Is fluoroscopy necessary for sacroiliac joint injections?

Area of Science:

• Pain Management
• Interventional Radiology
• Musculoskeletal Medicine

Background:

• Sacroiliac joint injections are increasingly used for diagnosis and therapy in the US.
• The procedure is perceived as simple due to joint accessibility and low morbidity.
• However, accurate needle placement is challenging without imaging due to unreliable clinical evaluation and diagnostic testing.

Purpose of the Study:

• To evaluate the accuracy of blind sacroiliac joint injections.
• To determine the efficacy of landmark-based placement without imaging guidance.

Main Methods:

• Sixty patients undergoing sacroiliac joint injections were studied.
• Injections were performed blindly by an experienced spinal injectionist.
• Needle placement was subsequently assessed under fluoroscopy for accuracy.

Main Results:

• Only 5 out of 60 (8.3%) blind injections achieved accurate needle placement near the sacroiliac joint.
• The posterior superior iliac spine was an unreliable landmark for guiding sacroiliac joint injections.
• Accurate sacroiliac joint injection without fluoroscopy was achieved in only 12% of patients, even with experienced providers.

Conclusions:

• Blind sacroiliac joint injections have a low success rate for accurate needle placement.
• Imaging guidance, such as fluoroscopy, is essential for ensuring therapeutic accuracy.
• Relying on anatomical landmarks alone is insufficient for precise sacroiliac joint injections.