chronic symptomatic symphyseal instability
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Chronic Symptomatic Symphyseal Instability. M.L. Chip Routt, Jr., M.D. Patient #1. 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

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Presentation Transcript
patient 1
Patient #1

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 films1
Presentation Pelvic Films

Alternating LE Standing Films

pelvic ct scan1
Pelvic CT Scan

Axials @ S1 & S2

SI Joints

surgery
Surgery

Supine

Pfannenstiel

Unstable Symphysis

Compressive Reduction Clamped

Symphyseal Plating – Frail Bone

Perc Upper and 2nd Sacral Segment IS Screws

postop ct imaging1
Postop CT Imaging

Axials @ S1 & S2 Levels

rehabilitation
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
4 Months After Surgery

Plain Films

Notable Plate Segmental Breakage

4 months after surgery1
4 Months After Surgery

No Pain Complaints

Normal Gait without Distance Limit

Lifts/Carries Son

“Normal” Sexual Activity

No GU Complaints

Still Working FT

patient 2
Patient #2

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
Plain Films

Inlet-Outlet

initial plain films
Initial Plain Films

Single LE Alternating Stance Films

surgery1
Surgery

Supine

Pfannenstiel

Fluid Filled “Cyst” Around Unstable Symphysis

Compressive Reduction Clamped

Symphyseal Plating

Perc Bilat IS Screws at Upper Sacral Segment

rehabilitation1
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
3 Months After Surgery

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 surgery1
3 Months After Surgery

Plain Films

No Implant Breakage….Yet!

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