Sacroiliac Joint Block Research Articles

Clinical outcomes for minimally invasive sacroiliac joint fusion with allograft using a posterior approach.

Sacroiliac joint (SIJ) dysfunction can occur as a result of injury, degeneration, or inflammation. This dysfunction presents symptoms of pain at various locations, including the low back, hips, buttocks, and legs. The diagnosis of SIJ dysfunction is challenging and cannot be achieved solely with imaging studies such as X-rays, MRI, or CT. The current gold standard diagnostic modality is intra-articular SIJ blocks using two differing local anesthetics. Current treatments for SIJ dysfunction may be beneficial for short-term relief but lack long-term efficacy. The purpose of our study was to examine the outcomes of patients who underwent minimally invasive, posterior SIJ fusion using allograft at a single center. This was a retrospective study which received exemption from the WCG IRB. Data regarding preoperative and postoperative pain levels, surgical time, complications, and medication usage were obtained retrospectively from patient electronic medical records and prescription drug monitoring program reports. No mapping was completed prior to the procedure. Pain was assessed with the 11-point (0-10) Visual Analogue Scale (VAS) and medication usage was assessed using Morphine Milligram Equivalents (MME). Patients were included if they had been diagnosed with SIJ dysfunction using two intra-articular diagnostic blocks that resulted in at least an 80% decrease in pain and had failed conservative management. Patients with sacral insufficiency fractures were excluded. VAS scores reduced from 8.26 (SD = 1.09) at baseline to 2.59 (SD = 2.57), 2.55 (SD = 2.56), 2.71 (SD = 2.88), and 2.71 (SD = 2.88) at 3, 6, 9, and 12 months, respectively. MME reduced from 78.21 mg (SD = 51.33) to 58.95 mg (SD = 48.64), 57.61 mg (SD = 47.92), 61.71 mg (SD = 45.64), and 66.29 mg (SD = 51.65) at 3, 6, 9, and 12 months, respectively. All reductions in VAS scores and MME were statistically significant. No adverse events occurred, and the average operating room time was 40.16 min (SD = 6.27). Minimally invasive, posterior SIJ fusion using allograft is a safe and efficacious method for managing SIJ dysfunction.

Diagnostic criteria of sacroiliac joint dysfunction in children and adolescents with pain in the lumbosacral region of the spine

BACKGROUND: Back pain is addressed by physicians of many specialties. In many ways, it is associated with a decreased volume of dynamic motor activity and increased static loading. In patients with an active lifestyle, back pain often develops when the technique of physical exercises or habitual movements are violated, often leading to secondary osteoarticular disorders. One of the most common causes of non-specific back pain is sacroiliac joint dysfunction. The ambiguity of information on the types, severity and significance of sacroiliac joint dysfunction has urged us to systematize the existing data so as to create an optimal diagnostic algorithm for the discussed pathology.
 AIM: To develop a system for examining patients with back pain so as to make the diagnostics of sacroiliac joint dysfunction more accurate.
 MATERIALS AND METHODS: 54 patients aged 718 (mean age 14.63.32) with pain in the lumbosacral spine were included in the study. All of them had the confirmed dysfunction of sacroiliac joint; specific causes of pain were excluded. The patients were divided into 2 groups, comparable in the number, sex, and age. The patients underwent a clinical neurological and neuroorthopedic examination with additional functional muscle testing, including the assessment of their overall and local muscle strength, elasticity, coordination, biomechanical characteristics, and muscle control. The state of the respiratory muscles (tonus, type of pain, irradiation, elasticity of ribs, etc.) was evaluated during the manual testing, too. A particular attention was paid to testing using an unstable support (redcord/exarta, fitballs and balancing pads). For the better objectivity of the findings, AlterG, TecnoBody, Oxiterra test devices were used additionally.
 RESULTS: The anamnestic predictors for the development of sacroiliac joint dysfunction were revealed. The specifics of the postural and biomechanical disorders in children and adolescents with unspecific back pain were analyzed. Cervical disorders were found which promoted secondary osteoarticular dysfunction, including the sacroiliac joint block. A diagnostic algorithm has been developed to identify the underlying cause of back pain in the case of sacroiliac joint dysfunction.
 CONCLUSION: The proposed diagnostic algorithm simplifies and systematizes the treatment of patients with sacroiliac joint dysfunction and complaints of back pain. The effectiveness of rehabilitation is improved due to a possibility to precisely select the rehabilitation technique.

