Sacroiliac Joint Injection



Sacroiliac Joint Injection


Donald V. La Barge, III, MD










Graphic depicting a posterior view of the sacrum shows the angular configuration of the sacral ala image, which results in the complex oblique orientation of the SI joints.






Graphic shows complex oblique articulation of the left SI joint image and overlying gluteal and hamstring muscular groups, as well as ligamentous supporting structures on the right.


TERMINOLOGY


Definitions



  • Image-guided injection of corticosteroid and long-acting anesthetic into sacroiliac (SI) joint


PRE-PROCEDURE


Indications



  • Diagnostic injection for hip/back/buttock pain


  • Sacroiliitis


  • Synovial cyst associated with SI joint


Contraindications



  • Systemic or local infection


  • Coagulopathy


  • Allergy to injectate


  • Relative



    • Pregnancy


    • Allergy to iodinated contrast


Getting Started



  • Things to check



    • Pre-procedure imaging



      • Assess anatomy of sacroiliac (SI) joint


      • Look for osseous fusion


      • Look for other findings to explain the patient’s pain


    • Clinical history



      • History of trauma


      • Surgical history


    • Coagulation parameters


    • Informed consent


  • Medications



    • Short-acting anesthetic


    • Long-acting anesthetic


    • Corticosteroid


    • Myelography-safe iodinated contrast


  • Equipment list



    • Radiopaque marker


    • Sterile prep and drape materials


    • 5 mL syringe and long 25-gauge needle for local anesthetic


    • 5-10 mL syringe and extension tubing for myelography-safe iodinated contrast


    • 3 mL syringe for injectate


    • 22-gauge spinal needle


    • Hydrogen peroxide


    • Bandage


PROCEDURE


Patient Position/Location



  • Best procedure approach



    • Prone



      • Oblique tube angulation to “open” SI joint and establish needle trajectory


      • Target inferior 1/3 of SI joint


Equipment Preparation



  • Draw ˜ 5 mL local anesthetic


  • Draw 5-10 mL myelography-safe iodinated contrast



    • Attach and preload extension tubing with contrast


    • Tubing should be air-free


  • Draw injectate



    • Corticosteroid and long-acting anesthetic (total volume: 2-3 mL)


Procedure Steps



  • Procedure “time out”



    • Correct patient


    • Correct side for injection


    • Correct procedure


    • All necessary equipment available


  • Establish proper x-ray tube angulation to visualize joint space


  • Mark skin overlying lower 1/3 of SI joint



    • Usually easiest portion of joint to access


  • Perform sterile prep and drape


  • Apply local anesthetic superficially and deep


  • Spot fluoroscopy or CT imaging of numbing needle is helpful to confirm skin entry and needle trajectory


  • Remove 25-gauge needle, and anchor 22-gauge spinal needle in subcutaneous tissue



  • Reconfirm skin entry and needle trajectory with fluoroscopy or CT imaging


  • Advance needle under intermittent imaging until “pop” into joint space is felt or bone is reached


  • If bone is encountered, confirm with imaging, and “walk” needle tip into joint
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Sep 22, 2016 | Posted by in EMERGENCY RADIOLOGY | Comments Off on Sacroiliac Joint Injection
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