An anesthesiologist typically administers a sacroiliac joint steroid injection for persistent back pain associated with injured, inflamed, or irritated nerves in the joint, especially if the patient cannot pinpoint the source of the pain. Moreover, sacroiliac joint pain is often difficult to diagnose, and most of the time, it results from back strain or traumatic injury. Researchers have even discovered that approximately 40-50% of adults diagnosed with sacroiliac joint pain can specifically describe an event that contributed to the pain’s onset. There are a variety of events that can cause this type of pain, including repetitive stress (e.g., heavy lifting), falling down, and motor vehicle accidents.
Steroid injections for the sacroiliac joints, which connect the spine’s base (sacrum) to the pelvis’s ilium bones, are used to diagnose and treat lower back pain caused by problems with one or both joints. When a sacroiliac joint (sacroiliac-joint dysfunction) is inflamed, patients can experience pain in their buttocks and lower back, which gets worse when they stand or run. Osteoarthritis, traumatic injury, pregnancy, inflammatory joint disease, and structural abnormalities can all lead to sacroiliac joint dysfunction.
According to clinical reports, approximately 15-30% of adults suffer from chronic, nonspecific lower back pain related to sacroiliac joint problems. Studies have also shown that steroid injections are very effective for this type of pain. Patients who receive injections into the surrounding tissue of the joint (extra-articular injections) or directly into the joint (periarticular injections) experience pain relief that is far greater than that experienced by those who receive placebo injections. Additionally, patients have reported that the effects can last up to one month in most cases, and repeated injections can extend pain relief.
If you are suffering back pain and unsure of the cause, contact Florida Surgery Consultants for an evaluation. Sacroiliac Joint Injections may be the best course of treatment for you. In this article we’ll discuss Sacroiliac Joint Steroid Injections in the following sections:
- How is the Procedure is Performed?
- Potential Risks and Complications
- Who is a Good Candidate for Sacroiliac Joint Injection?
- Sacroiliac Joint Injection Recovery
- Alternative Surgical Treatment
How The Procedure Is Performed
The Sacroiliac Joint injection procedure usually takes place in an operating room or special procedure room. The procedure takes only a few minutes for the entire procedure to be completed, and the patient goes home the same day. Here are the steps involved in a typical injection:
- Upon obtaining informed consent, the patient lies face down on a radiography table on his or her stomach. He or she might be provided with a pillow under their hips for comfort.
- Throughout the procedure, vital signs (e.g. blood pressure and pulse rate) are monitored.
- In some cases, an intravenous line may be inserted to deliver medication to help the patient relax, depending on the physician and the patient’s preference.
- A chlorhexidine 0.5% solution in 70% alcohol is used to clean the surface skin overlying a sacroiliac joint injection to maintain sterility. Throughout the procedure, sterile gloves are worn.
- Local anesthetic is often used to numb the needle insertion site. The needle is inserted into the joint under fluoroscopy guidance, then contrast – a ‘dye’ that can be seen under X-ray – is injected to verify needle placement within the joint and the spread of the solution within the joint.
- Diagnostic and/or therapeutic medications are injected into the joint after the needle has been guided in successfully.
Two types of medications are typically injected:
- Local anesthetics (most commonly lidocaine or bupivacaine) are generally injected into the joint to determine pain and confirm the sacroiliac joint is the source of the patient’s pain. The sacroiliac joint is injected with this solution during a diagnostic procedure.
- In general, anti-inflammatory drugs (usually corticosteroids) reduce inflammation in the joint over time, alleviating pain over several months (usually up to a year). A therapeutic sacroiliac joint injection is performed with this solution.
Potential Risks And Complications
Almost all surgical procedures involve the risk of bleeding, infection, or an allergic reaction to the medications used. Local anesthesia (numbing medicine) can temporarily numb or weaken your legs. When this interferes with your ability to walk safely, you will have to remain under observation for several hours until the problem is resolved. After the injection, you may experience localized pain at the injection site for a few days. In diabetics, the use of steroid medication may lead to a short-term elevation in blood sugar levels.
Based on a systematic review, a minority of patients experienced immediate transient side effects, such as vasovagal symptoms. The most common of these was pain and soreness. More serious complications include trauma to the nerves, accidental intervertebral injections, hematomas, sciatica, meningitis, abscess, and systemic infection. Additionally, pyogenic sacroiliitis and herpes simplex have been reported.
Who Is A Good Candidate For Sacroiliac Joint Steroid Injection?
Having significant back pain that has not responded to other treatments, such as anti-inflammatory drugs, physical therapy, and ice/heat therapy makes you a candidate for an SI joint injection. Lower back pain can be diagnosed and treated using SI joint injections.
