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Tantawy MF, Nazim WM. Comparison between intra-articular and combined intra- and periarticular sacroiliac injection: a prospective randomized controlled clinical trial. J Neurosurg Sci 2024; 68:294-300. [PMID: 35766202 DOI: 10.23736/s0390-5616.22.05581-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND Sacroiliac joint dysfunction is one of the most common causes of low back pain. The aim of our study was to determine whether combined injection (intra and periarticular) of sacroiliac joint provides greater pain relief than intra-articular injection. METHODS This is a randomized controlled trial between two groups. The first group involved thirty patients treated with combined injection (intra- and periarticular) of a mixture of methylprednisolone acetate 40 mg and local anesthetic into a symptomatic sacroiliac joint. The second group (30 patients) received the same mixture only intra-articular. Diagnostic block was done for all cases. All patients failed to respond to medical treatment before proceeding to the injection procedure. RESULTS Over 6 months of follow-up, there were statistically significant improvements in patients who received combined sacroiliac joint injection according to pain Visual Analog Scale (VAS) compared with intra-articular group. Comparing both groups, there was significant difference in the 1-month VAS (one month after the procedure) as the P value was 0.010, and in the 6-month VAS (6 months after the procedure) as the P value was 0.007. There was no significant difference in the pre-VAS (P value was 0.795) and immediate post-VAS (one week after the procedure) as the P value were 0.145. No complications were reported after the procedure. CONCLUSIONS Although both groups provide statistically significant pain relief, patients who received combined sacroiliac joint injection have significantly greater clinical improvement as regard to those who received only intra-articular injection.
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Affiliation(s)
- Mostafa F Tantawy
- Department of Neurosurgery, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt -
| | - Wael M Nazim
- Department of Neurosurgery, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
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AboElfadl GM, Ali WN, Askar FJE, Osman AM, Daghash NH, AbdelRady MM. Intra-articular pulsed radiofrequency with methyl prednisolone injection in chronic sacroiliac joint arthritis: A randomized clinical trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2025658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | - Wesam Nashat Ali
- Anesthesia and Intensive Care Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Fatma Jad Elrab Askar
- Anesthesia and Intensive Care Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ayman Mamdouh Osman
- Anesthesia and Intensive Care Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Noha Hassan Daghash
- Anesthesia and Intensive Care Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Marwa Mahmoud AbdelRady
- Anesthesia and Intensive Care Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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Wong O, Zhang G, Matthews H, Skalski M, Asadi H, Lalloo S, Kurda D. Image-guided spinal injection for pain management. J Med Imaging Radiat Oncol 2021; 66:79-91. [PMID: 34369081 DOI: 10.1111/1754-9485.13308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/11/2021] [Accepted: 07/15/2021] [Indexed: 01/12/2023]
Abstract
Radiculopathy and spinal pain are debilitating conditions affecting millions of people worldwide each year. While most cases can be managed conservatively with physiotherapy and nonsteroidal anti-inflammatory medications, minimally invasive corticosteroid injections are the mainstay intervention for those not responsive to conservative treatment. Historically, spinal injections were performed in the absence of imaging guidance; however, imaging modalities, in particular fluoroscopy and computer tomography (CT), have become the standard of care in performing most of these procedures. Under imaging guidance, operators can accurately confirm needle placement and safely target localised pathologies.
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Affiliation(s)
- Osanna Wong
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - George Zhang
- Department of Medical Imaging, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Hayden Matthews
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Mathew Skalski
- Palmer College of Chiropractic - West Campus, San Jose, California, USA
| | - Hamed Asadi
- Department of Radiology, Austin Health, Melbourne, Victoria, Australia.,Department of Radiology, Monash Health, Melbourne, Victoria, Australia.,Deakin University, Geelong, Victoria, Australia
| | - Shivendra Lalloo
- Department of Medical Imaging, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Dylan Kurda
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia.,Department of Medical Imaging, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
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4
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Intra-Articular Sacroiliac Joint Injection: Technical Guide. Clin Spine Surg 2021; 34:14-16. [PMID: 32433098 DOI: 10.1097/bsd.0000000000001010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 02/17/2020] [Indexed: 11/26/2022]
Abstract
Sacroiliac (SI) joint pathology has been an increasingly discussed pathology as a potential etiology for significant low back and lower extremity pain. While patient history and examination maneuvers can assist with identifying the SI joint as a potential cause of pain, an intra-articular SI joint injection is critical to properly diagnose the SI joint as a clinically relevant pain generator. In addition to the diagnostic information from the injection, SI joint intra-articular injections can be performed for therapeutic benefit as part of a multi-modal, conservative treatment approach for SI joint pathology. We discuss our technique for safe and effective SI joint intra-articular injections as a both diagnostic and therapeutic aid for SI joint pathology.