ASSESSMENT OF FUNCTIONAL OUTCOME OF SACRO-ILIAC BLOCK IN PATIENTS WITH SACROILIAC JOINT DYSFUNCTION: A PROSPECTIVE STUDY

The study aimed to investigate the therapeutic efcacy of sacroiliac joint (SIJ) blocks with triamcinolone acetonide in patients with SI Joint dysfunction. Numerous studies have demonstrated that SIJ blocks with corticosteroid provide long-term pain relief in seronegative spondyloarthropathy.We conducted a prospective observational study of patients at Chettinad Hospital and Research Institute. The above mentioned SIJ blocks were performed in 30 patients, and functional outcome was evaluated with NRS pain scale and Oswestry Disability Index. 30 patients (66.7%) experienced signicant pain reduction for more than 6 weeks; the overall mean duration of pain reduction in these responders was 36.8 _ 9.9 weeks. SIJ blocks with triamcinolone acetonide are benecial for patients with SIJ pain

Sacroiliac Joint Pain Should Be Suspected in Early Buttock and Groin Pain after Adult Spinal Deformity Surgery: An Observational Study.

Sacroiliac joint pain (SIJP) is one of the pathological conditions of adjacent segment disorders occurring after adult spinal deformity (ASD) surgery. This study aimed to test the hypothesis that even in ASD surgery using S2 alar-iliac (S2AI) screws, SIJP can develop much earlier than reported previously and can be rescued by ultrasound-guided sacroiliac joint block. Overall, 94 patients with ASD treated with long spinal fusion using S2AI screws were prospectively investigated for SIJP postoperatively, and the effect of ultrasound-guided sacroiliac joint block was evaluated. Additionally, the relationship between the symptomatic side of the SIJP and the surgical procedure; the preoperative and postoperative whole-spine sagittal and coronal alignment, lumbar pelvis sagittal plane alignment, and pelvic incidence-lumbar lordosis were retrospectively compared between the groups with and without SIJP. Eleven of 94 cases (11.7%) developed SIJP. The average onset was 12.0 (±6.2) days after surgery. The "one-finger test," "Gaenslen test," and "tenderness of the posterosuperior iliac spine" had high positivity rates for SIJP. Night pain occurred in 81.8% of patients and was one of the diagnostic features. There were no significant relationships between the symptomatic side of SIJP and the approach-side of lumbar interbody fusion, donor site of the iliac bone graft, or malposition of the S2AI screw. There were no significant differences in preoperative characteristics and radiological parameters between the SIJP-positive and -negative groups preoperatively, postoperatively, or in postoperative changes. Two of the 11 cases required the SIJ block four times, but all patients eventually achieved >70% pain relief with no recurrence. For good pain control and physical therapy, the fact that early buttock-groin pain after spinal fusion surgery has a 12% likelihood of being due to SIJP and can be relieved with the ultrasound-guided SIJ block is clinically important for diagnosis and pain management.

Preliminary Results of Endoscopic Radiofrequency Treatment of the Sacroiliac Joint Syndrome.

