Sacroiliac Joint Injections

Sacroiliac Joint Injection Overview

Sacroiliac Joint (SIJ) Disease is one of the major causes of low back pain. The sacroiliac joint is located at the junction between the spine and the pelvis. The sacroiliac joint is a weight baring joint as the weight form the upper body transmitted down the spine, through the sacroiliac joint and into the pelvis, hips, and lower extremities. The sacroiliac joint is supported by many muscle groups and ligaments that are richly innervated by free nerve endings and spinal nerve roots. When there is inflammation to the sacroiliac joint the patient may experience intense low back pain. Patients typically complain that the pain associated with sacroiliac joint worsens when sitting form long periods of time or performing twisting motions.

What is a Sacroiliac Joint Injection?

An SIJ injection is a minimally invasive procedure that can temporarily relieve back pain caused by an inflamed or irritated SIJ. Using precision guidance a small amount of steroid and local anesthesia is placed directly into the SIJ. AN SIJ injection has two potential purposes. First, it can be used as a diagnostic test to see if the pain is actually coming from you SIJ. Second, it can be used as a treatment to relieve inflammation and pain. Pain relief may last for several days to years, but 2-3 months is average. The goal is to reduce pain so that you may resume normal activities and a physical therapy program.

Prior to the procedure

Patients who take blood thinner medication (Coumadin, Heparin, Plavix, Ticlid, Fragmin, Orgaran, Lovenox, high-dose aspirin) may need to stop taking their medications prior to the ESI. You must obtain approval from your prescribing physician prior to stopping any medication.

If you think you may be pregnant or are trying to get pregnant, please tell the doctor. Fluoroscopy X-rays are used during the procedure may be harmful to the fetus.

Sedation is rarely necessary or used, but If it is used you must take nothing by mouth for 4 hours prior to the procedure.

Day of the procedure:

  • Plan to arrive 30 minutes before your scheduled appointment time.
  • We recommend that you have something light to eat before the appointment.
  • Make arrangements to have someone drive you to and from the office the day of the procedure.
  • The procedure generally takes 15-30 minutes followed by a recovery period.

Step 1: Prepare the patient

The patient lays face down on the table, the skin is cleaned and the skin is numbed with a local anesthetic.

Step 2: Insert the needle

With the aid of a fluoroscope (a special X-ray), the doctor directs a needle through the skin to the area of the facet joints. Fluoroscopy allows the doctor to inject contrast and ensure correct placement of the needle.

Step 3: Inject the medication

When the needle is in place, the medications are delivered on to each facet joint. The needle is then removed.

Step 4: Recovery

Most patients can walk around immediately after the procedure. After being monitored for a short time, you usually can leave the office or suite. Someone must drive you home.

After the procedure

Typically patients resume full activity the next day although we do recommend ‘taking it easy’ for 2-3 days after the procedure. Soreness around the injection site may be relieved by using ice and taking a mild analgesic (Tylenol). The patient may resume taking all medications immediately after the procedure.

Generally, SIJ injections begin to work within 3 or 4 days although it may take as long as 7 days for the steroid to start working.

What are the results?

Most patients experience some pain relief from facet injection, on average lasting form 2-3 months. More importantly, the timing of injections should coincide with the start of physical therapy and/or home exercise program to strengthen the back muscles and prevent future pain episodes.

What are the risks?

As with any procedure, there are both potential risks and benefits. SIJ injections are generally safe and serious complications are rare especially when using proper safety techniques such as fluoroscopy. The potential risks associated with inserting the needle include spinal headache from a dural puncture, bleeding, infection, allergic reaction, elevated blood pressure, nerve damage/paralysis (rare) and death. Corticosteroid side effects may cause weight gain, water retention, flushing (hot flashes), mood swings, insomnia, and elevated blood sugar levels in people with diabetes. Any numbness or mild muscle weakness usually resolves within 3-8 hours in the affected arm or leg (similar to the facial numbness experienced after dental work).

SIJ injections should NOT be performed on people who have an infection, are pregnant, or have bleeding problems.

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