Sacroiliac Injections Lit References
Rofo. 2003 Jun;175(6):814-21. [Sacroiliitis in children with spondyloarthropathy: therapeutic effect of CT-Guided intra-articular corticosteroid injection]
[Article in German] Fischer T, Biedermann T, Hermann KG, Diekmann F, Braun J, Hamm B, Bollow M. Institut fur Radiologie, Universitatsklinikum
Charite, Campus Mitte, Humboldt-Universitat zu Berlin. thom.fischer@charite.de PURPOSE: The prospective investigation of the therapeutic effect of
CT-guided intra-articular corticosteroid injection into inflammatory sacroiliac (SI) joints compared to conventional treatment with nonsteroidal
anti-inflammatory drugs (NSAIDS) in children with juvenile spondyloarthropathy (jSpA) and the determination of the role of dynamic magnetic resonance
imaging (MRI) in establishing the indication and monitoring the therapy. MATERIALS AND METHODS: The study comprises 89 children with known jSpA
who were diagnosed by MRI to have a unilateral or bilateral sacroiliitis. Therapy with NSAIDS was initiated or continued in all 89 patients. Four weeks after
the diagnostic MRI, two groups were distinguished according to the clinical response to NSAIDS, with group 1 consisting of 33 responders and group 2 of 56
non-responders. The patients of group 2 were treated with CT-guided intra-articular corticosteroid injection (low-dose injection) while the therapy with
NSAIDS was continued. A total of 83 SI joints were punctured without complications, 27 bilaterally and 29 unilaterally. The indication for the intervention
was based on inflammatory activity as determined by MRI. The therapy was monitored by clinical follow-up every 8 to 12 weeks over a period of 20 months.
Follow-up by dynamic MRI was performed in all 56 children of group 2 and in 15 of the 33 children of group 1 within 8 +/- 4 months of the initial
examination. RESULTS: A total of 87.5% of the children in group 2 showed a statistically significant decrease in their subjective complaints from 6.9 +/- 3.4
to 1.8 +/- 1.7 (p < 0.05) as measured on a visual analog scale (VAS from 0 to 10). Improvement was seen as early as 1.5 +/- 1.0 weeks after the intervention
and lasted for a mean of 12 +/- 6 months. The children in group 1 already showed similar improvement of the VAS from 6.8 +/- 3.2 to 1.5 +/- 1.4 (p < 0.05)
during the initial four weeks of NSAIDS therapy, with the improvement lasting for the 20-month observation period. The follow-up dynamic MRI (0.1
mmol/kg body weight) during therapy showed a statistically significant lower contrast-enhancement in both groups (group 1: 117 +/- 43 % versus 38 +/- 24
%, p < 0.05; group 2: 127 +/- 59 % versus 38 +/- 22 %, p < 0.05). One third of the patients of group 2 showed progression of joint destruction despite
absence of subjective complaints. CONCLUSION: CT-guided intra-articular corticosteroid injection has proven an effective, symptomatic, and
uncomplicated therapy of acute sacroiliitis in patients with jSpA. Dynamic MRI has a role in establishing the indication for intervention but its role for any
follow-up is restricted to cases with inconclusive clinical response.
J Spinal Disord Tech. 2003 Feb;16(1):96-9. The sacroiliac joint: a potential cause of pain after lumbar fusion to the sacrum. Katz V, Schofferman J,
Reynolds J. SpineCare Medical Group, San Francisco Spine Institute, Daly City, California, USA. The sacroiliac joint (SIJ) can cause pain after lumbosacral
fusion. Diagnosis requires >75% relief after local anesthetic SIJ injection. This study is a retrospective review of patients with low back pain after
lumbosacral fusion who had SIJ injections. Percentage and duration of pain relief were noted. Results are as follows: there were 34 patients; 8 fused at
L5-S1, 14 fused at L4-S1, and 12 had multilevel fusions. Twenty had >75% relief within 45 minutes, and 11 had prolonged relief. Six had relief >20% but
<75%, and one had prolonged relief. Eight never improved. Eight had posterior iliac crest bone harvested, and there was no correlation between donor side
and pain side. In 34 patients with low back pain after lumbosacral fusion, SIJ was the cause of pain in 32% and possibly the cause in 29%. This is the first
detailed description of this problem.
