Sacroiliac Joint Precision Treatment

Introduction

A 2015 Review of interventional procedures found high heterogeneity, with a meta-analysis not feasible.^[1] In general cooled radiofrequency is the only procedure with RCT evidence [Level 2]

Intraarticular Injections

There are two RCTs based on controlled blocks. An anteroposterior approach is faster and equal in efficacy to the traditional oblique approach.^[2]

SIJ Intraarticular Injections RCTs
Study	N	Arms	Selection Criteria	Results	Comments
Kim et al 2010 (RCT)^[3]	50	Fluoroscopic injections of 25% dextrose prolotherapy, up to 3 times, until >90% relief Fluoroscopic injections of 40mg triamcinolone, up to 3 times, until >90% relief	1 x positive intraarticular block (>50% pain relief)	✅Positive study Success defined as >50% relief 2 weeks: 100% vs 100% 6 months: 63.6% vs 27.2% 15 months: 58.7% vs 10.2% Prolotherapy group needed more injections to reach initial 90% pain reduction (2.7 vs 1.5)	No placebo control Difference in number of injections, single block
Jee et al 2014 (RCT)^[4]	120	Ultrasound guided with colour doppler (1 dominant colour to confirm IA) injection of lidocaine, omnipaque, plus 10mg dexamethasone. Accuracy assessed by fluoroscopy. Fluoroscopically guided injection of same	1 x positive intraarticular block (>80% pain relief)	Focused more on accuracy of ultrasound rather than outcomes Ultrasound group: 87% accuracy, Fluoroscopic group: 98.2% accuracy No difference in pain scores and ODI at 2 and 12 weeks.	Looking at the utility of using ultrasound versus fluoroscopy

References

↑ Simopoulos TT, Manchikanti L, Gupta S, et al. Systematic Review of the Diagnostic Accuracy and Therapeutic Effectiveness of Sacroiliac Joint Interventions. Pain Physician. 2015;18(5):E713-E756.
↑ Pictures from: Chauhan G, Hehar P, Loomba V, Upadhyay A. A Randomized Controlled Trial of Fluoroscopically-Guided Sacroiliac Joint Injections: A Comparison of the Posteroanterior and Classical Oblique Techniques. Neurospine. 2019;16(2):317-324. doi:10.14245/ns.1836122.061
↑ Kim WM, Lee HG, Jeong CW, Kim CM, Yoon MH. A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain. J Altern Complement Med. 2010;16(12):1285-1290. doi:10.1089/acm.2010.0031
↑ Jee H, Lee JH, Park KD, Ahn J, Park Y. Ultrasound-guided versus fluoroscopy-guided sacroiliac joint intra-articular injections in the noninflammatory sacroiliac joint dysfunction: a prospective, randomized, single-blinded study. Arch Phys Med Rehabil. 2014;95(2):330-337. doi:10.1016/j.apmr.2013.09.021

[1] Simopoulos TT, Manchikanti L, Gupta S, et al. Systematic Review of the Diagnostic Accuracy and Therapeutic Effectiveness of Sacroiliac Joint Interventions. Pain Physician. 2015;18(5):E713-E756.

[2] Pictures from: Chauhan G, Hehar P, Loomba V, Upadhyay A. A Randomized Controlled Trial of Fluoroscopically-Guided Sacroiliac Joint Injections: A Comparison of the Posteroanterior and Classical Oblique Techniques. Neurospine. 2019;16(2):317-324. doi:10.14245/ns.1836122.061

[3] Kim WM, Lee HG, Jeong CW, Kim CM, Yoon MH. A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain. J Altern Complement Med. 2010;16(12):1285-1290. doi:10.1089/acm.2010.0031

[4] Jee H, Lee JH, Park KD, Ahn J, Park Y. Ultrasound-guided versus fluoroscopy-guided sacroiliac joint intra-articular injections in the noninflammatory sacroiliac joint dysfunction: a prospective, randomized, single-blinded study. Arch Phys Med Rehabil. 2014;95(2):330-337. doi:10.1016/j.apmr.2013.09.021

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