Original articleUltrasound-Guided Versus Fluoroscopy-Guided Sacroiliac Joint Intra-articular Injections in the Noninflammatory Sacroiliac Joint Dysfunction: A Prospective, Randomized, Single-Blinded Study
Section snippets
Participants
After obtaining approval and registering for a clinical trial with the institutional review board, 120 patients were enrolled into this prospective, randomized, single-blinded study. Between June 2011 and June 2012, 154 patients who had chronic low back pain (>3mo) without radiculopathy were evaluated for SIJ dysfunction. The patients, referred by medical practitioners, neurosurgeons, or orthopedists for further diagnosis and treatment, received a diagnosis based on the medical history, image
Participant flow
A schematic illustration of patient flow is provided (fig 4). The study period with a 12-week follow-up lasted for a year. Among the 154 patients recruited, 34 patients were excluded and 120 patients were included in this study. Of these 120 patients, 5 patients in the US-guided group were excluded during follow-up because they received peripheral injections (hip) (n=2) or took medications other than acetaminophen (n=3), and 5 patients in the FL-guided group were excluded during follow-up
Discussion
The SIJ block, an IA injection procedure of local anesthetic into the SIJ, is thought to be a diagnostic test to confirm the presence of SIJ-related pain.25 The prevalence of SIJ dysfunction seems to be between 10% and 26.6%.26, 27, 28 The CT-guided procedure is already being used for the SIJ IA injections in routine clinical settings.7, 29, 30 Although the FL- and CT-guided techniques have the advantages of being safe and efficient, the disadvantage of radiation exposure limits their use.17
Conclusions
The US-guided SIJ IA injection approach showed similar improvement in pain relief and function, and similar patient satisfaction scores as the FL-guided approach, without the risk of radiation exposure. Therefore, the US-guided SIJ IA injection method may be a reliable imaging modality for therapeutic SIJ IA injections. Advantages such as convenience and being free of a radiation hazard make US preferable to FL. However, the US-guided approach may still have limitations in comparison to the
Suppliers
- a.
Omnipaque 300; GE Healthcare, Carrigtwohill Co. Cork, Ireland.
- b.
Accuvix XQ; Medison, Samsung Medison Building, 1003 Daechi-dong Gangnam-gu, Seoul, Korea, 135-851.
- c.
Spinocan; B. Braun, Postfach 1120, 34209 Melsungen, Germany, 34212.
- d.
SAS Enterprise Guide 4.1 (4.1.0.471); SAS Institute Inc, 100 SAS Campus Dr, Cary, NC 27513.
References (40)
- et al.
Ultrasound as a screening tool for proceeding with caudal epidural injections
Arch Phys Med Rehabil
(2010) - et al.
The feasibility of color Doppler ultrasonography for caudal epidural steroid injection
Pain
(2005) - et al.
Effect of periarticular and intraarticular lidocaine injections for sacroiliac joint pain: prospective comparative study
J Orthop Sci
(2007) - et al.
Sacroiliac joint pain referral zones
Arch Phys Med Rehabil
(2000) - et al.
The false-positive rate of uncontrolled diagnostic blocks of the lumbar zygapophysial joints
Pain
(1994) The sacroiliac joint: an underappreciated pain generator
Am J Orthop (Belle Mead NJ)
(1995)Sacroiliac sprain: an overlooked cause of back pain
Am Fam Physician
(1992)- et al.
Interventions in chronic low back pain
Aust Fam Physician
(2004) - et al.
Sacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment
Am J Phys Med Rehabil
(2006) - et al.
Computerized tomographic localization of clinically-guided sacroiliac joint injections
Clin J Pain
(2000)
Fluoroscopy-guided sacroiliac joint injections
Radiology
CT-guided intraarticular corticosteroid injection into the sacroiliac joints in patients with spondyloarthropathy: indication and follow-up with contrast-enhanced MRI
J Comput Assist Tomogr
Interventional MR imaging for injection of sacroiliac joints in patients with sacroiliitis
AJR Am J Roentgenol
Accuracy of ultrasound guided injections in the foot and ankle
Foot Ankle Int
Ultrasound-guided cervical selective nerve root block: a fluoroscopy-controlled feasibility study
Reg Anesth Pain Med
Comparison of the caudal and lumbar approaches to the epidural space
Ann Rheum Dis
Accuracy of blind versus fluoroscopically guided caudal epidural injection
Spine (Phila Pa 1976)
Ultrasound-guided sacroiliac joint injection in patients with established sacroiliitis: precise IA injection verified by MRI scanning does not predict clinical outcome
Rheumatology (Oxford)
Feasibility of ultrasound-guided sacroiliac joint injection considering sonoanatomic landmarks at two different levels in cadavers and patients
Arthritis Rheum
Sacroiliac joint injections performed with sonographic guidance
J Ultrasound Med
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Supported by a 2013 research grant from Inje University, Gimhae, Korea.
No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.