The sacroiliac joint (SIJ) may be the primary source of pain in 15 to 25% of patients with axial low back pain. Furthermore, 75% of patients who have had fusion surgery develop SIJ pain within 10 years. Treatment options include SIJ blocks, radiofrequency (RF) denervation, and fusion. The RF techniques range from ablation of the nerves supplying the joint, creating lesions to the joint itself, or a combination of both techniques. However, different clinical studies could only identify a limited or, in some cases, no effect in decreasing of pain intensity and duration of the effect. In this retrospective study, we selected 23 patients with SIJ pain, with a duration of more than 12 months and a 50% pain reduction on the Numeric Rating Scale (NRS) after diagnostic block. All patients received endoscopic ablation of the medial branch L5/S1 and the lateral branches, exiting the sacral foramina on S1/S2 and S2/S3 on both sides while using only one incision on each side. Telephone interviews were conducted with all patients. The outcome was determined with Odom's criteria, percent reduction NRS, subjective assessment of the patient, and duration of the effect. According to Odom's criteria, 79% of the patients showed acceptable to excellent results and confirmed that denervation helped them to manage their daily lives better. The average pain reduction in the responder group was 57% with an average duration of 13.4 months. In this retrospective study, we could demonstrate the practicability and effectiveness of endoscopic SIJ denervation in the treatment of SIJ pain using only one incision for three levels on each side. Further studies should investigate if this procedure is more effective than percutaneous RF.

Durability and Failure Types of S2-Alar-Iliac Screws: An Analysis of 312 Consecutive Screws

S2-alar-iliac (S2AI) screws improve stability across the lumbosacral junction in spinopelvic fixation procedures by crossing the cortical surfaces of the sacroiliac joint (SIJ), thereby increasing the biomechanical strength of the instrumentation. To investigate the durability and failure types of S2AI screws after spinopelvic reconstruction surgery. A single-center, single-surgeon consecutive series of patients who underwent spinopelvic fixation using bilateral S2AI screws with a≥1-yr follow-up and at least 1 postoperative computed tomographic scan were retrospectively reviewed. Patient characteristics, radiographic parameters, operative data, clinical outcomes, and complications were analyzed. In total, 312 S2AI screws in 156 patients were evaluated (mean follow-up, 26.1 mo; range 12-71 mo). There were no significant differences in screw diameter, length, or insertion angle between right-side and left-side screws. Visual analogue scale scores for back pain, ambulatory status, and Oswestry Disability Index scores significantly improved. A total of 10 patients (3.2%) experienced SIJ pain after S2AI screw installation. SIJ pain improved in 8 of them following SIJ block. In total, 7 screws (2.2%) showed partial periscrew lucency. Set screw dislodgement occurred in 7 screws (2.2%). Screw fracture occurred in 6 screws (1.9%): 5 neck fractures and 1 shaft fracture. A total of 5 patients (1.6%) underwent revision surgery for S2AI screw failure. Distal device (L4-pelvis region) breakage occurred in 5 patients. The radiographic and clinical outcomes of S2AI screw fixation were acceptable. However, S2AI screw fixation has several drawbacks, including screw fracture and dislodgement of the set screw. SIJ irritation symptoms after S2AI screw fixation occurred with considerable frequency.

Accuracy of the Diagnostic Tests of Sacroiliac Joint Dysfunction

ObjectiveThe purpose of this study was to assess the reliability and validity of motion palpation and pain provocation compared with sacroiliac joint (SIJ) block as the gold-standard assessment method of patients with sacroiliac joint dysfunction (SIJD). MethodsA cross-sectional study was conducted in the Department of Sports and Exercise Medicine at Rasool Akram Hospital. Forty-eight patients suspected of having SIJD were selected from a total of 150 patients on the basis of a combination of symptoms, physical tests, and magnetic resonance imaging findings. The patients suspected of having SIJD received the SIJ block, to which the accuracy of all the physical tests was compared. Sensitivity, specificity, and positive and negative predictive values were calculated for each test. The receiver operating characteristic curve and the area under the receiver operating characteristic curve were measured. ResultsThe Flexion, Abduction and External Rotation (FABER) test had the highest specificity and positive predictive values of the physical tests. Furthermore, the combination of the FABER test and the thigh thrust test improved overall diagnostic ability more so than any of the other test combinations. ConclusionA combination of the motion and provocation tests increased specificity and positive predictive values, and the FABER test had the highest of these single values. The palpation tests did not change after the SIJ block, suggesting that their accuracy cannot be determined using this method.

Use of Diagnostic Injections to Evaluate Sacroiliac Joint Pain.

