Andel Hoke suffered from lower back pain. Many unsuccessful attempts to diagnose the source of her pain left her with no options and little hope. An elementary school teacher, Andel used all of her daily energy to maintain a positive attitude with her students. Outside of the classroom she began to isolate herself from family and friends. “I couldn’t be my upbeat self,” she explains. The pain became so great that she was no longer able to sit for any period of time. Standing or lying down became her only options and she was losing her will to live. “I didn’t want to bring the people I care about into my pain.”

Olympia Orthopaedic Associates
Olympia Orthopaedic Associates’ Dr. Andrew Manista offered hope for relieving Andel Hoke’s pain. Photo courtesy: Olympia Orthopaedic Associates

Fortunately, she met Dr. Andrew Manista at Olympia Orthopaedic Associates. Dr. Manista listened to Andel’s story and felt strongly that she was suffering from Sacroiliac Joint Dysfunction. The sacroiliac joint, also known as the SI joint, is located between the sacrum and the pelvis. There are two joints located on either side of the body. The SI joint provides support and stability and plays a major role in reducing the impact of daily activities. It is an essential component for shock absorption to prevent impact forces during walking from reaching the spine. Hoke could not put any pressure on her spine without feeling tremendous pain.

For many years this “forgotten joint” wasn’t considered when investigating lower back pain. Many patients being treated for spine or hip problems are actually suffering from SI joint pain. More common in women than in men, the pain often starts during pregnancy when the sacroiliac ligaments are loosened for childbirth. Physicians now know that patients who have undergone spine surgeries can develop problems post-surgery with their SI joint.

Dr. Manista admits that he wasn’t taught very much about this joint in medical school. The access point to the joint was so difficult and the surgery so “brutal” for the patient that it was rarely considered to be a reasonable treatment option. This changed seven years ago when the iFuse Implant System was introduced. Using a similar technology that is implemented when repairing a fractured pelvis, the implant allows orthopedic surgeons to approach the SI joint through a small 4-5 inch incision.

The sacrum is the keystone of the body providing strength and stability. Photo credit:SI-BONE Implant Sytems
The sacrum is the keystone of the body providing strength and stability.
Photo credit: SI-BONE Implant Sytems

“This surgery is such a breakthrough for patients who have been suffering from undiagnosed lower back pain,” explains Dr. Manista. “15-20% of patients with what we call “failed back syndrome” are actually suffering from SI joint dysfunction.”

Dr. Manista further explains, “Only 10% of those patients will need surgery.” Once the sacroiliac disease is diagnosed, many patients can experience great relief with physical therapy and proper pain management. “Finding out what is causing the pain is paramount,” says Dr. Manista.

Dr. Manista was able to pinpoint the cause of Andel’s pain by giving her an injection directly into the SI joint. “I literally melted on the table,” she says.  The pain was gone and Dr. Manista knew that he had found the root of the teacher’s agony. The injection lasted about three weeks. During the pain-free interim Andel was able to sit at her desk and even go to a movie. Andel was the ideal surgical candidate.

The iFuse Implant System is ingenious. The patented, triangular design is stronger than a circle to handle the stress of the sacrum, legs and spine all meeting in one place. The titanium implant is sprayed with a patented plasma coating. The gritty surface is specially designed to “grab” bone as it passes by. Over time bone will grow around the implant as the body heals and will strengthen the joint even further.

Olympia Orthopaedic Associates
Andel Hoke and her husband Mike hike at Lake Quinault after her SI surgery. Photo courtesy: Andel Hoke

Dr. Manista is a leader in this field and now trains other surgeons from around the country on how to diagnose sacroiliac joint pain and implement the iFuse Implant System. Over 20,000 surgeries have been performed with the iFuse Implant System with a 90% success rate.  Fortunately, surgery is not the only option. Olympia Orthopaedics Associates has many non-surgical partners in the community.  Physical therapy, cortisone injections and sacroiliac belts are all potential treatments to be considered.

Dr. Manista operated on Andel Hoke on a Friday morning and she was walking within an hour and home by noon. “My whole outlook on life has changed now that I am pain-free,” she says.  “I can get on the floor and play with my students.”

Drs. Andrew Manista and Douglas Taylor will be providing an educational seminar on Sacroiliac Joint Pain at their Westside clinic on Thursday, February 16 from 6:00 – 7:00 p.m.  For more information or to RSVP, please contact Rachel Sherburne at 360-570-4862.


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