Abstract
The injection of mixture of plain bupivacaine and triamcinolone acetonide into the sacroiliac joint (SIJ) to relieve chronic low back pain is uncommon in the West African sub-region. The objective of this study was to demonstrate the efficacy or otherwise of fluoroscopic-guided SI joint injection in the management of chronic axial low back pain in Nigeria. This was a prospective observational interventional study. The study was carried out at a tertiary hospital in Nigeria. Twenty-six patients with SI joint pain, based on IASP diagnostic criteria, who presented to our unit over 36 months from March 2012 to March 2015 and. Fluoroscopic-guided injections of 5mls mixture of bupivacaine and triamcinolone acetonide into the sacro-iliac (SI) joints of 26 patients with SI joint pain out of 116 patients who were offered different interventions for chronic low back pain. The patients were followed up for year and pain intensity and functional status were assessed at 3-, 6- and 12 months post-intervention. Pain relief and functional improvement were the main outcome measures. The mean numeric rating score (NRS) and Oswestry Disability index (ODI) score in 14 (53.9%) patients at 12 months post-interventions were significantly lower compared with baseline values; 3.19 ± 1.10 vs 8.54 ±1.14 p=0.000 and 25.35 ± 5.40 vs 37.54 ±8.41, p=0.000 respectively. Fluoroscopic-guided steroid injection into the SI joint resulted into reduction in pain intensity and improved physical function in the majority of patients with SI joint pain. Not declared.
Highlights
Sacro-iliac (SI) joint is an important source of chronic axial low back pain;[1, 2] with frequency of its occurrence increasing with age.[2]
Of the total 116 patients assessed for chronic low back pain, transformational epidural steroid injections, medial branch blocks or both were offered to 96 patients and only 26 met the diagnostic criteria for sacro-iliac joint pain, putting the incidence at 22.4% (26/116) in our centre
The left sacroiliac joint (SIJ) was more affected than the right in more than 70% (19) of the patients; duration of low back pain was greater than 6 months in 76.9% (20) of the patients and the pain was localized in the gluteal region in 69.2% (18) of the patients, Table 1
Summary
Sacro-iliac (SI) joint is an important source of chronic axial low back pain;[1, 2] with frequency of its occurrence increasing with age.[2]. Pain originating from the SIJ can be intra-articular, extra-articular or unknown. Intra-articular causes include infection, arthritis, spondyloarthropathies and malignancies while enthesopathy, fractures, ligamentous injuries and myofascial pain constitute the extra-articular causes of SI joint pain.[3] Based on the proposed criteria by the International Association for the Study of Pain (IASP), SIJ pain is defined as pain localized in the region of the SI joint, reproducible by stress and provocation tests of SI joint, and reliably relieved by elective infiltration of the joint with local anaesthetic.[4]. Conservative treatment of SIJ pain with analgesics, as usually the case with other specific causes of chronic low back pain, are ineffective. Interventional pain management techniques for specific sub-diagnosis of causes of back pain based on evidence-based practice guidelines have been shown to improve the chances of successful treatment outcome.[3]
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