Sacroiliac joint injection

Dr Henry Knipe and A.Prof Frank Gaillard et al.

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
  • coagulopathy
  • contrast reaction or other medication allergies
  • pregnancy
  • 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
  1. The target SI joint is localized, with a slight rotation of the fluoroscope (20-30°) to optimally visualize the inferior component of the articular space.
  2. Aiming about 1 cm above the lower end of the articular space.
  3. Sterile preparation and draping.
  4. Advance a 22G spinal needle in the posteroinferior aspect of the SI joint.
  5. Optional intra-articular injection of a small amount of contrast to confirm intra-articular position.
  6. Injection of 1 mL steroid and 1 mL long-acting local anesthetic.
  1. Perform a preliminary CT of the SI joints.
  2. The target SI joint is localized, with an aim at about 1cm above the lower end of the articular space.
  3. Sterile preparation and draping.
  4. Advance a 22G spinal needle in the posteroinferior aspect of the SI joint.
  5. Optional intra-articular injection of a small amount of contrast to confirm intra-articular position.
  6. 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 are rare 3-5:

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

rID: 2012
Synonyms or Alternate Spellings:
  • SI joint injection
  • SIJ injection

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Cases and figures

  • Case 1: normal sacroiliac joint injection
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