Physician’s Perspective: Richard Coursey, MD

The Omnia medical implant device PsiF is an SI joint fusion system that supports pain management intervention for lower-back pain caused by sacroiliac joint (SI joint) degeneration. The device is inserted via a minimally invasive posterior approach to stabilize the SI joint. It is used to alleviate pain and prevent further degeneration.

Richard Coursey, MD, is a highly skilled vascular and interventional radiologist with a further specialty in advanced pain management. While the device has been FDA-approved since 2014, Dr. Coursey was the first known interventional radiologist in the country to successfully do the Omnia PsiF procedure using precise CT image guidance earlier this year.

“The SI joint slides, so during certain maneuvers, that joint will have some movement. If there is arthritis in that joint, then movement can cause inflammation. The more maneuvers you do that make the joint move, the more inflamed the joint gets, leading to increased lower-back and buttock pain than can spread to the legs or off to the side and into the hip. It is a debilitating thing as it progresses,” Dr. Coursey noted.

Most PsiF procedures utilize fluoro X-ray. Dr. Coursey’s approach, utilizing CT guidance, enhances his capacity to navigate the joint as “this joint can have some complex anatomy and bends, which can sometimes be hard to see on a fluoro X-ray. Being able to look at the joint under CT makes the anatomy much simpler to see and the procedure much easier and safer to do,” he said.

Dr. Coursey further highlighted the advantage of this approach: “I think it makes it safer, as you know exactly where the implant is going to go. And also, since you have such great views, your incisions can probably be much smaller and in the right spot, so you don’t have to move things around.”

Clinic Team and Approach:

Dr. Coursey and his clinical colleagues are specialists in pain management and have been doing so for 12 years, including the past five years that he has been practicing at northern Colorado Banner locations. “We see inpatient consults and hold a daily clinic in Windsor where we see all our outpatients.”

Dr. Coursey and his team prioritize reliable appointment access and a comprehensive approach with interventions requiring limited downtimes and minimal anesthesia. “Each patient will have a full evaluation, and we will follow through their care journey with them and start with the least invasive thing and progress as we need to,” Dr. Coursey said. “While the Omnia PSIF procedure has excellent results, we still reserve this for patients who have failed other, even easier procedures first. We always make sure we do the least the patient needs to make them feel their very best.”

Procedure Breakdown:

The procedure takes about 30 to 40 minutes to complete and is done under general anesthesia (the patient is completely asleep).

“Since this is an outpatient procedure, we will only fuse one SI joint at a time, even if there is pain coming from both sides. Fusing more than one side at a time makes it harder for the patient to be safe to go home. As a rule, we usually wait about 45 to 60 days between each SI joint procedure to make sure patients are safe,” he said.

During the procedure, the patient is put under general anesthesia and then turned on his or her belly. Dr. Coursey performs a CT scan of the SI joints. After he reviews the anatomy, Dr. Coursey marks the area where the fusion device will be placed on the skin. Numbing medication is given in this area, and then a single, small incision is made along the upper buttocks region. Through a couple of steps, the SI joint being treated is entered with a long, skinny, metal pin. This metal pin is then used to allow a metal delivery tube to be advanced through the soft tissues of the buttocks to the SI joint entry site. A small drill is then inserted through the metal delivery tube to make space inside the joint for the Omnia PsiF device. The Omnia PsiF device is then coated with a type of biological bone cement, and then the device is inserted through the metal tube and then into the joint. All of these steps are done using CT guidance, enabling Dr. Coursey to ensure every step is done precisely.

Following the procedure, the patient can usually be discharged home and return to seminormal activity, and Dr. Coursey advises against high-exertion activities with lots of bending and squatting for a few weeks. Dr. Coursey says patients can expect a burning sensation temporarily within the joint and some lower-back pain, but medications given for a week or two after the procedure make all this very tolerable. “Compared to the other ways of fusing SI joints, this new device and method is far easier with all the same benefits,” he said.

Dr. Coursey’s clinic will then see the patient in follow-up about a week after the procedure and then again about a month later.

Treatment Alternatives:

Dr. Coursey previously and still offers all other SI joint pain treatments currently available. These treatments include SI joint steroid injections, SI joint RFA (radiofrequency ablation) and the use of spinal cord stimulators.

“Unfortunately, there is no guarantee that any procedure will eliminate someone’s pain in its entirety. That’s why it is important to always go slow and try the least invasive procedure possible first. We should really only be getting to SI joint fusion if all other treatment options have not helped to relieve pain for very long,” he said.

“Compared to other pain doctors, we have the most advanced machines to image the body throughout the procedures. While many pain procedures are very easy to do and don’t need very expensive or fancy imaging, having this always available to use does, in my opinion, improve patient results. I think we have Colorado’s most comprehensive interventional spine and pain program … treating not only normal aches and pain but also pain related to cancer,” he said.

Dr. Coursey is excited about RIA’s continued and further use of the newest and most minimally invasive procedures available to help people feel better and do more in their lives. “All of these advancements in technology and procedures are great for patients, because it means they don’t have to stay in the hospital overnight, and they spend less time recovering from a procedure or surgery,” he said.

Congratulations to Dr. Coursey and his entire clinical team for investing their expertise in innovative techniques to provide quality care to our patients.