Short‐Term Efficacy of Sacroiliac Joint Corticosteroid Injection Based on Arthrographic Contrast Patterns

Abstract

Objective To determine the relationship between sacroiliac joint (SIJ) contrast dispersal patterns during SIJ corticosteroid injection and pain relief at 2 and 8 weeks after the procedure. The association between the number of positive provocative SIJ physical examination maneuvers (minimum of one in all patients undergoing SIJ injection) and the patient’s response to the intervention was also assessed. Design Retrospective chart review. Setting Academic outpatient musculoskeletal practice. Patients Fifty-four subjects who underwent therapeutic SIJ corticosteroid injection were screened for inclusion; 49 subjects were included in the final analysis. Methods A retrospective review of electronic medical records identified patients who underwent SIJ corticosteroid injection. Fluoroscopic contrast flow patterns were categorized as type I (intra-articular injection with cephalad extension within the SIJ) or type II (intra-articular injection with poor cephalad extension). Self-reported numeric pain rating scale (NPRS) values at the time of injection and 2 and 8 weeks after the procedure were recorded. The number of positive provocative SIJ physical examination maneuvers at the time of the initial evaluation was also recorded. Main Outcome Measures The primary outcome measure was the effect of contrast patterns (type I or type II) on change in NPRS values at 2 weeks and 8 weeks after the injection. The secondary outcome measure was the association between the number of positive provocative SIJ physical examination maneuvers and decrease in the level of pain after the procedure. Results At 2 weeks after the procedure, type I subjects demonstrated a significantly lower mean NPRS value compared with type II subjects (2.8 ± 1.4 versus 3.8 ± 1.6, respectively, P =.02). No statistically significant difference was observed at 8 weeks after the procedure. NPRS values were significantly reduced both at 2 weeks and 8 weeks, compared with baseline, in both subjects identified as having type I flow and those with type II flow (P < .0001 for all within-group comparisons). Conclusions Fluoroscopically guided corticosteroid injections into the SIJ joint are effective in decreasing NPRS values in patients with SIJ-mediated pain. Delivery of corticosteroid to the superior portion of the SIJ leads to a greater reduction in pain at 2 weeks, but not at 8 weeks. Patients with at least one positive provocative maneuver should benefit from an intra-articular corticosteroid injection.

Fluoroscopically Guided Diagnostic and Therapeutic Intra-Articular Sacroiliac Joint Injections: A Systematic Review

“…One article compared patients’ pain relief with contrast media flow during SIJ . This study showed no differences in pain scores at 2 months between patients when the contrast medium reached the superior aspect of the joint or when there was poor cephalad spread of contrast medium.…”

Treatment outcomes of peri-articular steroid injection for patients with work-related sacroiliac joint pain and lumbar para-spinal muscle strain

“…Corticosteroids may be administered through the intra-articular route to decrease the intensity and duration of pain [19]. Scholten et al [20] confirmed that fluoroscopically guided corticosteroid injections, based on arthrographic contrast patterns, into the superior portion of SIJ were effective in de- for LBP, this study did not find any statistically significant difference in the mean BMI between the discharged and transferred groups. These findings could be attributed to the small sample size which was used in this study.…”

Image‐Guided Sacroiliac Joint Injections: an Evidence‐based Review of Best Practices and Clinical Outcomes

“…Scholten and colleagues found that patients with cephalad extension of contrast flow patterns during SIJ injections demonstrated improved pain scores at 2 weeks as compared to patients who had poor cephalad extension. However, there were no significant intergroup differences in pain outcomes at 8 weeks, with both groups improving significantly compared to preinjection baseline pain scores …”

“…However, there were no significant intergroup differences in pain outcomes at 8 weeks, with both groups improving significantly compared to preinjection baseline pain scores. 26…”