Sacroiliac joint injection
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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.
- diagnostic: relief of pain after injection of local anesthetic
- therapeutic: to relieve pain from degenerative or inflammatory conditions of the SI joints 3-5
There are no specific absolute contraindications, but relative contraindications include 3-5:
- systemic infection or cutaneous infection over the injection site
- contrast reaction or other medication allergies
- 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
- the patient is typically in a prone position
- 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
- 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.
- 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
- pain score assessed immediately and 15-20 minutes post-procedure
- observe for 20-30 minutes for any immediate complications
Complications are rare 3-5:
- allergic/anaphylactic reaction
- local reaction to steroid injection (usually >48 hours)
- transient numbness/paralysis (should resolve in minutes)
- transient difficulty voiding
- 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 4,5
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