Sacroiliac Joint Injection: Comparison of Xray Versus Ultrasound

Not Applicable

Completed

Brief Summary: This project involves the assessment of the efficacy of two different image guided techniques in patients with low back pain due to arthritis of the sacroiliac joint (SIJ). Intra-articular injection of local anesthetics and steroids is performed to relieve pain originating from the SIJ. Fluoroscopy has been used traditionally for image guidance for this procedure but there is a growing interest in use of ultrasound (US) for this procedure. US avoids radiation exposure to the patient and the health care team (HCT) and is less expensive. We aim to compare procedural efficacy related outcomes for SIJ injections performed using these image-guided modalities.

Detailed Description: The study is a prospective, randomized trial. Patients with low back pain which is diagnosed secondary to SIJ disease will be identified beforehand in clinic and offered a therapeutic joint injection. Informed consent will be obtained. Patients will be randomized for SIJ block with 3 mL of 0.25% bupivacaine with 1:200,000 epinephrine and 40 mg depomedrol using guidance with ultrasound or fluoroscopy. In both groups, confirmation of needle placement will be obtained using contrast injection imaging before the injection is performed. Record will be made of the number of times the needle is correctly placed into the articular space, as well as the number of attempts to do so. The final position of the needle will be recorded. Pain scores will be assessed before the procedure, as well as post-procedure at 24 and 72 hours, as well as 1 week, 1 month, and 3 months. Patients will keep a pain diary and will be followed up at 3 months time in clinic.

Recruitment & Eligibility

Inclusion Criteria

Suspicion of SIJ disease on history: pain below the lumbo-sacral junction; pain with full weight-bearing on one leg; pain worse going down hills or inclines; very low back pain associated with groin pain and absence of lumbar symptoms
Two positive responses to the following maneuver: FABER (flexion abduction and external rotation of hip), POSH (posterior shear test), REAB (resisted abduction)
Baseline NRS pain score > or = to 4
Refractory to oral analgesic therapy

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Ultrasound Guided SIJ Injection	Sacroiliac Joint Injection	Needle placement will be performed under US guidance. Fluoroscopy will be used to confirm needle placement prior to medication injection.
Xray Guided SIJ Injection	Sacroiliac Joint Injection	Needle placement will be performed under fluoroscopy.

Primary Outcome Measures

Name	Time	Method
Incidence of needle placement into SIJ	Assessed at time of injection
Pain - Numeric Rating Scale Score at 1 month	One month from time of injection

Secondary Outcome Measures

Name	Time	Method
Patient Satisfaction	1 month from time of injection
Number of needle readjustments	Measured at time of procedure
Average daily consumption of opioids at 1 month	1 month from injection
Patient discomfort with procedure	Measured at time of procedure
Improvement of functional ability at 1 month	1 month from time of injection	Oswestry Disability Index completed at 1 month to determine level of disability

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