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Oren NC, Ali S, Mok J, Lu ZF, Lee SK. Sacroiliac joint injections with the guidance of three-dimensional cone beam computed tomography (3D-CBCT) and fluoroscopy fusion. J Neurointerv Surg 2020; 13:191-195. [PMID: 32554694 DOI: 10.1136/neurintsurg-2020-016212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND We describe our diagnostic sacroiliac joint (SIJ) injection technique under the guidance of three-dimensional cone beam computed tomography (3D-CBCT) fused with real-time fluoroscopy. METHODS A retrospective review of 17 patients (mean age 55.4 (range 40-74) years) who received a total of 23 diagnostic SIJ injections between March 2016 and November 2017 were performed. Pre- and post-procedure pain scores were reviewed from the medical records and then these findings were correlated with which patients were and were not diagnosed with SIJ pain by clinical management. The final diagnosis of SIJ-related pain was made in cases with at least 50% symptomatic improvement following SIJ-specific pain treatments. RESULTS Some 87% (n=20/23) of injections achieved more than 50% pain relief after the diagnostic SIJ injection. The final diagnosis of the target SIJ-related pain after follow-up and management was found in 90% (n=18/20) of cases. There were two cases with positive tests diagnosed as non-SIJ pain including one with the diagnosis of femuroacetabular impingement and one with pain related to loosening of knee hardware. The sensitivity, specificity, positive predictive value, and negative predicative value of diagnostic SIJ injections were 100%, 60%, 89%, and 100%, respectively, with a 40% false-positive rate. There were no procedure-related complications. CONCLUSION 3D-CBCT fused with real-time fluoroscopy for SIJ injection is accurate and safe.
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Affiliation(s)
- Nisa Cem Oren
- Radiology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Saad Ali
- Radiology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - James Mok
- Spine Surgery, DuPage Medical Group, Downers Grove, Illinois, USA
| | - Zheng Feng Lu
- Radiology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Seon-Kyu Lee
- Radiology, Montefiore Hospital and Medical Center, Bronx, New York, USA
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Oh DCS, First L, Rakesh N, Oh H, Gulati A. Inferior and Intra-/Peri-Articular Superior Sacroiliac Joint Injection Approaches Under Ultrasound Guidance to Treat Metastasis-Related Posterior Pelvic Bone Pain. Pain Pract 2020; 20:769-776. [PMID: 32270598 DOI: 10.1111/papr.12896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Numerous mechanical and pathologic variables contribute to sacroiliac joint (SIJ) pain. The oncologic population has additional considerations, including tumor burden causing fracture, nerve compression, joint instability, and periosteal inflammation. Post-treatment changes may also restrict joint mobility, causing transitional pain. Currently, fluoroscopically guided SIJ injections, aimed at the inferior one third of the SIJ, are the gold standard for treatment but have only been described in the nononcologic population. Ultrasound (US) guidance may confer several benefits, including positioning, ease of procedure, lower costs, and, importantly, guidance to avoid neovascularization, metastatic disease, and other soft tissue structures. OBJECTIVES We aim to describe the advantages of US-guided SIJ injections for refractory malignant SIJ pain from extra-articular tumors. We then describe our technique and decision framework for accessing the superior or inferior SIJ in patients with metastatic sacroiliac pain. METHODS A retrospective review was performed on 5 patients with refractory malignant SIJ pain who underwent US-guided superior or inferior approach SIJ injection. Using imaging and outcomes, we developed a decision framework. RESULTS Patients received either inferior or superior approach SIJ injections depending on location of tumor, extent of tumor invasion, and stability of the SIJ as per our framework. All patients reported improvement in pain and function without complications. CONCLUSIONS We propose a decision framework for inferior vs. superior approach US-guided SIJ injections in the oncologic population with SIJ pain from metastases to the pelvis or sacrum. Having multiple techniques to approach the SIJ is important in the oncologic population, in whom metastatic tumor burden poses a technical challenge to performing these injections.
