Original article
Ultrasound-Guided Versus Fluoroscopy-Guided Sacroiliac Joint Intra-articular Injections in the Noninflammatory Sacroiliac Joint Dysfunction: A Prospective, Randomized, Single-Blinded Study

https://doi.org/10.1016/j.apmr.2013.09.021Get rights and content

Abstract

Objective

To compare the short-term effects and safety of ultrasound (US)-guided sacroiliac joint (SIJ) injections with fluoroscopy (FL)-guided SIJ injections in patients with noninflammatory SIJ dysfunction.

Design

Prospective, randomized controlled trial.

Setting

University hospital.

Participants

Patients (N=120) with noninflammatory sacroiliac arthritis were enrolled.

Intervention

All procedures were performed using an FL or US apparatus. Subjects were randomly assigned to either the FL or US group. Immediately after the SIJ injections, fluoroscopy was applied to verify the correct placement of the injected medication and intravascular injections.

Main Outcome Measures

Treatment effects and functional improvement were compared at 2 and 12 weeks after the procedures.

Results

The verbal numeric pain scale and Oswestry Disability Index improved at 2 and 12 weeks after the injections without statistical significances between groups. Of 55 US-guided injections, 48 (87.3%) were successful and 7 (12.7%) were missed. The FL-guided SIJ approach exhibited a greater accuracy (98.2%) than the US-guided approach. Vascularization around the SIJ was seen in 34 of 55 patients. Among the 34 patients, 7 had vascularization inside the joint, 23 had vascularization around the joint, and 4 had vascularization both inside and around the joint. Three cases of intravascular injections occurred in the FL group.

Conclusions

The US-guided approach may facilitate the identification and avoidance of the critical vessels around or within the SIJ. Function and pain relief significantly improved in both groups without significant differences between groups. The US-guided approach was shown to be as effective as the FL-guided approach in treatment effects. However, diagnostic application in the SIJ may be limited because of the significantly lower accuracy rate (87.3%).

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.

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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.

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