Landmark-guided Injections for Treatment of Sacroiliac Joint Pain

Abstract

<h3>Research Objectives</h3> To investigate patients' degree and duration of pain relief from landmark-guided injections without fluoroscopy or image-guidance for the treatment of sacroiliac joint (SIJ) pain. <h3>Design</h3> A retrospective cohort study was conducted to examine patients' degree and duration of SIJ pain relief from landmark-guided injections. Patients' self-reported measures to the provider's common follow-up questions were assessed in the electronic medical record from their follow-up visits. <h3>Setting</h3> An out-patient orthopedic spine surgery clinic. <h3>Participants</h3> 311 patients identified as having SIJ pain that received at least one landmark-guided injection were reviewed. Four patients with a history of image-guided or fluoroscopy-guided SIJ injections were excluded. <h3>Interventions</h3> The SIJ was palpated and a landmark-guided, periarticular injection consisting of an anesthetic agent and corticosteroid was administered with a 22-gauge needle without image or fluoroscopy guidance. The patient was prepped using an aseptic technique and ethyl chloride. <h3>Main Outcome Measures</h3> The primary outcomes included the duration of relief recorded in weeks and the degree of relief recorded as a percentage. Secondary outcomes included reported adverse side effects. Covariates of interest including age, smoking status, BMI, reason for pain onset, and sex were collected for further comparative analysis. <h3>Results</h3> Of these 311 patients included in this review, 191 patients returned for follow-ups with reports of duration and degree of pain relief. The average length of relief reported was 8.88 weeks. The average percent relief reported was 53.55%. Reported adverse side effects included: increased low back pain, an irregular menstrual cycle, and vaginal bleeding unrelated to menstruation. No other adverse side effects were reported. No comparisons between outcomes and covariates were statistically significant. <h3>Conclusions</h3> Landmark-guided SIJ injections are a reasonable and safe treatment option for SIJ pain, as our patient population had on average greater than 50% sustained relief for over 2 months. This treatment option is a more affordable and accessible option that can be done quickly in the clinic as compared to the gold-standard approach of fluoroscopically-guided SIJ Injections. A prospective, controlled study of the efficacy of these injections is underway at our institution. Other future research should investigate patients' degree and length of relief from subsequent landmark-guided injections. <h3>Author(s) Disclosures</h3> No conflicts to report.