Sacroiliac Joint Injection

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The sacroiliac joint, located in the lower spine above the tailbone, is the largest joint in the spine. Inflammation of the sacroiliac joint can cause low back and buttock pain.  Sacroiliac joint pain can be treated. Using fluoroscopy and local anesthetic, steroid medication is injected into the sacroiliac joint.  If pain is relieved, it could mean the joint is the pain generator.

Patient Preparation: At Home

Below is a short list of common instructions.  Specific information will be provided by the physician.

• Stop blood-thinning medication 2 days prior to the test
• Do not take any aspirin product 5 days prior to the test
• Stop anti-inflammatory medication 5 days prior to the test
• Stop pain medication 8 hours prior to the test
• Do not eat or drink 6 hours prior to the test
• Arrange for someone to drive you home

Patient Preparation: At the Medical Facility

Typically, the patient arrives at the medical facility, completes paperwork, and is interviewed by a clinician about his or her history, condition, current medications, and known allergies. The patient changes into a hospital gown and is placed on a hospital bed. A nurse monitors heart function (EKG), blood pressure, blood-oxygen levels (finger oximeter), and other vital signs.

An intravenous line is placed through which the patient receives medication to relax. The patient is awake during sacroiliac joint injection and may be asked to respond to the physician’s questions during the procedure.

What to Expect During the Procedure

The procedure is performed in a sterile setting similar to an operating room. The injection site is cleaned and draped. The patient is positioned in such a way that the physician has access to the sacroiliac joint. This involves the patient lying face down with a cushion under the lower abdomen for support. Skin-numbing medication is injected into and around the procedure site.

Before proceeding, the fluoroscopic C-arm (named for its characteristic C-shape) is positioned over the patient. Fluoroscopes are a type of video x-ray and project x-ray images in real-time on monitors in the procedure room. The fluoroscope is used to make sure the injection is performed properly precisely placed.

Diagnostic injections may include an anesthetic, steroid, and/or antibiotic. During or immediately after the injection, the physician may ask the patient about his or her symptoms.

After the Procedure

After the procedure, the patient is moved to a recovery area. A nurse monitors the patient. At discharge (usually 30 to 60 minutes after the injection), the patient receives written instructions for home care. The patient may experience the following:

• The area around the injection site may continue to feel numb for several hours.  
• Relief from typical symptoms may last for 6-hours following the injection.  

Side effects may occur:

• Steroids may cause side effects including blurred vision, frequent urination, increased thirst and change in blood sugar levels, especially in diabetic patients.  If these side effects become bothersome or worsen, please contact the physician’s office.
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• If fever, chills, increased pain, weakness or loss of bowel/bladder function occurs, seek immediate medical attention. Do not call the doctor’s office; call 911.

After the procedure, a follow-up visit is scheduled to discuss results.

Possible Complications

A sacroiliac joint injection, like other medical procedures, may present risks. Potential complications include infection, low blood pressure, headache, and injury to nerve tissue. The physician discusses the potential risks and benefits with the patient in advance of the procedure.

Patient Restrictions

Some patients should not undergo a sacroiliac joint injection. A sacroiliac joint injection may not be appropriate for all patients who have:

• An allergy to the contrast medium or the drugs to be injected
• Are anemic
• Significant asthma
• Bleeding problems
• An infection
• Kidney disease
• Are pregnant or breast-feeding
• Severe spinal abnormality

Conclusion

Sacroiliac joint injections are important to help identify the source of pain. Many patients have derived significant benefit from this procedure. Not all patients are candidates for a sacroiliac joint injection.