The sacroiliac joint is a complex, variable, and irregular structure, thought to be the source of 15% to 30% of low back, pelvic, and radicular pain. Several predisposing factors, including prior spinal surgery and particularly lumbar fusion, can contribute to joint inflammation and acceleration of joint degeneration. Evaluation of the sacroiliac joint as a pain generator using history and physical alone can prove difficult, because a number of other pathologies can have a similar presentation. Whereas a number of tests are used to examine the joint, no single test alone has proven validity. Imaging alone has also not been proven efficacious, particularly in nonspondyloarthropathy-mediated pain. Although no "gold standard" exists, diagnostic sacroiliac joint block has been shown to be a useful confirmatory tool in assessing sacroiliac (SI) joint-mediated pain. Sacroiliac joint injection with local anesthetic and steroids can be used as a possible therapeutic endeavor to manage pain and inflammation.

En Bloc Resection and Pelvic Ring Reconstruction for Primary Malignant Bone Tumors Involving Sacroiliac Joint.

ObjectiveTo observe the process of sacroiliac joint invasion by primary malignant tumors of sacrum and iliac bone, and to explore the methods of surgical resection and reconstruction.MethodsFrom January 2009 to November 2017, there were nine patients with primary malignant bone tumors involving sacroiliac joints, five males and four females, aged from 16 to 63 years, with an average age of 35 years. Of these there were three cases of primitive neuroectodermal tumors, three cases of chondrosarcoma, and three cases of osteosarcoma. Pelvic ring reconstruction was performed with longitudinal half sacrum, sacroiliac joint and partial iliac bone block excision and screw‐rod system combined with bone grafting.ResultsThe operation time was 155–310 min, with an average of 245 ± 55 min, and the bleeding volume was 1400–8500 ml, with an average of 3111 ± 2189 ml. Follow‐up ranged from 5 to 108 months, with a median follow‐up of 24 months. Three patients (33.3%) had local recurrence, three patients (33.3%) survived without tumors, and one patient had lung metastasis 2 years after operation, and survived with tumors. Five patients (55.6%) died, of which four died of lung metastasis and one died of brain metastasis. Survival analysis showed that the 3‐year overall survival rate was 57%. Bone grafts did not heal in four patients, and bone grafts healed in five patients. The healing time ranged from 5 to 7 months, with an average of 6.2 months. Complications: one patient developed deep infection 2 months after operation; one patient had skin edge necrosis; titanium rod loosening and displacement were found in two patients with nonunion of bone graft, and no fracture of nail rod was found. The MSTS 93 functional score of nine patients ranged from 20% to 50%, with an average of 34%.ConclusionThe tumors around the sacroiliac joint often invade the contralateral bone by ligament, and the en bloc resection and pelvic ring reconstruction for primary malignant bone tumors involving sacroiliac joint was feasible.

Update on Reversal and Decline of Growth of Utilization of Interventional Techniques In Managing Chronic Pain in the Medicare Population from 2000 to 2018