Acta Radiol. 2002 Jul;43(4):425-7. Fluoroscopy-guided intraarticular corticosteroid injection into the sacroiliac joints in patients with ankylosing spondylitis.
Karabacakoglu A, Karakose S, Ozerbil OM, Odev K. Department of Radiology, Selcuk University, Konya, Turkey. PURPOSE: Our goal was to prospectively
study the therapeutic efficacy of CT-marking and fluoroscopy-guided intraarticular corticosteroid instillation of inflamed sacroiliac joints in patients with
ankylosing spondylitis. MATERIAL AND METHODS: A total of 22 fluoroscopy-guided intraarticular corticosteroid injections in the sacroiliac joints were
performed in 17 patients with ankylosing spondylitis and severe low back pain. Needle puncture point, angle of intervention and distance of sacroiliac joint
from the skin were determined by sacroiliac joint axial CT examination in prone position. 14 mg of betamethasone were instilled in each joint under
fluoroscopy. RESULTS: Twenty of 22 joints (90.9%) reported good improvement during a month after corticosteroid injection of the sacroiliac joint. The
remaining 2 joints reported fair improvement. CONCLUSION: CT-marking and fluoroscopy-guided intraarticular corticosteroid instillation in the sacroiliac
joints may be regarded as an effective therapy. This technique was useful, rapid and safe.
Zhonghua Yi Xue Za Zhi. 2002 May 25;82(10):692-5. [CT-guided percutaneous needle biopsy and intra-articular injection of sacroiliac joint] [Article in
Chinese] Liu Y, Wang Q, Xiao Z, Chen S, Zeng Q. Department of Radiology, First Hospital, Shantou University Medical School, Shantou 515041, China.
OBJECTIVE: To investigate the clinical value of CT-guided percutaneous needle biopsy and intra-articular injection of sacroiliac joint. METHODS:
CT-guided percutaneous puncture was conducted to the bilateral sacroiliac joints of 3 specimens of adult pelvis, 18 patients with ankylosing spondylitis (AS),
and 10 patients with undifferentiated spondyloarthropathy (uSpA) suspected as early AS clinically. All 28 patients had taken non-steroidal
anti-inflammatory agents without adequate control of symptoms or with serious side effects. Biopsy of synovium with 16G or 18G needles and
intra-articular injection of steroid were made to the 28 patients. RESULTS: The general success rate of puncture was 4/6 among the specimens of pelvis and
was 96.4% (54/56) among the 28 patients. The level of needle insertion was 1.69 cm +/- 0.63 cm up the lower edge of the joint. The obtainment rate of
biopsy specimen was 88.5% (46/54) for the cases punctured successfully. The positive rate of pathological examination was 91.7% (22/24). Marked
inflammatory changes were found in the biopsy specimens from AS patients and early inflammatory changes were found in the biopsy specimens from
uSpA patients. The immediate effective rate of intra-articular steroid injection was 78.6% (22/28). No complication and side effect was found.
CONCLUSION: CT-guided percutaneous puncture is an effective and safe guided method for biopsy and intra-articular injection of sacroiliac joint. The
proper level of puncture is by the juncture of the middle 1/3 and lower 1/3 of sacroiliac joint. Needle biopsy helps early diagnosis of AS for patients with
uSpA. Intra-articular injection is an effective supplementary therapy for AS and uSpA patients.
Clin Exp Rheumatol. 2002 Jan-Feb;20(1):52-4. Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients
with chronic low back pain in the region of the sacroiliac joint. Luukkainen RK, Wennerstrand PV, Kautiainen HH, Sanila MT, Asikainen EL. Satalinna
Hospital, Harjavalta, Finland. reijo.luukkainen@satshp.fi OBJECTIVE: To investigate the efficacy of periarticular corticosteroid treatment of the sacroiliac
joint (SIJ) in non-spondylarthropathic patients with chronic low back pain in the region of the SIJ in a double blind, controlled study. METHODS:
Twenty-four consecutive non-spondylarthropathic patients with chronic pain in the region of the SIJ entered the study. Thirteen patients were treated with
a periarticular injection of methylprednisoloneacetate and lidocaine (MP group) of the SIJ, whereas 11 patients received isotonic sodium chloride and
lidocaine. Clinical assessment at the onset of the study and after one month included the patient's estimation of pain in the region of the SIJ by the visual
analogue scale (VAS) and by a pain index, which was calculated from tenderness and stressing tests on the SIJ. RESULTS: At the one month's follow-up
examination both the VAS (p = 0.047) and the pain index (0.017) had improved significantly in the MP group compared with the non-MP group.
