Sacroiliac Joint Injections
What Is the Sacroiliac Joint?
The sacroiliac joint (SIJ) is a large joint in the region of the low back are and buttock. It connects the pelvis with the spine (sacrum). It acts as a shock absorber from forces transmitted from the upper body to the legs. As a joint, it has limited motion.
What Is a Sacroiliac Joint Injection?
It is a procedure in which a local anesthetic (numbing medication) and a steroid (long acting anti inflammatory) is injected in the SIJ for the purpose of diagnose or exclude the source of pain and to treat persistent inflammation in the SIJ.
What Are the Indications for Sacroiliac Joint Injections?
Patients with known sacroiliac joint pain, due to conditions such as traumatic, inflammatory and occupational, who have failed conservative therapy. This injection often allows the physical therapist or chiropractor to more effectively restore function and stability. In a significant number of patient with persistent buttock, low back and leg pain, in which an accurate diagnosis have not been obtained, a SIJ injection can determine or exclude the source of pain. With this information, a more specific and accurate treatment can be prescribed.
Usually the procedure is performed under local anesthetic alone. Some patients that are apprehensive may benefit from intravenous sedation. This decision will be made based on individual preference and medical necessity. Oral medications are also available to assist with relaxation before and during the procedure. You will be taken to the procedure suite, place in the fluoroscopy bed lying on your stomach. Blood pressure and cardiac monitors will be applied.
Next, your sacroiliac area will be scrub and cleansed in a sterile fashion. With the aid of an X-ray machine, which provides constant imaging (called fluoroscopy), the specific area to be injected will be identified. The physician will then inject a small amount of local anesthetic in the skin and deeper tissues to numb the area. This may be associated with a mild and brief stinging sensation. Once the area is numb, your doctor will insert a small needle into the appropriate sacroiliac joint, under x-ray guidance. A small amount of contrast (X-ray dye) will be injected to confirm proper needle placement. Following this, a solution of local anesthetic and steroid (long acting anti-inflammatory) will be injected in the joint.
After the Procedure
You will go back to the post anesthesia care unit (if you received intravenous sedation), where you will be monitored for 30-60 minutes according to your response. If no sedation was used, according to your specific condition, you may proceed to the post procedure observation area. Immediately after the procedure, you will be evaluated to assess for specific response. A post procedure evaluation form to assess the effectiveness of the injections will be given to the patient prior to discharge. Post procedure instructions will be given in a pre-printed form. A follow up appointment will be made for follow up and to determine if a repeat injection may be necessary. Frequently, according to your specific response, more injections may be indicated. It is not advisable that you drive the day of the procedure.
General Pre and Post Procedure Instructions
If no intravenous sedation is planned, you continue with your usual dietary habits the day of the procedure. If intravenous sedation is planned, avoid eating any king of solid foods prior to the procedure and you may have clear liquids up to 4 hours prior to the procedure. If you are taking Coumadin, Heparin, Plavix or non-steroidal anti-inflamatories (such as aspirin, ketoprofen, naproxen or others), stop taking them at least one week prior to the procedure. If you are diabetic and planning on having IV sedation, our office will give you specific instructions.
You will be at the facility or hospital for approximately 1-2 hours for your procedure. It is important that you bring a driver with you, since you will not be allowed to drive the day of the procedure. You may return to your usual pre injection activities in 24 hours. The decision to return to work after the procedure will be made on an individual basis considering medical necessity and your specific condition.