Background: The cost of US health care continues to increase, with treatments related to low back and neck pain and other musculoskeletal disorders accounting for the third highest amount of various disease categories. Interventional techniques for managing pain apart from conservative modalities and surgical interventions, have generally been thought to be growing rapidly. However, a recent analysis of utilization of interventional techniques from 2000 to 2016 has shown a modest decline from 2009 to 2016, compared to 2000 to 2009. Objectives: The objectives of this analysis include providing an update on utilization of interventional techniques in managing chronic pain in the Medicare population from 2009 to 2018 in the fee-for-service (FFS) Medicare population of the United States. Study Design: Utilization patterns and variables of interventional techniques in managing chronic pain were assessed from 2000 to 2009 and from 2009 to 2018 in the FFS Medicare population of the United States. Methods: The data for the analysis was obtained from the master database from the Centers for Medicare & Medicaid Services (CMS) physician/supplier procedure summary from 2000 to 2018. Results: The analysis of data showed that there was a decline in utilization of interventional techniques from 2009 to 2018 of 6.7%, with an annual decline of 0.8% per 100,000 FFS Medicare population, despite an increase of 0.7% per year of population growth (3.2% of those 65 years or older) and a 3% annual increase in Medicare participation from 2009 to 2018. Medicare data from 2000 to 2009 showed an increase of 11.8% per year per 100,000 individuals of the Medicare population. The 2009 to 2018 data also showed a 2.6% annual decrease in the rate of utilization of epidural and adhesiolysis procedures per 100,000 population of FFS Medicare, and a 1% decrease for disc procedures and other types of nerve blocks, while there was an increase of 0.9% annually for facet joint interventions and sacroiliac joint blocks. Limitations: Limitations of this analysis include: only the Medicare population was utilized, and among the Medicare population, only the FFS population was evaluated; utilization patterns in Medicare Advantage Plans, which constitutes almost 30% of the population were not considered. Further, the utilization data for individual states was sparse and may not be accurate. Conclusion: The decline in utilization of interventional techniques continued from 2009 to 2018 with 6.7% per 100,000 Medicare population, with an annual decline of 0.8%, despite an increase in the population rate and Medicare enrollees of 0.7% and 3% annually. Key words: Interventional pain management, chronic spinal pain, interventional techniques, epidural injections, adhesiolysis, facet joint interventions, sacroiliac joint injections, disc procedures, other types of nerve blocks

Middle cluneal nerve entrapment mimics sacroiliac joint pain.

Sacroiliac joint (SIJ)-related pain is associated with low back- and buttock pain and the SIJ score is diagnostically useful because it helps to differentiate between SIJ-related pain and pain due to other factors such as lumbar disc herniation and lumbar spinal canal stenosis. Middle cluneal nerve (MCN) entrapment (MCN-E) can produce pain involving the lower back and buttocks. Therefore, the origin of the pain must be identified. We successfully treated patients with a high SIJ score whose pain was attributable to MCN-E. Between August 2016 and June 2017, we treated 40 patients with non-specific low back pain. Among them, 18 (45%) presented with a positive SIJ score. Although SIJ treatment was unsuccessful in 4 of these patients, they responded to MCN-E treatment. All 4 patients reported tenderness at the site of the sacrotuberous ligament (STL); 3 were positive for the one-finger test and experienced pain while sitting in a chair. The effect of SIJ block was inadequate in the 4 patients. As they reported severe pain at the trigger point in the area of the MCN, we performed MCN blockage. It resulted in pain control. However, in 1 patient, the effect of MCN block was transient and required MCN neurolysis. At the last visit, our patients' symptoms were significantly improved; their average numerical rating scale score fell from 8.3 to 1.0, their Roland-Morris Disability Questionnaire score fell from 12.8 to 0.3, and their average Japanese Orthopaedic Association score rose from 12.5 to 19.5. In patients with suspected SIJ-related pain, the presence of MCN-E must be considered when the effect of SIJ block is unsatisfactory.

Ultrasound-guided sacroiliac joint block

Ultrasound-guided sacroiliac joint block

Persistent Iliosacral Joint Syndrome following Instrumentation to the Sacropelvis in Patients with Adult Spinal Deformity.

Persistent sacroiliac joint syndrome (PSIJS) may complicate adult spinal deformity surgery (ASDS). This study assesses the relationship between clinical/morphometric parameters and PSIJS following ASDS including pelvic fixation and the therapeutic efficacy of secondary iliosacral fusion (ISF). Perioperative health-related quality of life (HRQOL) outcomes (Oswestry Disability Index, Short Form 12-item health survey, version 2 scores) at 6, 12, and 24 months, and radiographic studies were analyzed retrospectively in a cohort of 71 consecutive patients undergoing ASDS. PSIJS was confirmed in nine individuals (12.7%) by placebo-controlled dual sacroiliac joint (SIJ) blocks. The relationships between global and regional spinopelvic morphometry, PSIJS, and HRQOL outcomes were assessed by logistic regression and receiver operating characteristic curve (ROC) analysis. PSIJS, independently causing significantly reduced improvement in HRQOL scores (p < 0.001) 6 months postoperatively, warranted secondary ISF in nine patients (12.7%) within 12 months of index surgery, without evidence of progressive SIJ arthrosis, pseudarthrosis, or hardware issues. Eight of nine patients undergoing secondary ISF reported≥ 70% pain reduction at 24 months. Logistic regression/ROC analysis revealed a close association between PSIJS and nonharmonious postoperative L4-S1 fractional lordosis (p < 0.0001), pelvic incidence angle > 53 degrees, hip arthrosis, and preexistent advanced SIJ arthrosis (p < 0.01). PSIJS may negatively impact the clinical outcome of ASDS. Recurrent preoperative SIJ syndrome requiring interventional treatment, preexisting hip and SIJ arthrosis, insufficient restoration of L4-S1 fractional lordosis, and high pelvic incidence predispose to PSIJS. PSIJS may potentially be avoided by restoring physiologic lumbosacral geometry and S2 sacral alar-iliac screw fixation during index surgery. Secondary ISF appears to be effective in reducing pain and physical impairment due to PSIJS.

