Sacroiliac Joint Injection

The sacroiliac joint has been implicated as a source of chronic pain in up to 30 % of the patients with chronic low back pain. Usually the pain is localized in one or both sides of the lower back and has not responded to conservative management. Quite often the pain may radiate to the leg, groin, buttock or middle of the back. Various radiological studies show a poor correlation with the actual pain experienced by the patient. Injection of a local anesthetic mixed with or without steroids (cortisone) will numb the sacroiliac joint or the nerves arising from this structure. In this way, the painful signals will be blocked and the patient may feel relief anywhere between a few hours or a few months. Steroids are anti-inflammatory agents injected in conjunction with the local anesthetic medications. This will allow the break of the pain cycle, while the patient can exercise and improve range of movement and muscle strength. If after two similar injections the pain returns, one may consider a radio frequency ablation (destruction) of the small nerves innervating this joint. This might afford a longer and more sustained pain relief. These injections should be considered only after simpler interventions have failed to produce any type of sustained relief.

What to expect during the procedure?
For optimal outcome, this procedure needs to be performed only under fluoroscopic (X-ray) guidance. The patient lies on the stomach; the back is prepped with an antiseptic solution and then a local anesthetic is used to numb the skin. Under direct X-ray visualization the needle is introduced towards the target area. A mild, temporary discomfort may be perceived at the time of the injection. A mixture of local anesthetic with or without steroids will be injected through the needle.

After the injection the patient will keep a close diary of the pain level so a decision can be made regarding the next therapeutic step. A mild local discomfort may persist at the side of the injection for a day or two.

On the day of the procedure, the patient needs to be accompanied by a designated driver since after the procedure temporary residual numbness may be perceived. Further discharge instructions will be provided by our staff before leaving the surgical area. The following day the patient will be called by the nurse and the outcome will be reassessed. A follow up appointment will be set up in two to three weeks after the procedure with one of the physicians or nurse practitioners.