skin and no classic cut. Implants are placed through a minimal opening in the skin that is only wide enough for the implant to pass, and everything is done under X-ray control. At all times we have information and a clear picture of where exactly we are and what is the ideal trajectory and position of these implants. It belongs to the group of minimally invasive spinal procedures. ”
In Serbia, unfortunately, this intervention has not become the standard in treatment because it is relatively new in the world.
Dr. Milenko Savić: ” It is still an expensive technology. It takes one period for surgeons to be trained, because this method requires a longer period of practice, experience. It is necessary to educate patients and other doctors, who come to patients with back pain. Doctors need to understand that there is sacroiliac pain and that it is a reality. Sacroiliac pain can be recognized, of course you need experience and knowledge, but the most important thing is that it is a condition that is also treated surgically. In the beginning, physical therapies, anti-painful procedures, medications, exercise, sports are recommended, but when all that does not work, the only thing that remains is surgical treatment.
Therefore, both patients and doctors need to adopt these facts, in order for the procedure to become truly standard. It takes some time to confirm this in practice, to convince all those who have some fear or disbelief. I expect that in the near future it will become the standard and that it will be done in most centers that deal with spine treatment. ”
The patient is expected to get up quickly and return to daily life without pain.
Dr. Milenko Savić: “ Since this is a minimally invasive procedure, we do not have any blood loss. The incision on the skin is really minimal, so that the patient practically gets up tonight, he will feel minimal local pain, which is negligible. The patient can go home the next day. In the first two or three months, it is only necessary for the patient to take care and restrain from great physical effort, and the usual life activities such as driving, walking and sitting he will be able to perform the next day. Also, from the next day, patient should be without pain. ”
Conversation with the patient after the operation
Patient: ” I feel really nice, compared to yesterday, the day before yesterday and all these days. Today is a beautiful day and I can say it is pleasant, without pain without anything unpleasant. ”
What brought you here, what problems did you have before?
Patient: “ I had spinal stabilization L4, L5, S1. Left and right sacroiliac joint surgery is now being performed. ”
How long after the first spine surgery did the pain start?
Patient: ” The pain in the lower part of the spine was like an electric shock. The pain spread throughout the left leg, and reached the hip through the right leg. It just cuts you off and you can’t sit, lie down, and walk for long. It is most difficult to handle mentally, you can’t adjust in any way. ”
And you asked for help then?
Patient: ” I was even in Banjica hospital, the doctor examined me and suggested the operation of my spine again. However, I had to sign and operate at my own risk. The doctor looked at the spine on magnetic resonance imaging and everything was fine. ”
Everything was fine and you were in pain?
Patient: “ Yes. ”
How did you find out about Dr. Savic and Atlas General Hospital?
Patient: ” The neighbor of mine was operated by Dr. Savić. in 2018, then, Republika Srpska had a contract with Atlas Hospital. I was supposed to come to the Military Medical Academy then, however, they told me that my operating schedule would be in the next year and a half. They told me that I could also have surgery at the Atlas General Hospital with Dr. Savić. I sent a decision and got approval. Really, all compliments for Dr. Savić. ”
The patient got out of bed the next day, without pain, and was released from the hospital.
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