Peripheral Nerve Blocks: A Color Atlas, 3rd Edition

70. Sacroiliac Joint Injection

Nashaat N. Rizk

Albert J. Carvelli

Patient Position: Prone on the fluoroscopy table.

Indications: Sacroiliac pain syndrome.

Needle Size: 22-gauge, 88-mm spinal needle.

Medication/Volume: 0.5% bupivacaine 2 mL plus 40 mg methylprednisolone.

Anatomic Landmarks: Posterior superior iliac spine and sacrum.

Approach and Technique: After sterile preparation of the region, the sacroiliac joint is identified under fluoroscopy in the anteroposterior view (Fig. 70-1A). To gain access to this joint space, the fluoroscopic beam must be rotated approximately 15° to 30° to the opposite side of the joint to locate the posterior face of the sacroiliac joint, and then 20° to 30° cephalad and caudad (Ferguson view; Fig. 70-1B). Two separate injections can be performed. The first injection is aimed at the inferior one-third of the joint. Accordingly, the 22-gauge spinal needle is aimed in the same direction as the fluoroscopic beam to gain access to the joint. A loss of resistance is often felt as the joint space is entered. Next, the superior one-third of the joint space is entered in a similar fashion. To help confirm the joint space location, 0.5 to 1.0 mL of contrast dye can be injected prior to the injection of the local anesthetic mixture.

Tips

1.   The feeling of a “pop” or loss of resistance when advancing the needle can be misleading. The joint space itself can be difficult to enter with the needle. Always reconfirm the correct positioning of the needle with fluoroscopy.

 

Figure 70-1. A: Anteroposterior view. B: Ferguson view.

Suggested Readings

Kransdorf MJ. Sacroiliac joint injection. In: Fenton DS, Czervionke LF, eds. Image-guided spine intervention. Philadelphia: WB Saunders, 2003.

Manning DC, Rowlingson JC. Back pain and the role of neural blockade. In: Cousins MJ, Bridenbaugh PO, eds. Neural blockade in clinical anesthesia and management of pain, 3rd ed. Philadelphia: Lippincott-Raven, 1998.