CONCLUSION: These results suggest that periarticular injection of methylprednisolone may be effective in the treatment of pain in the region of the SIJ
in non-spondylarthropathic patients.
Am J Phys Med Rehabil. 2001 Jun;80(6):425-32. Fluoroscopically guided therapeutic sacroiliac joint injections for sacroiliac joint syndrome. Slipman CW,
Lipetz JS, Plastaras CT, Jackson HB, Vresilovic EJ, Lenrow DA, Braverman DL. The Penn Spine Center, Department of Rehabilitation Medicine,
Philadelphia 19104, USA. OBJECTIVE: To investigate the outcomes resulting from the use of fluoroscopically guided therapeutic sacroiliac joint injections
in patients with sacroiliac joint syndrome. DESIGN: A retrospective study design with independent clinical review was utilized. Thirty-one patients were
included; each patient met specific physical examination criteria and failed to improve clinically after at least 4 wk of physical therapy. Each patient
demonstrated a positive response to a fluoroscopically guided diagnostic sacroiliac joint injection. Therapeutic sacroiliac joint injections were administered
in
conjunction with physical therapy. Outcome measures included Oswestry scores, Visual Analog Scale pain scores, work status, and medication usage.
RESULTS: Patients' symptom duration before diagnostic injection averaged 20.6 mo. An average of 2.1 therapeutic injections was administered. Follow-up
data collection was obtained at an average of 94.4 wk. A significant reduction (P = 0.0014) in Oswestry disability score was observed at the time of follow-up.
Visual Analog Scale pain scores were reduced (P < 0.0001) at the time of discharge and at follow-up. Work status was also significantly improved at the time
of discharge (P = 0.0313) and at follow-up (P = 0.0010). A trend (P = 0.0645) toward less drug usage was observed. CONCLUSIONS: These initial findings
suggest that fluoroscopically guided therapeutic sacroiliac joint injections are a clinically effective intervention in the treatment of patients with sacroiliac
joint syndrome. Controlled, prospective studies are necessary to further clarify the role of therapeutic injections in this patient population.
Curr Rev Pain. 2000;4(5):356-61. Anatomy and pathophysiology of the sacroiliac joint. Calvillo O, Skaribas I, Turnipseed J. Center for Pain Medicine,
Department of Anesthesiology, Baylor College of Medicine, 6560 Fannin, Suite 1900, Houston, TX 77030, USA. ocalvillo@mysurgeon.com The sacroiliac
joint as a source of chronic pain has been a subject of debate for a long period of time. This controversy stems from the inherent anatomic location of the
sacroiliac joint. Adjacent spinal structures may cause pain to be referred to the sacroiliac joint, thus making a precise diagnosis difficult. The most reliable
method to establish the diagnosis of sacroiliac arthralgia is fluoroscopic-guided intra-articular injection of a local anesthetic preceded by a sacroiliac
arthrogram. Although there are many therapeutic options for sacroiliac joint syndrome, the ideal treatment has not yet been discovered. There is evidence
that intra-articular viscosupplementation of the sacroiliac joint with hylan can consistently and reliably induce a prolonged analgesic response in sacroiliac
joint syndrome. Viscosupplementation restores joint homeostasis, allows increased joint motion, and induces analgesia. Hylan is highly viscoelastic
hyaluronan (hyaluronic acid), and is capable of increasing the viscoelastic properties of synovial fluid.
Clin Exp Rheumatol. 1999 Jan-Feb;17(1):88-90. Periarticular corticosteroid treatment of the sacroiliac joint in patients with seronegative
spondylarthropathy. Luukkainen R, Nissila M, Asikainen E, Sanila M, Lehtinen K, Alanaatu A, Kautiainen H. Satalinna Hospital, Harjavalta and
Rheumatism Foundation Hospital, Heinola, Finland. OBJECTIVE: To evaluate the efficacy of periarticular corticosteroid injection of the sacroiliac joint
(SIJ) in patients with seronegative spondylarthropathy in a double blind, controlled study. METHODS: 20 patients with seronegative spondylarthropathy and
clinical sacroiliitis entered the study. In 10 patients one affected SIJ was treated with periarticular injection of 1.5 ml (40 mg/ml) methylprednisoloneacetate
and 1.5 ml (20 mg/ml) lignocaine (MP group), whereas 10 patients received 1.5 ml isotonic sodium chloride and 1.5 ml (20 mg/ml) lignocaine (non-MP
group). Clinical assessment at the onset of the study and after two months follow-up included the patients' estimation of pain in the SIJ by the visual
analogue scale (VAS) and by a pain index which was calculated from tenderness and stressing tests on the SIJ. RESULTS: At the two months follow-up
examination the VAS (p = 0.02) and the pain index (p = 0.01) had improved significantly in the MP group compared with the non-MP group. CONCLUSION:
The results of our study indicate that the periarticular injection of methylprednisolone may be effective in the treatment of clinical sacroiliitis in patients
with seronegative spondylarthropathy.