P89 - Does Level of Response to SI Joint Block Predict Response to SI Joint Fusion?

IntroductionThe threshold percent pain relief required to diagnose sacroiliac joint (SIJ) dysfunction during a diagnostic SIJ block (SIJB) is not known. Although there is no gold standard, one refe...

Does Level of Response to SI Joint Block Predict Response to SI Joint Fusion?

Introduction The threshold percent pain relief required to diagnose sacroiliac joint (SIJ) dysfunction during a diagnostic SIJ block (SIJB) is not known. Although there is no gold standard, one reference standard is response to definitive treatment. Methods Subgroup analysis of 320 subjects in two prospective trials of SIJ fusion: INSITE (NCT01681004) a randomized trial versus nonsurgical management (NSM) and SIFI (NCT01640353), a singlearm study. All participants were diagnosed with SIJ dysfunction via history (buttocks/leg pain and a positive Fortin finger test), at least 3 positive provocative physical examination signs, and a standardized diagnostic SIJB using fluoroscopically guided injection of local anesthetics in the target joint with a reduction of at least 50% in pain at 30 or 60 minutes after SIJB. The degree of improvement in VAS SIJ pain and Oswestry Disability Index (ODI) scores, expressed as absolute or percentage improvement from baseline, was correlated with the average acute improvement in SIJ pain during the SIJB, calculated as per Cohen et al. Results The average pain reduction during the first hour after SIJB was 79.3%. Pain reduction during block was unrelated to standard demographic predictors. Six months after SIJ fusion, the mean VAS SIJ pain reduction was 50.9 (28.6) points and the mean ODI reduction was 24.6 (20.5) points. SIJ pain and ODI reductions at 12 months in the SIJ fusion group were 50.8 (29.2) and 25.8 (20.5) points, respectively. There was little correlation in 6 or 12month improvements in SIJ pain or ODI with average reduction in pain during SIJB. In the SIJF group, the proportion of subjects achieving meaningful reductions in SIJ pain and ODI scores did not vary by average response during SIJB ( p = 0.8407 and 0.3069, respectively for 6 month changes, and p = 0.6368 and 0.5913). Similarly, response during SIJB did not predict the proportion of patients with followup pain scores &lt; 30 or ODI &lt; 20. Conclusions. In this study of &gt; 300 patients with carefully diagnosed with SIJ dysfunction, the degree of improvement in acute pain during an SIJB did not predict 6month improvements in VAS SIJ pain or ODI score. Based on our study, a 50% acute pain reduction threshold during SIJB was resulted in excellent postsurgical results. The use of overly stringent selection criteria for determining which patients should undergo SIJF may serve to withhold a beneficial procedure from a substantial number of patients with SIJ dysfunction.

