Sacroiliac Joint Injection: Comparison of Xray Versus Ultrasound

University Health Network, Toronto

Status: Completed

Conditions: Sacroiliac Joint Arthritis Causing Low Back Pain

Treatments: Procedure: Sacroiliac Joint Injection

Study type: Interventional

Funder types: Other

Identifiers

NCT01719081

11-0880-AE

Details and patient eligibility

About

This project involves the assessment of the efficacy of two different image guided techniques in patients with low back pain due to arthritis of the sacroiliac joint (SIJ). Intra-articular injection of local anesthetics and steroids is performed to relieve pain originating from the SIJ. Fluoroscopy has been used traditionally for image guidance for this procedure but there is a growing interest in use of ultrasound (US) for this procedure. US avoids radiation exposure to the patient and the health care team (HCT) and is less expensive. We aim to compare procedural efficacy related outcomes for SIJ injections performed using these image-guided modalities.

Full description

The study is a prospective, randomized trial. Patients with low back pain which is diagnosed secondary to SIJ disease will be identified beforehand in clinic and offered a therapeutic joint injection. Informed consent will be obtained. Patients will be randomized for SIJ block with 3 mL of 0.25% bupivacaine with 1:200,000 epinephrine and 40 mg depomedrol using guidance with ultrasound or fluoroscopy. In both groups, confirmation of needle placement will be obtained using contrast injection imaging before the injection is performed. Record will be made of the number of times the needle is correctly placed into the articular space, as well as the number of attempts to do so. The final position of the needle will be recorded. Pain scores will be assessed before the procedure, as well as post-procedure at 24 and 72 hours, as well as 1 week, 1 month, and 3 months. Patients will keep a pain diary and will be followed up at 3 months time in clinic.

Enrollment: 40 patients

Sex: All

Ages: 18 to 85 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Suspicion of SIJ disease on history: pain below the lumbo-sacral junction; pain with full weight-bearing on one leg; pain worse going down hills or inclines; very low back pain associated with groin pain and absence of lumbar symptoms
• Two positive responses to the following maneuver: FABER (flexion abduction and external rotation of hip), POSH (posterior shear test), REAB (resisted abduction)
• Baseline NRS pain score > or = to 4
• Refractory to oral analgesic therapy

Exclusion criteria

• ongoing litigation issues related to the patient's pain
• pregnancy
• allergy to steroids or local anesthetics
• multiple comorbidities
• BMI > 35

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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40 participants in 2 patient groups

Ultrasound Guided SIJ Injection

Experimental group

Description:

Needle placement will be performed under US guidance. Fluoroscopy will be used to confirm needle placement prior to medication injection.

Treatment:

Procedure: Sacroiliac Joint Injection

Xray Guided SIJ Injection

Active Comparator group

Description:

Needle placement will be performed under fluoroscopy.

Treatment:

Procedure: Sacroiliac Joint Injection