sacroiliac joint injection

Sacroiliac joint injections can be performed using a posterior approach into the sacroiliac (SI) joint under fluoroscopic or CT guidance. It is often performed bilaterally.

Indications

  • diagnostic: relief of pain after injection of local anesthetic
  • therapeutic: to relieve pain from degenerative or inflammatory conditions of the SI joints

Contraindications

There are no specific absolute contraindications, but relative contraindications include :

  • systemic infection or cutaneous infection over the injection site
  • coagulopathy
  • contrast reaction or other medication allergies
  • pregnancy

Procedure

Preprocedural evaluation
  • history of presenting complaint: type, nature, severity, duration and location of back pain
  • relevant medical and surgical history
  • review relevant laboratory results
  • review prior imaging
  • counseling patient about onset, length and likelihood of pain relief
  • gaining informed consent
Positioning/room set-up
  • the patient is typically in a prone position
Equipment
  • sterile dressing pack; sterile gown and gloves
  • 10 mL syringe, hypodermic needle and local anesthetic (e.g. lidocaine) for subcutaneous infiltration
  • long spinal needle (typically 22 G), 3 mL syringe, steroid (e.g. betamethasone), long-acting local anesthetic (e.g. ropivacaine, bupivacaine) for intra-articular injection
  • low osmolar contrast
Technique
Fluoroscopic-guided
  • target SI joint is localized, with a slight rotation of the fluoroscope (20-30°) to optimally visualize the inferior component of the articular space.
  • aiming about 1 cm above the lower end of the articular space.
  • sterile preparation and draping.
  • advance a 22G spinal needle in the posteroinferior aspect of the SI joint.
  • optional intra-articular injection of a small amount of contrast to confirm intra-articular position.
  • Injection of 1 mL steroid and 1 mL long-acting local anesthetic.
CT-guided
  • perform a preliminary CT of the SI joints
  • the target SI joint is localized, with an aim at about 1 cm above the lower end of the articular space
  • sterile preparation and draping
  • advance a 22G spinal needle in the posteroinferior aspect of the SI joint
  • optional intra-articular injection of a small amount of contrast to confirm intra-articular position
  • injection of 1 mL steroid and 1 mL long-acting local anesthetic
Post-procedure care
  • pain score assessed immediately and 15-20 minutes post-procedure
  • observe for 20-30 minutes for any immediate complications

Complications

Complications are rare :

  • infection
  • allergic/anaphylactic reaction
  • local reaction to steroid injection (usually >48 hours)
  • transient numbness/paralysis (should resolve in minutes)
  • transient difficulty voiding
  • bleeding

Outcomes

  • 50-80% of patients have immediate pain relief
  • 90% of patients without previous spine surgery have pain relief at 12 hours
  • symptomatic relief is of 10 months duration, on average
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