Br J Rheumatol. 1996 Aug;35(8):767-70. Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies: a double-blind study.
Maugars Y, Mathis C, Berthelot JM, Charlier C, Prost A. Department of Rheumatology, Nantes University Hospital Centre, France. Despite previously
carrying out a first open study of sacroiliac injection of long-acting corticosteroid, it was not possible to evaluate the role of a placebo effect. We therefore
performed a double-blind study in 10 patients/13 articulations, suffering painful sacroiliitis. At 1 month, 5/6 sacroiliac joints injected with corticosteroid
described a relief of > 70%, in comparison to 0/7 of the placebo group (P < 0.05). Dolometry showed a marked decrease in the corticosteroid group from
(mean +/- S.E.M.) 6.8 +/- 0.6 to 1.3 +/- 0.3, and decreases were mild in the placebo group: 7.0 +/- 0.6 to 5.2 +/- 0.5 (P < 0.005). Six of the seven sacroiliac
joints of the placebo group and two patients with failure and relapse of the corticosteroid group were reinjected with corticosteroid. At 1 month, 12/14
(85.7%) were assessed as having a good result. Results were still significant at 3 months (62%) and 6 months (58%). Tolerance was good or very good in
86% of the cases, and we did not report any notable complication. This technique is safe and very efficient, and it has to be considered more widely in
patients with contraindications or complications with NSAID, or if the medical treatment is unable to control sufficiently the active sacroiliitis.
Rofo. 2003 Jun;175(6):814-21. [Sacroiliitis in children with spondyloarthropathy: therapeutic effect of CT-Guided intra-articular corticosteroid injection]
[Article in German] Fischer T, Biedermann T, Hermann KG, Diekmann F, Braun J, Hamm B, Bollow M. Institut fur Radiologie, Universitatsklinikum
Charite, Campus Mitte, Humboldt-Universitat zu Berlin. thom.fischer@charite.de PURPOSE: The prospective investigation of the therapeutic effect of
CT-guided intra-articular corticosteroid injection into inflammatory sacroiliac (SI) joints compared to conventional treatment with nonsteroidal
anti-inflammatory drugs (NSAIDS) in children with juvenile spondyloarthropathy (jSpA) and the determination of the role of dynamic magnetic resonance
imaging (MRI) in establishing the indication and monitoring the therapy. MATERIALS AND METHODS: The study comprises 89 children with known jSpA
who were diagnosed by MRI to have a unilateral or bilateral sacroiliitis. Therapy with NSAIDS was initiated or continued in all 89 patients. Four weeks after
the diagnostic MRI, two groups were distinguished according to the clinical response to NSAIDS, with group 1 consisting of 33 responders and group 2 of 56
non-responders. The patients of group 2 were treated with CT-guided intra-articular corticosteroid injection (low-dose injection) while the therapy with
NSAIDS was continued. A total of 83 SI joints were punctured without complications, 27 bilaterally and 29 unilaterally. The indication for the intervention
was based on inflammatory activity as determined by MRI. The therapy was monitored by clinical follow-up every 8 to 12 weeks over a period of 20 months.
