Assessing the Accuracy of Ultrasound-Guided Needle Placement in Sacroiliac Joint Injections

EMERGENCY DEPARTMENT INTRAARTICULAR CORTICOSTEROID INJECTION FOR SACROILIAC JOINT DYSFUNCTION

BACKGROUND

Sacroiliac joint (SIJ) dysfunction is a common but underrecognized source of low back pain (LBP). With provocative testing, emergency physicians can diagnose SIJ dysfunction and begin appropriate treatment in the emergency department (ED).

DISCUSSION

For patients with significant pain from SIJ dysfunction, ultrasound-guided SIJ injection of anesthetic and corticosteroid can reduce patients' pain considerably.

CONCLUSIONS

For patients who are good candidates for SIJ injection, emergency physicians can begin treatment in the ED, before the patient follows up with a specialist.

Incidence of sacroiliac joint pain after lumbosacral spine fusion: A systematic review

OBJECTIVES

To determine the incidence of sacroiliac joint (SIJ) pain after lumbosacral spinal fusion.

BACKGROUND

Persistent low back pain is a potential source of disability and poor outcomes following lumbar spine fusion. The SIJ has been described as a potential source. However, there is a paucity of data concerning its importance.

METHODS

This is a PROSPERO registered systematic review. A systematic search of the English literature was performed in Medline, Embase and Cochrane Library databases. MeSH terms such as Lumbar vertebrae, Sacrum, Spinal Fusion, Pain, Sacrum, Ligaments, Sacroiliac Joint were utilized for the search. Key words such as "sacroiliac dysfunction.mp." and "sacroiliac complex.mp." were utilized for the search. Two independent reviewers reviewed articles to determine eligibility for final review and analysis. The Newcastle-Ottawa Scale was used to appraise the quality of all nonrandomized observational studies. Inverse variance weighting with random effects was used to pool data. The GRADE approach, PRISMA workflow and checklists was performed.

RESULTS

Twelve studies were included. All studies were observational and of moderate to low quality. The pooled incidence of sacroiliac joint pain was 15.8%. The pooled incidence of SIJ pain for patients without fusion extending to the sacrum was 15.8%. The pooled incidence of SIJ pain for patients with fusion extending to the sacrum was 32.9%. There was high heterogeneity.

CONCLUSION

SIJ pain is a potential cause of persistent pain after lumbar spine surgery. The current literature of poor quality. Patients presenting with pain after lumbosacral spine fusion should be evaluated for SIJ related pain.

First Spanish study on the effectiveness of ultrasound-guided sacroiliac joint injection in patients with spondylarthritis

Objective

To assess clinical improvement after ultrasound-guided injection of corticosteroids into the sacroiliac joint of patients with spondyloarthritis.

Methods

Observational, descriptive, retrospective study of patients with spondyloarthritis and sacroiliitis who received an ultrasound-guided injection into the sacroiliac joint between June 1, 2020 and May 31, 2021. Means were compared using the t test for the variables VAS, BASDAI, ASDAS, CRP, and ESR before and after the procedure. We evaluated the association between these variables and the clinical response using the odds ratio.

Results

We analyzed 32 patients with spondyloarthritis (age 42.69 ± 8.19 years; female sex, 56.25%) with a VAS score of 7.88 ± 0.79, BASDAI of 5.43 ± 1.48, and ASDAS of 3.27 ± 0.86 before the procedure. At 2–3 months, 75% of patients had improved: VAS 3.81 ± 2.33 (–4.07, p < 0.0001) and BASDAI 3.24 ± 1.6 (–2.19, p < 0.0001). At 5–6 months, 59.37% had improved: VAS 4.63 ± 2.31 (–3.25, p < 0.0001), BASDAI 3.57 ± 1.67 (–1.86, p < 0.0001), and ASDAS 2.27 ± 0.71 (–1.0, p < 0.0001). Bone marrow oedema resolved in 87.5% of cases compared with the previous magnetic resonance scan. No significant association was identified with the clinical response to the injection.

Conclusions

Ultrasound-guided injection of corticosteroids into the sacroiliac joint of patients with spondyloarthritis and active sacroiliitis leads to an improvement in symptoms that is maintained at 5–6 months. The procedure is effective, safe, inexpensive, and easy to apply.

New Simple Ultrasound-Guided Transforaminal Injection in Patients With Radiculopathy in the Lower Cervical Spine: A Computed Tomography-Controlled Study

OBJECTIVES

To evaluate the feasibility of a new simple ultrasound-guided transforaminal injection in patients with cervical radiculopathy.

METHODS

Ultrasound scans of the neck in a plastic model and in 5 unaffected participants were first performed to identify the intervertebral foramen. Then ultrasound-guided transforaminal injections were performed in 20 patients with radiculopathy in the lower cervical spine, and computed tomography was used to verify the accuracy. Complications, the visual analog score, and the neck disability index were assessed at 1 and 3 months after the injection.

RESULTS

Computed tomography confirmed that the needle tip was correctly placed in the intervertebral foramen in 88.5% (23 of 26) of injections. No immediate or short-term complications were observed in all patients. The visual analog score and neck disability index at 1 and 3 months were significantly lower than those before the injection (both P < .0001).

CONCLUSIONS

Ultrasound may be a feasible and accurate method to guide cervical transforaminal injection.

Does the presence of cranial contrast spread during a sacroiliac joint injection predict short-term outcome?

BACKGROUND

The innervation of the sacroiliac joint (SIJ) is complex, with a dual innervation originating from the lumbosacral plexus anteriorly as well as the sacral lateral branches posteriorly. Nociceptors are found in intra-articular structures as well as periarticular structures. In patients with SIJ pain, a fluoroscopy-guided SIJ injection is usually performed posteriorly into the bottom one-third of the joint with local anesthetic and corticosteroids, but this does not always reach all intra-articular structures. The correlation between a cranial contrast spread and clinical success is undetermined in patients with SIJ pain.

METHODS

In a tertiary referral pain center, electronic medical records of patients who underwent an SIJ injection were retrospectively analyzed. Only patients with at least three positive provocation maneuvers for SIJ pain were selected. Contrast images of the SIJ were classified as with or without cranial spread on fluoroscopy as a marker of intra-articular injection. Clinical success was defined as ≥50% improvement in the patient's global perceived effect after 3-4 weeks. The primary outcome was defined as the correlation between cranial contrast spread and clinical success after an SIJ injection.

RESULTS

128 patients in total were included. In 68 patients (53.1%) fluoroscopy showed cranial contrast spread. Clinical success was higher in patients with cranial spread of contrast (55 of 68, 81%) versus those without (35 of 60, 58%) (p=0.0067). In a multivariable analysis with age, gender, presence of rheumatoid arthritis, side, and number of positive provocation maneuvers, the cranial spread of contrast remained the only independent factor of clinical success (p=0.006; OR 3.2, 95% CI 1.4 to 7.7).

CONCLUSION

In patients with SIJ pain, identified by positive pain provocation maneuvers, cranial contrast spread as a marker of intra-articular injection, with subsequent injection of 3 mL of local anesthetic and methylprednisolone 40 mg, was significantly correlated with clinical success up to 4 weeks. Therefore, attempts should be made to reach this final needle position before injecting local anesthetic and corticosteroids. This result needs to be confirmed in a high-quality prospective trial.