Serial therapeutic sacroiliac joint injections: a practice audit

To determine the long-term response to serial sacroiliac joint (SIJ) corticosteroid injections. Design. Retrospective practice audit.

Tertiary care spine center. Review of charts of all patients in a single practice who underwent diagnostic and therapeutic fluoroscopically guided SIJ injections with combined local anesthetic, long-acting corticosteroid, and contrast.

Response was evaluated at 1 hour and again at follow-up clinic visits. Response to injection was graded as positive if there was > or =50% relief of the targeted pain during the local anesthetic phase and at least 2 weeks of > or =50% relief afterward. If pain recurred, patients had to have been sufficiently satisfied with the relief to request repeat injection.

There were 164 patients; 5 had incomplete records, 4 had <2 year follow-up. Of the 155 patients, 120 (77%) were positive responders; 45 were men and 75 were women; and the mean age was 48 (27-91) years. Sixty-nine had prior lumbar surgery. Mean duration of follow-up was 44 months (26-101). Two were lost to follow-up. The 118 positive responders received a mean of 2.7 injections per patient. Forty patients required 1 injection only, 29 required two, 22 required three, and 27 required four or more. The mean duration of response for those receiving >1 injection was 9.3 months per injection (1-58). There were no adverse events.

SIJ corticosteroid injections appear to be an effective palliative treatment for selected patients with SIJ pain. Most patients whose pain is responsive to SIJ steroid injections improved sufficiently and remained well after 1 to 3 injections, but some required frequent injections on a long-term basis.