Follow-up by dynamic MRI was performed in all 56 children of group 2 and in 15 of the 33 children of group 1 within 8 +/- 4 months of the initial
examination. RESULTS: A total of 87.5% of the children in group 2 showed a statistically significant decrease in their subjective complaints from 6.9 +/- 3.4
to 1.8 +/- 1.7 (p < 0.05) as measured on a visual analog scale (VAS from 0 to 10). Improvement was seen as early as 1.5 +/- 1.0 weeks after the intervention
and lasted for a mean of 12 +/- 6 months. The children in group 1 already showed similar improvement of the VAS from 6.8 +/- 3.2 to 1.5 +/- 1.4 (p < 0.05)
during the initial four weeks of NSAIDS therapy, with the improvement lasting for the 20-month observation period. The follow-up dynamic MRI (0.1
mmol/kg body weight) during therapy showed a statistically significant lower contrast-enhancement in both groups (group 1: 117 +/- 43 % versus 38 +/- 24
%, p < 0.05; group 2: 127 +/- 59 % versus 38 +/- 22 %, p < 0.05). One third of the patients of group 2 showed progression of joint destruction despite
absence of subjective complaints. CONCLUSION: CT-guided intra-articular corticosteroid injection has proven an effective, symptomatic, and
uncomplicated therapy of acute sacroiliitis in patients with jSpA. Dynamic MRI has a role in establishing the indication for intervention but its role for any
follow-up is restricted to cases with inconclusive clinical response.
J Spinal Disord Tech. 2003 Feb;16(1):96-9. The sacroiliac joint: a potential cause of pain after lumbar fusion to the sacrum. Katz V, Schofferman J,
Reynolds J. SpineCare Medical Group, San Francisco Spine Institute, Daly City, California, USA. The sacroiliac joint (SIJ) can cause pain after lumbosacral
fusion. Diagnosis requires >75% relief after local anesthetic SIJ injection. This study is a retrospective review of patients with low back pain after
lumbosacral fusion who had SIJ injections. Percentage and duration of pain relief were noted. Results are as follows: there were 34 patients; 8 fused at
L5-S1, 14 fused at L4-S1, and 12 had multilevel fusions. Twenty had >75% relief within 45 minutes, and 11 had prolonged relief. Six had relief >20% but
<75%, and one had prolonged relief. Eight never improved. Eight had posterior iliac crest bone harvested, and there was no correlation between donor side
and pain side. In 34 patients with low back pain after lumbosacral fusion, SIJ was the cause of pain in 32% and possibly the cause in 29%. This is the first
detailed description of this problem.
Acta Radiol. 2002 Jul;43(4):425-7. Fluoroscopy-guided intraarticular corticosteroid injection into the sacroiliac joints in patients with ankylosing spondylitis.
Karabacakoglu A, Karakose S, Ozerbil OM, Odev K. Department of Radiology, Selcuk University, Konya, Turkey. PURPOSE: Our goal was to prospectively
study the therapeutic efficacy of CT-marking and fluoroscopy-guided intraarticular corticosteroid instillation of inflamed sacroiliac joints in patients with
ankylosing spondylitis. MATERIAL AND METHODS: A total of 22 fluoroscopy-guided intraarticular corticosteroid injections in the sacroiliac joints were
performed in 17 patients with ankylosing spondylitis and severe low back pain. Needle puncture point, angle of intervention and distance of sacroiliac joint
from the skin were determined by sacroiliac joint axial CT examination in prone position. 14 mg of betamethasone were instilled in each joint under
fluoroscopy. RESULTS: Twenty of 22 joints (90.9%) reported good improvement during a month after corticosteroid injection of the sacroiliac joint. The
remaining 2 joints reported fair improvement. CONCLUSION: CT-marking and fluoroscopy-guided intraarticular corticosteroid instillation in the sacroiliac
joints may be regarded as an effective therapy. This technique was useful, rapid and safe.
Zhonghua Yi Xue Za Zhi. 2002 May 25;82(10):692-5. [CT-guided percutaneous needle biopsy and intra-articular injection of sacroiliac joint] [Article in
Chinese] Liu Y, Wang Q, Xiao Z, Chen S, Zeng Q. Department of Radiology, First Hospital, Shantou University Medical School, Shantou 515041, China.