Fluoroscopy-Guided Sacroiliac Joint Injection: Description of a Modified Technique

Sacroiliac joint (SIJ) pathology is a common etiologic cause for 10 - 27% of cases of mechanical low back pain (LBP) below the L5 level. In the absence of definite clinical or radiologic diagnostic criteria, controlled blocks of the SIJ have become the choice assessment method for making the diagnosis of SIJ pain. The SI joint is most often characterized as a large, auricular-shaped, diarthrodial synovial joint. In reality, its synovial characteristic is limited only to the distal third and anterior third. In SIJ interventions, the lateral view has been underutilized. In our technique, we used the lateral view to create a three-dimensional view of the SIJ to aid in gauging the accurateness of the contrast spread and to obtain a precise block. After obtaining appropriate fluoroscopic images, a curved tip spinal needle was directed into the inferior aspect of the SIJ using a posterior approach. As the needle contacts firm tissues on the posterior aspect of the joint, position of the needle tip is checked using lateral fluoroscopy. In the lateral view, the needle tip position is manipulated to keep it in the anterior third of the SIJ and contrast is injected. Our criteria for accurate SIJ block, in posteroanterior (PA) view, is the injection of the contrast medium should outline the joint space and the contrast medium should be seen to travel cephalad along the joint line. In the lateral view, the contrast medium most densely outlines the parameter of the joint. We have utilized this method with good effect in approximately 30 cases over one year. Out of 30 cases, needle position and contrast spread was satisfactory in 28 and 27 cases, respectively. So satisfactory needle placement and contrast spread was in 93% and 87% cases. Pain relief of 80% or more after intra-articular injection of local anesthetic was seen in 50% (15 of 30) patients; pain relief of 50 - 79% was witnessed in 30% (9 of 30) patients. Thus, pain decreased 50% or more in 80% (24 of 30) of the joints. Out of 24 joints where we got satisfactory needle position and contrast spread, 23 joints got more than 50% relief. Thus, if needle position and contrast spread is satisfactory as per the criteria, pain relief of 50% or more was in 96% (23 of 24) of joints. There are few possible limitations with this study like difficulty to go up to the anterior third of the SIJ, it may be more painful as a narrow joint line has to be travelled in depth, sciatic numbness due to drug leak, or injuring the pelvic structure. Advantages of this method are that depth and level of the needle tip for a SIJ block is described for the more precise block. This will reduce false positive and false negative results, i.e., sensitivity and specificity of SIJ blocks and results for diagnostic blocks become more reliable. It will also reduce the chances of a case getting abandoned due to inappropriate contrast spread obscuring the fluoroscopic landmarks. As we know the depth of the needle, the chances of injuring pelvic structures become less and safety improves.

Sacroiliac joint pain: Prospective, randomised, experimental and comparative study of thermal radiofrequency with sacroiliac joint block

ObjectiveTo compare the analgesic effects between the blockade and bipolar thermal radiofrequency in the treatment of sacroiliac joint pain. MethodProspective, randomised and experimental study conducted on 60 patients selected in the two hospitals over a period of nine months, who had intense sacroiliac joint pain (Visual Analogue Scale [VAS]>6) that lasted more than 3months. Patients were randomised into three groups (n=20): Group A (two intra-articular sacroiliac injections of local anaesthetic/corticosteroid guided by ultrasound in 7days). Group B: conventional bipolar radiofrequency “palisade”. Target points were the lateral branch nerves of S1, S2, and S3, distance needles 1cm. Group C: modified bipolar radiofrequency “palisade” (needle distance >1cm). Patients were evaluated at one month, three months, and one year. Demographic data, VAS reduction, and side effects of the techniques were assessed. ResultsOne month after the treatment, pain reduction was >50% in the three groups p<.001. Three and 12months after the technique, the patients of the Group A did not have a significant reduction in pain. At 3 months, almost 50% patients of the Group B referred to improvement of the pain (p=.03), and <25% at 12months, and those results were statistically significant (p=.01) compared to the baseline. Group C showed an improvement of 50% at 3 and 12months (p<.001). All patients completed the study. ConclusionsBipolar radiofrequency “palisade”, especially when the distance between the needles was increased, was more effective and lasted longer, compared to join block and steroids, in relieving pain sacroiliac joint.

Diagnostic Sacroiliac Joint Injections: Is a Control Block Necessary?

