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Computerized tomographic localization of clinically-guided sacroiliac joint injections.
J M Rosenberg1, T J Quint, A M de Rosayro
1Department of Anesthesiology, University of Michigan Hospitals, Ann Arbor, USA. jackrose@umich.edu
The Clinical Journal of Pain
|March 31, 2000
Summary
Clinically guided sacroiliac (SI) joint injections are often inaccurate, with only 22% of injections reaching the joint. Computed tomographic (CT) scanning revealed material spread to the epidural space in 24% of cases, highlighting the need for image guidance.
Area of Science:
- Pain management and interventional radiology.
- Anatomy and procedural accuracy.
Background:
- Sacroiliac (SI) joint injections are a common treatment for SI joint disease.
- Clinically guided techniques are often used when image guidance is unavailable.
Purpose of the Study:
- To evaluate the accuracy of clinically guided SI joint injections using computed tomographic (CT) scanning.
- To identify unintended spread of injected materials to adjacent structures.
Main Methods:
- Prospective, double-blind study involving 39 SI joint injections without image guidance.
- Patients received a mixture of bupivacaine, methylprednisolone, and iohexol.
- CT scans were performed immediately after needle placement and contrast injection.
Main Results:
- Only 22% of injections were accurately placed within the SI joint.
- Injected material was within 1 cm of the joint in 68% of cases.
- Epidural spread into the spinal canal occurred in 24% of injections.
Conclusions:
- Clinically guided SI joint injections have a low rate of accuracy.
- Image guidance (fluoroscopy or CT) is likely necessary for reliable SI joint injections.
- The findings explain occasional post-injection weakness and suggest caution with non-image-guided techniques.