OBJECTIVE: To investigate the clinical value of CT-guided percutaneous needle biopsy and intra-articular injection of sacroiliac joint. METHODS:
CT-guided percutaneous puncture was conducted to the bilateral sacroiliac joints of 3 specimens of adult pelvis, 18 patients with ankylosing spondylitis (AS),
and 10 patients with undifferentiated spondyloarthropathy (uSpA) suspected as early AS clinically. All 28 patients had taken non-steroidal
anti-inflammatory agents without adequate control of symptoms or with serious side effects. Biopsy of synovium with 16G or 18G needles and
intra-articular injection of steroid were made to the 28 patients. RESULTS: The general success rate of puncture was 4/6 among the specimens of pelvis and
was 96.4% (54/56) among the 28 patients. The level of needle insertion was 1.69 cm +/- 0.63 cm up the lower edge of the joint. The obtainment rate of
biopsy specimen was 88.5% (46/54) for the cases punctured successfully. The positive rate of pathological examination was 91.7% (22/24). Marked
inflammatory changes were found in the biopsy specimens from AS patients and early inflammatory changes were found in the biopsy specimens from
uSpA patients. The immediate effective rate of intra-articular steroid injection was 78.6% (22/28). No complication and side effect was found.
CONCLUSION: CT-guided percutaneous puncture is an effective and safe guided method for biopsy and intra-articular injection of sacroiliac joint. The
proper level of puncture is by the juncture of the middle 1/3 and lower 1/3 of sacroiliac joint. Needle biopsy helps early diagnosis of AS for patients with
uSpA. Intra-articular injection is an effective supplementary therapy for AS and uSpA patients.
Clin Exp Rheumatol. 2002 Jan-Feb;20(1):52-4. Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients
with chronic low back pain in the region of the sacroiliac joint. Luukkainen RK, Wennerstrand PV, Kautiainen HH, Sanila MT, Asikainen EL. Satalinna
Hospital, Harjavalta, Finland. reijo.luukkainen@satshp.fi OBJECTIVE: To investigate the efficacy of periarticular corticosteroid treatment of the sacroiliac
joint (SIJ) in non-spondylarthropathic patients with chronic low back pain in the region of the SIJ in a double blind, controlled study. METHODS:
Twenty-four consecutive non-spondylarthropathic patients with chronic pain in the region of the SIJ entered the study. Thirteen patients were treated with
a periarticular injection of methylprednisoloneacetate and lidocaine (MP group) of the SIJ, whereas 11 patients received isotonic sodium chloride and
lidocaine. Clinical assessment at the onset of the study and after one month included the patient's estimation of pain in the region of the SIJ by the visual
analogue scale (VAS) and by a pain index, which was calculated from tenderness and stressing tests on the SIJ. RESULTS: At the one month's follow-up
examination both the VAS (p = 0.047) and the pain index (0.017) had improved significantly in the MP group compared with the non-MP group.
CONCLUSION: These results suggest that periarticular injection of methylprednisolone may be effective in the treatment of pain in the region of the SIJ
in non-spondylarthropathic patients.
Am J Phys Med Rehabil. 2001 Jun;80(6):425-32. Fluoroscopically guided therapeutic sacroiliac joint injections for sacroiliac joint syndrome. Slipman CW,
Lipetz JS, Plastaras CT, Jackson HB, Vresilovic EJ, Lenrow DA, Braverman DL. The Penn Spine Center, Department of Rehabilitation Medicine,
Philadelphia 19104, USA. OBJECTIVE: To investigate the outcomes resulting from the use of fluoroscopically guided therapeutic sacroiliac joint injections
in patients with sacroiliac joint syndrome. DESIGN: A retrospective study design with independent clinical review was utilized. Thirty-one patients were
included; each patient met specific physical examination criteria and failed to improve clinically after at least 4 wk of physical therapy. Each patient
demonstrated a positive response to a fluoroscopically guided diagnostic sacroiliac joint injection. Therapeutic sacroiliac joint injections were administered
in
conjunction with physical therapy. Outcome measures included Oswestry scores, Visual Analog Scale pain scores, work status, and medication usage.
RESULTS: Patients' symptom duration before diagnostic injection averaged 20.6 mo. An average of 2.1 therapeutic injections was administered. Follow-up
data collection was obtained at an average of 94.4 wk. A significant reduction (P = 0.0014) in Oswestry disability score was observed at the time of follow-up.
Visual Analog Scale pain scores were reduced (P < 0.0001) at the time of discharge and at follow-up. Work status was also significantly improved at the time
of discharge (P = 0.0313) and at follow-up (P = 0.0010). A trend (P = 0.0645) toward less drug usage was observed. CONCLUSIONS: These initial findings
suggest that fluoroscopically guided therapeutic sacroiliac joint injections are a clinically effective intervention in the treatment of patients with sacroiliac
joint syndrome. Controlled, prospective studies are necessary to further clarify the role of therapeutic injections in this patient population.
