Efficacy of Lateral View Needle Placement for Sacroiliac Joint Injections

Abstract

Introduction

Sacroiliac joint (SIJ) pathology is typically diagnosed and treated with fluoroscopy-guided intraarticular injections. Most practitioners use only an anteroposterior (AP) or oblique view. Although injection into the periarticular space may yield adequate pain relief, intraarticular needle placement is imperative to identify SIJ pathology and plan future management. This study highlights the importance of obtaining an additional lateral view during fluoroscopy to better evaluate SIJ disease.

Methods

A retrospective review of 38 patients who underwent fluoroscopy guided SIJ injection was conducted, for which IRB approval was granted by the MetroWest Medical Center Institutional Review Board. Patient demographics (age, sex, BMI) and pre- and post-operative numerical rating scale (NRS) scores were collected, and initial needle location was reviewed. Patients were placed into groups according to initial needle location. Statistical analysis was conducted using a Mann–Whitney U-test with significance defined as p < 0.05.

Results

The 21 females and 17 males had a mean age and BMI of 70.5 years and 27.8 kg/m², respectively. Thirty-one patients had initial intraarticular needle placement confirmed with lateral arthrogram, and 7 patients had initial periarticular needle placement, requiring needle readjustment in lateral confirmatory view. Both groups had similar demographic characteristics. No statistically significant differences were found between the two groups’ mean NRS score improvement (p=0.108).

Conclusion

Using only the AP or oblique view during needle placement results in miss rates of nearly 20% while adding a lateral view can lower miss rates to near 0%. While pain relief may be adequate in either case, proper diagnosis and future management relies upon accurate needle placement.

Keywords:

• corticosteroid injections
• fluoroscopy
• intraarticular
• periarticular

Ethics

IRB approval was granted by the MetroWest Medical Center Institutional Review Board, the overseeing IRB for the Cantor Spine Center at The Paley Orthopedic & Spine Institute investigative site. Informed consent was obtained from the study participants and guidelines outline in the Declaration of Helsinki were followed.

Acknowledgments

The authors would like to thank Donna Cabral for her assistance in preparation of the manuscript.

Disclosure

Dr. Pilitsis is a consultant for Boston Scientific, Nevro, Medtronic, Saluda, and Abbott and receives grant support from Medtronic, Boston Scientific, Abbott, Nevro, Saluda, NIH 2R01CA166379-06 and NIH U44NS115111. She is the medical advisor for Aim Medical Robotics and has stock equity. None of the other authors have any conflicts of interest to declare for this work.

Additional information

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.