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Prospective outcomes for therapeutic CT fluoroscopy guided sacroiliac joint injections 2011

Interventional Spine

Amanjit, S, Baadh, MD
Orlando, Ortiz, MD, MBA, Non ASSR Member

Paper/Mentor

Purpose

To assess the safety and efficacy of CT fluoroscopy (CTF) guided sacroiliac joint injections in the management of lower back pain (LBP).

Methods & Materials

Medical records were reviewed retrospectively for all patients who underwent CTF guided sacroiliac joint injections from April 2008 to September 2010. Medical records were analyzed for patient demographics, injection effect on lower back pain and procedure complications. All patients who presented with a minimum of 7/10 LBP on a visual analog pain scale were included in the study. A total of 117 injections were performed. Based on the patients pain diagram, either a unilateral (n=63) or bilateral (n=54) injection was performed. All injections were performed by an experienced spine interventionalist utilizing CTF guidance, strict aseptic technique, and 1% Lidocaine injection at the puncture site(s). A 22 gauge spinal needle was used for each injection. Needle position within the symptomatic sacroiliac joint was confirmed by CTF and by arthrography using 1-3ml of Omnipaque 180. The joint was then injected with 2-3ml mixture of 3ml 0.5% Bupivacaine and 2ml (80mg) Methylprednisolone. The patient was interrogated for the presence of pain provocation at the time of arthrography and joint injection. All patients were followed at 3 weeks post injection in clinic.

Results

Out of the 99 patients included in this study, 71were female and 28 were male. The mean age of these patients was 64.8 years (age range - 28 to 98 years). All patients experienced significant (>3 point of the visual analog pain scale reduction) pain relief that lasted at least 3 weeks. 19.1% patients had recurrent pain between 3 weeks and 3 months after the procedure and subsequently underwent either repeat injection(s) with further relief (n=13, (13.1%)) or sacral radiofrequency neurolysis (n=15 (15.2%)) with extended pain relief of at least one year duration. All procedures were performed without complications.

Conclusion

CTF guided sacroiliac joint injections are a safe and effective treatment for patients with moderate to severe LBP. All patients reported significant improvements with respect to pain reduction for at least 3 weeks post injection. Patients with transient response to initial injection responded well to either repeat injection(s) or radiofrequency neurolysis, reporting extended periods of pain relief. With CTF image guidance sacroiliac joint injections can be performed safely.

References/Financial Disclosures

1. Thanos L, Mylona S, Kalioras V, Pomoni M, Batakis. Percutaneous CT-guided interventional procedures in musculoskeletal system. Eur J Radiol. 2004 Jun;50(3):273-7 2. Stone JA, Bartynski WS. Treatment of facet and sacroiliac joint arthropathy: steroid injections and radiofrequency ablation. Tech Vasc Interv Radiol. 2009 Mar;12(1):22-32 3. Rupert MP, Lee M, Manchikanti L, Datta S, Cohen SP. Evaluation of sacroiliac joint interventions: a systematic appraisal of the literature. Pain Physician. 2009 Mar-Apr;12(2):399-418 4. Levin G, Luchs J, Ortiz AO. Facet and sacroiliac joint injection techniques. In Gangi A, Guth S, Guermazi A (eds): Imaging in Percutaneous Musculoskeletal Interventions. New York, Springer 2008:73-82 Financial Disclosures- Dr. Ortiz: Orthovita, Speakers Bureau

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