Sacroiliac joint injection
Updates to Article Attributes
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was changed:
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 anaesthetic
- therapeutic: to relieve pain from degenerative or inflammatory conditions of the SI joints 3-5
Contraindications
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
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
- counselling 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 anaesthetic (e.g. lidocaine) for subcutaneous infiltration
- long spinal needle (typically 22 G), 3 mL syringe, steroid (e.g. betamethasone), long-acting local anaesthetic (e.g. ropivacaine, bupivacaine) for intra-articular injection
- low osmolar contrast
Technique
Fluoroscopic-guided
-
Thetarget SI joint is localized, with a slight rotation of the fluoroscope (20-30°) to optimally visualise the inferior component of the articular space. -
Aimingaiming about 1 cm above the lower end of the articular space. -
Sterilesterile preparation and draping. -
Advanceadvance a 22G spinal needle in the posteroinferior aspect of the SI joint. -
Optionaloptional 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 anaesthetic.
CT-guided
-
Performperform a preliminary CT of the SI joints. -
Thethe target SI joint is localized, with an aim at about 1 cm above the lower end of the articular space. -
Sterilesterile preparation and draping. -
Advanceadvance a 22G spinal needle in the posteroinferior aspect of the SI joint. -
Optionaloptional intra-articular injection of a small amount of contrast to confirm intra-articular position. -
Injectioninjection of 1 mL steroid and 1 mL long-acting local anaesthetic.
Post-procedure care
- pain score assessed immediately and 15-20 minutes post
procedure-procedure - observe for 20-30 minutes for any immediate complications
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
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 4,5
-<li>The target SI joint is localized, with a slight rotation of the fluoroscope (20-30°) to optimally visualise the inferior component of the articular space.</li>-<li>Aiming about 1 cm above the lower end of the articular space.</li>-<li>Sterile preparation and draping.</li>-<li>Advance a 22G spinal needle in the posteroinferior aspect of the SI joint.</li>-<li>Optional intra-articular injection of a small amount of contrast to confirm intra-articular position.</li>- +<li>target SI joint is localized, with a slight rotation of the fluoroscope (20-30°) to optimally visualise the inferior component of the articular space.</li>
- +<li>aiming about 1 cm above the lower end of the articular space.</li>
- +<li>sterile preparation and draping.</li>
- +<li>advance a 22G spinal needle in the posteroinferior aspect of the SI joint.</li>
- +<li>optional intra-articular injection of a small amount of contrast to confirm intra-articular position.</li>
-<li>Perform a preliminary CT of the SI joints.</li>-<li>The target SI joint is localized, with an aim at about 1 cm above the lower end of the articular space.</li>-<li>Sterile preparation and draping.</li>-<li>Advance a 22G spinal needle in the posteroinferior aspect of the SI joint.</li>-<li>Optional intra-articular injection of a small amount of contrast to confirm intra-articular position.</li>-<li>Injection of 1 mL steroid and 1 mL long-acting local anaesthetic.</li>- +<li>perform a preliminary CT of the SI joints.</li>
- +<li>the target SI joint is localized, with an aim at about 1 cm above the lower end of the articular space.</li>
- +<li>sterile preparation and draping.</li>
- +<li>advance a 22G spinal needle in the posteroinferior aspect of the SI joint.</li>
- +<li>optional intra-articular injection of a small amount of contrast to confirm intra-articular position.</li>
- +<li>injection of 1 mL steroid and 1 mL long-acting local anaesthetic.</li>
-<li>pain score assessed immediately and 15-20 minutes post procedure</li>- +<li>pain score assessed immediately and 15-20 minutes post-procedure</li>