Sacroiliac Joint Injection

The sacroiliac joints are joints in the lower back which connect the spine to the pelvis. These joints typically do not move, but do support most of our body weight when we are standing. Due to this stress and many other medical conditions, the SI joint can become inflamed and cause significant pain in the lower back, hips, groin, and buttocks or down the back of the legs to the knee. The pain is typically worse with standing and walking and improved when lying down. Inflammation and arthritis in the SI joint can also cause stiffness and a burning sensation in the pelvis. This typically does not require surgical correction and can be alleviated with home exercises, physical therapy, anti-inflammatory medications and SI joint injections.

Conditions commonly treated with sacroiliac joint injections:

1. Sacroilitis – inflammation of the sacroiliac joints
   

1. Rheumatoid Arthritis
   

1. Ankylosing spondylitis
   

1. Degenerative bone disease
   

1. Osteoarthritis
   

1. Pregnancy
   

1. Any condition causing abnormal walking pattern – previous history of polio, one leg shorter than another, walking with cane or crutches, uneven walking due to injury or damage to the other leg, knee, foot or ankle.
   

The procedure:

Please arrive 20 minutes prior to your appointment on procedure day. Our nurses will start an IV if you are requesting sedation and take a pre-operative nurse assessment. All patients are taken to the procedure room on a hospital bed. Once in the procedure room you will be given sedation to help make you comfortable. A cold cleaning solution will be placed on your skin to help decrease chances of infection. The procedure site is then identified by your doctor under x-ray guidance. Once the site is identified a shot of numbing medicine (typically bupivicaine) will be given. This may feel like a bee sting, but will only last a few seconds. The spinal needle is then placed into the position using x-ray guidance. Dye is injected to confirm proper placement of the needle. Medication consisting of steroid (methylprednisilone) and local anesthetics (bupivicaine) is injected through the needle. This medication spreads around and bathes the sacroiliac joint – thus reducing inflammation and alleviating pain. The needle is then removed and you will be taken to the recovery room. The procedure itself takes 10-15 minutes and then you will be observed for another 15 minutes after the procedure. You may then go home and enjoy the rest of your day.

What to expect after procedure:

The steroid will usually begin working within 3-5 days, but in some cases it can take up to a week to feel the benefits. Most patients will report less pain and can actually do more physical activity and often physical therapy with less pain. The steroids are generally very well tolerated, but some patients may experience side effects, including a flushing, anxiety, trouble sleeping, change in menstrual cycle, or temporary water retention. Diabetics may also have elevated blood sugars for several days. These side effects are usually very mild and will often resolve within a few days.

Sacroiliac joint injections have been performed for many decades, and are generally considered as a very safe and effective treatment for chronic pain conditions. Complications are rare, but could include allergic reaction, bleeding, infection, nerve damage, headaches or paralysis.

Although not everyone obtains pain relief with sacroiliac joint injections, often the injections can provide you with improvement in pain and function that last several months or longer. Physical therapy is also a key treatment in sacroiliac joint dysfunction. If you get significant benefit from this injection series, the injections can be safely repeated periodically to maintain the improvements. Injections are also commonly coupled with other treatments (medications, physical therapy, etc) in an attempt to either maximize the benefit or prolong the effects.