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Affiliation(s)
- Daniel Chun-Suk Oh
- Department of Rehabilitation and Regenerative Medicine, NewYork-Presbyterian Hospital-University Hospital of Columbia and Cornell, New York, New York, U.S.A
| | - Lucas First
- Department of Rehabilitation and Regenerative Medicine, NewYork-Presbyterian Hospital-University Hospital of Columbia and Cornell, New York, New York, U.S.A
| | - Neal Rakesh
- Department of Rehabilitation and Regenerative Medicine, NewYork-Presbyterian Hospital-University Hospital of Columbia and Cornell, New York, New York, U.S.A
| | - Hanna Oh
- Department of Rehabilitation and Regenerative Medicine, NewYork-Presbyterian Hospital-University Hospital of Columbia and Cornell, New York, New York, U.S.A
| | - Amitabh Gulati
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A
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Zheng P, Schneider BJ, Yang A, McCormick ZL. Image‐Guided Sacroiliac Joint Injections: an Evidence‐based Review of Best Practices and Clinical Outcomes. PM R 2019; 11 Suppl 1:S98-S104. [DOI: 10.1002/pmrj.12191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Patricia Zheng
- Department of Orthopaedic SurgeryUniversity of California San Francisco San Francisco CA
| | - Byron J. Schneider
- Department of Physical Medicine and RehabilitationVanderbilt University Nashville TN
| | - Aaron Yang
- Department of Physical Medicine and RehabilitationVanderbilt University Nashville TN
| | - Zachary L. McCormick
- Department of Physical Medicine and RehabilitationUniversity of Utah Salt Lake City UT
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Pelvic orthosis effects on posterior pelvis kinematics An in-vitro biomechanical study. Sci Rep 2018; 8:15980. [PMID: 30374032 PMCID: PMC6206162 DOI: 10.1038/s41598-018-34387-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/15/2018] [Indexed: 11/16/2022] Open
Abstract
The sacroiliac joint (SIJ) is a well-known source of low back pain, with increasing interest for both conservative and surgical treatment. Alterations in pelvis kinematics are hypothesized as a contributor to SIJ pain and pelvic orthoses one treatment option, but their effects on the pelvis are poorly understood. Alterations in movement patterns induced by the application of pelvic orthoses were determined in five human cadaveric pelvises. Deformations were obtained from the lumbosacral transition and the bilateral SIJ, using digital image correlation and a customized routine to compute the movements within the pelvis. Significant alterations were found for the movements at the SIJ, in particular a vast increase in axial (x-axis) rotation, accompanied by increased inferior (y-) translation of the sacrum relative to the ilium. Movement patterns at the lumbosacral transition changed, causing increases in axial rotation and decreased inferior translation of L5 relative to S1. Using a physiologic mode of load application gives novel insights into the potential effects of pelvic orthoses. The results of these in-vitro experiments vary markedly from previous experiments with loading limited to two or less axes. Furthermore, the influence of pelvic orthoses on the lumbosacral transition warrants further investigation.
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Chang MC, Ahn SH. The effect of intra-articular stimulation by pulsed radiofrequency on chronic sacroiliac joint pain refractory to intra-articular corticosteroid injection: A retrospective study. Medicine (Baltimore) 2017; 96:e7367. [PMID: 28658160 PMCID: PMC5500082 DOI: 10.1097/md.0000000000007367] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We investigated the degree of pain reduction following intra-articular (IA) pulsed radiofrequency (PRF) stimulation of the sacroiliac joint (SIJ) in patients with chronic SIJ pain that had not responded to IA corticosteroid injection. Twenty patients were recruited. Clinical outcomes after applying PRF stimulation of the SIJ were evaluated by a numeric rating scale (NRS) and a 7-point Likert scale. The NRS scores significantly changed over time. The NRS scores at 1, 2, and 3 months after PRF were significantly lower than those before PRF. However, 4 of the 20 patients (20%) reported successful pain relief (pain relief of ≥ 50%) and were satisfied with the PRF stimulation at 3 months after treatment. IA PRF stimulation of the SIJ was not successful in most patients (80% of all patients). Based on our results, we cannot recommend this procedure to patients with chronic SIJ pain that was unresponsive to IA SIJ corticosteroid injection. Further studies on the effective mode of PRF stimulation and appropriate patient group, and studies on pain conditions that are most responsive to PRF are needed in the future.
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Affiliation(s)
- Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University
| | - Sang Ho Ahn
- Dr Ahn's Spine and Pain Clinic, and Dr Ahn's Spine and Pain Institute, Daegu, Republic of Korea
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Mezian K. A New Sacroiliac Joint Injection Technique and Its Short-Term Effect on Chronic Sacroiliac Region Pain. PAIN MEDICINE 2016; 17:2148-2149. [PMID: 27125286 DOI: 10.1093/pm/pnw081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kamal Mezian
- Czech Technical University in Prague, Faculty of Biomedical Engineering, Department of Medicine and Humanities, Kladno, Czech Republic
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