Curr Rev Pain. 2000;4(5):356-61. Anatomy and pathophysiology of the sacroiliac joint. Calvillo O, Skaribas I, Turnipseed J. Center for Pain Medicine,
Department of Anesthesiology, Baylor College of Medicine, 6560 Fannin, Suite 1900, Houston, TX 77030, USA. ocalvillo@mysurgeon.com The sacroiliac
joint as a source of chronic pain has been a subject of debate for a long period of time. This controversy stems from the inherent anatomic location of the
sacroiliac joint. Adjacent spinal structures may cause pain to be referred to the sacroiliac joint, thus making a precise diagnosis difficult. The most reliable
method to establish the diagnosis of sacroiliac arthralgia is fluoroscopic-guided intra-articular injection of a local anesthetic preceded by a sacroiliac
arthrogram. Although there are many therapeutic options for sacroiliac joint syndrome, the ideal treatment has not yet been discovered. There is evidence
that intra-articular viscosupplementation of the sacroiliac joint with hylan can consistently and reliably induce a prolonged analgesic response in sacroiliac
joint syndrome. Viscosupplementation restores joint homeostasis, allows increased joint motion, and induces analgesia. Hylan is highly viscoelastic
hyaluronan (hyaluronic acid), and is capable of increasing the viscoelastic properties of synovial fluid.
Clin Exp Rheumatol. 1999 Jan-Feb;17(1):88-90. Periarticular corticosteroid treatment of the sacroiliac joint in patients with seronegative
spondylarthropathy. Luukkainen R, Nissila M, Asikainen E, Sanila M, Lehtinen K, Alanaatu A, Kautiainen H. Satalinna Hospital, Harjavalta and
Rheumatism Foundation Hospital, Heinola, Finland. OBJECTIVE: To evaluate the efficacy of periarticular corticosteroid injection of the sacroiliac joint
(SIJ) in patients with seronegative spondylarthropathy in a double blind, controlled study. METHODS: 20 patients with seronegative spondylarthropathy and
clinical sacroiliitis entered the study. In 10 patients one affected SIJ was treated with periarticular injection of 1.5 ml (40 mg/ml) methylprednisoloneacetate
and 1.5 ml (20 mg/ml) lignocaine (MP group), whereas 10 patients received 1.5 ml isotonic sodium chloride and 1.5 ml (20 mg/ml) lignocaine (non-MP
group). Clinical assessment at the onset of the study and after two months follow-up included the patients' estimation of pain in the SIJ by the visual
analogue scale (VAS) and by a pain index which was calculated from tenderness and stressing tests on the SIJ. RESULTS: At the two months follow-up
examination the VAS (p = 0.02) and the pain index (p = 0.01) had improved significantly in the MP group compared with the non-MP group. CONCLUSION:
The results of our study indicate that the periarticular injection of methylprednisolone may be effective in the treatment of clinical sacroiliitis in patients
with seronegative spondylarthropathy.
Br J Rheumatol. 1996 Aug;35(8):767-70. Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies: a double-blind study.
Maugars Y, Mathis C, Berthelot JM, Charlier C, Prost A. Department of Rheumatology, Nantes University Hospital Centre, France. Despite previously
carrying out a first open study of sacroiliac injection of long-acting corticosteroid, it was not possible to evaluate the role of a placebo effect. We therefore
performed a double-blind study in 10 patients/13 articulations, suffering painful sacroiliitis. At 1 month, 5/6 sacroiliac joints injected with corticosteroid
described a relief of > 70%, in comparison to 0/7 of the placebo group (P < 0.05). Dolometry showed a marked decrease in the corticosteroid group from
(mean +/- S.E.M.) 6.8 +/- 0.6 to 1.3 +/- 0.3, and decreases were mild in the placebo group: 7.0 +/- 0.6 to 5.2 +/- 0.5 (P < 0.005). Six of the seven sacroiliac
joints of the placebo group and two patients with failure and relapse of the corticosteroid group were reinjected with corticosteroid. At 1 month, 12/14
(85.7%) were assessed as having a good result. Results were still significant at 3 months (62%) and 6 months (58%). Tolerance was good or very good in
86% of the cases, and we did not report any notable complication. This technique is safe and very efficient, and it has to be considered more widely in
patients with contraindications or complications with NSAID, or if the medical treatment is unable to control sufficiently the active sacroiliitis.
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