Background: Sacroiliac joint (SIJ) pain presents as a deep and somatic pain, predominantly affecting the lower back and buttock and referring down the leg, sometimes as far as the foot. Given that the features of SIJ pain are non-specific and that this referred pain is similar to lumbar facet joint and lumbar disc pain, diagnostic local anesthetic injections (diagnostic blocks) into the SIJ are used to identify the source of pain. Despite wide use, little is known about the false positive rate of a single diagnostic sacroiliac (SI) block and the requirement for a control block. Objective: To determine whether a control SI block is necessary and to monitor the false positive rate for a single injection. Study Design: A prospective and observational study was conducted as part of a practice audit, with data collected over 3.5 years at the authors’ private practice. Patients & Methods: Under fluoroscopic guidance, 1408 consecutive patients presenting with prominent deep somatic pain over the SIJ region were sterilely injected with anesthetic into the SIJ and/or the deep interosseous ligament (DIL). Pain was measured on the 11-point Numerical Rating Scale (NRS) prior to injection and incrementally over the following 1- 2 weeks. Fully completed and unequivocal data sets were available for 1060 patients. Decreases in pain scores (of >80%) at >2 hours of post-injection were indicative of SIJ pain and recorded as a positive SIJ block. Results: Of 1060 patients receiving a first SIJ diagnostic block, 680 (64.1%) recorded a positive result. Subsequently, 271 positive patients and 22 who were negative for SIJ pain opted to receive a second control block. SIJ pain diagnosis was confirmed in 237/271 (87.5%) of those with an initial positive response, while 18/22 patients (81%) had their initial negative result confirmed. The false positive rate of a single block is therefore calculated at 12.5%, and on a contingency table analysis, a single anesthetic SIJ injection has diagnostic accuracy of 87.03%, with high sensitivity (98.3%), when compared with a second control diagnostic block. Limitations: All injections were performed at one clinical centre. A proportion (348/1408) of initial patients did not return fully completed pain records or had equivocal responses (≥80% pain relief, but transiently, for ≤30 min) and were excluded from further analysis. Conclusion: Given the observed high rates of accuracy in this study, it is reasonable to suggest the use of one diagnostic block as the criterion standard for assessing the SIJ as the source of a patient’s pain.

Evaluation of Diagnostic Accuracy of Sacroiliac Joint Block under Sonographic Guidance in Low Back and Pelvic Pain

Evaluation of Diagnostic Accuracy of Sacroiliac Joint Block under Sonographic Guidance in Low Back and Pelvic Pain

The Effect of Sedation on the Accuracy and Treatment Outcomes for Diagnostic Injections: A Randomized, Controlled, Crossover Study

Diagnostic injections are used to diagnose myriad pain conditions, but are characterized by a high false-positive rate. One potential cause of inaccurate diagnostic blocks is the use of sedation. We sought to determine the effect of sedation on the validity of diagnostic injections. Randomized, crossover study in which 73 patients were allocated to receive a diagnostic sacroiliac joint or sympathetic nerve block performed either with or without sedation using midazolam and fentanyl. Those who obtained equivocal relief, good relief lasting less than 3 months, or who were otherwise deemed good candidates for a repeat injection, received a subsequent crossover injection within 3 months (N = 46). A tertiary care teaching hospital and a military treatment facility. In the primary crossover analysis, blocks performed with sedation resulted in a larger mean reduction in pain diary score than those done without sedation (1.2 [2.6]; P = 0.006), less procedure-related pain (difference in means 2.3 [2.5]; P < 0.0001), and a higher proportion of patients who obtained > 50% pain relief on their pain diaries (70% vs. 54%; P = 0.039). The increased pain reduction was not accompanied by increased satisfaction (sedation mean 3.9 [1.1] vs. 3.7 [1.3]; P = 0.26). Similar findings were observed for the parallel group (N = 73) and omnibus (all sedation vs. no sedation blocks, N = 110) analyses. No differences in outcomes were noted between the use and non-use of sedation at 1-month. The use of sedation during diagnostic injections may increase the rate of false-positive blocks and lead to misdiagnoses and unnecessary procedures, but has no effect on satisfaction or outcomes at 1-month.