Sacroiliac injections are not recommended if you have severe allergies to local anesthetics, contrast dye, or steroids. Furthermore, you should not undergo Sacroiliac injections if you have bleeding or clotting problems or an infection of the blood or skin near the injection site. It is important to inform your doctor if you are taking blood thinners such as aspirin, heparin, or Coumadin. Before the procedure, you will likely be instructed to stop taking those medications, but do not stop taking blood thinners without your provider’s instructions. Consult your doctor if you are or might be pregnant so you can determine whether this procedure is appropriate for you.
Sacroiliac Joint Steroid Injection Recovery
The effects of a sacroiliac joint injection can be immediate, or they can take a few hours or days. Following the procedure, you will be observed for fifteen to thirty minutes for signs of an allergic or leg numbness reaction. Finally, your pain level will be evaluated before you are discharged. Keep a diary of how much pain you experience over the next two weeks. A physical examination is performed and the percentage of pain relief is documented. It is considered positive if the patient’s pain related to activity improves by at least 75 percent. During the period when the numbing medicine wears off and before the corticosteroid takes effect, you may notice a slight increase in pain. After sacroiliac injections, there are no activity restrictions. Some soreness may be felt at the injection site for a couple of days; this will eventually go away. There is a possibility you will require more than one injection to achieve full relief.
After the procedure, you may take your regular medications, but limit them for the first 4-6 hours after the procedure to ensure accurate diagnostic results. Physical or manual therapy may be recommended after the injections while the numbing medicine takes effect as well as for several weeks after the cortisone takes effect.
There may be variations among recommendations depending on the situation of the patient and the physician’s preference, but here are some typical recommendations:
- To flush the dye out of the body after fluoroscopy, drink plenty of water.
- Don’t engage in an excessive activity the day after your procedure, especially if you were sedated.
- During discharge, the patient will often receive a list of signs or symptoms that require immediate medical attention.
Sacroiliac Joint Steroid Injection Success Rate
- General Efficacy:
- The success of SI joint steroid injections in alleviating pain varies, but many clinical studies and reviews have reported a significant reduction in pain for a majority of patients post-injection. Success rates in literature often range from 50% to 80% for meaningful pain relief, though this can vary based on the population studied and the specific criteria used for success.
- Duration of Relief:
- Pain relief after an SI joint steroid injection can last anywhere from a few weeks to several months. The duration often depends on the underlying cause of the pain and the severity of the inflammation.
- It’s not uncommon for some patients to need repeat injections if or when the pain returns.
- Diagnostic and Therapeutic Role:
- The procedure often serves a dual purpose. Along with the therapeutic aim of reducing pain, the injection can also have a diagnostic value. If the pain is significantly relieved immediately after the injection, it can confirm the SI joint as the source of the pain.
- Factors Influencing Outcome:
- Accurate placement of the injection, confirmed using fluoroscopic guidance (real-time X-ray), can influence the effectiveness of the procedure.
- The underlying pathology (e.g., osteoarthritis, sacroiliitis, or mechanical dysfunction) can also affect outcomes.
- Safety and Side Effects:
- SI joint injections are generally considered safe when performed by skilled practitioners. Potential side effects or risks, though rare, include infection, bleeding, increased pain, allergic reactions to the medication, or injury to surrounding structures.
- Comparative Efficacy:
- When comparing SI joint injections to other treatments, they often provide more direct relief than oral medications, given the targeted delivery of medication. They can also serve as a bridge to more long-term treatments, such as physical therapy or even surgical interventions, if required.
Alternative Surgical Treatment
In the event that the Sacroiliac Joint Injections fail to work, you may need to consider surgical treatment. Sacroiliac Joint Fusion is a minimally invasive procedure that stabilizes the injured joint and relieves pain. Among our spine surgeons at Florida Surgery Consultants, this is considered the most effective procedure. Nearly 82% of patients say they would have the same surgery again if it yielded the same results. Patients who have had the surgery report a significant reduction in pain. This procedure can also be considered a minimally invasive procedure since the incision is less than 2 inches long. As an outpatient procedure, patients are able to return home the same day. Recovery is also much shorter with this minimally invasive procedure.
Titanium is used for the implant system with a porous outer surface. Essentially, the implant system is designed to prevent movement of the SI Joints. Additionally, these implants are coated with a titanium plasma spray, which has been used in orthopedic surgeries for decades. The surgeon carefully drills a channel along with the pin while protecting your soft tissues. After passing through the SI joint into the sacrum, it enters the ilium. Here, the first implant is inserted, locking the bones in place. Normally, two to more implants are needed to stabilize the joint. The implants will grow new bone around them and across the joint, forming a stable fusion.
Please note that sacroiliac joint fusion is elective surgery, meaning the patient has the option of undergoing the procedure. Therefore, patients must exhaust all non-surgical options before considering sacroiliac joint fusion. Before you consider surgery for Sacroiliac joint pain, most doctors suggest that you try nonsurgical treatment options for at least eight to twelve weeks. A sacroiliac joint fusion may be necessary if pain symptoms persist after non-surgical treatment.
