Open AccessUltrasound-Guided Sacroiliac Joint Injection Technique
Author(s) -
Dominic Harmon,
Michael E. O’Sullivan
Publication year - 2008
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2008/11/543
Subject(s) - medicine , sacroiliac joint , ultrasound , transducer , sacrum , low back pain , radiology , fluoroscopy , biomedical engineering , anatomy , acoustics , physics , alternative medicine , pathology
We describe a case report and technique for using a portable ultrasound scannerand a curvilinear transducer (4-5MHz) (SonoSite Micromaxx SonoSite, Inc. 2191930th Drive SE Bothwell W. A.) to guide sacroiliac joint (SIJ) injection.A 42-year-old male presented with chronic lower back pain centered on his left SIJ.His pain averaged 7 out of 10 (numerical rating scale). For the ultrasound-guidedSIJ injection the patient was placed in the prone position. The ultrasound transducer was oriented in a transverse orientation at the level of the sacral hiatus. Here thesacral cornuae were identified. Moving the transducer laterally from here, the lateral edge of the sacrum was identified. This bony edge was followed in a cephalad direction with the transducer maintained in a transverse orientation. A secondbony contour, the ileum, was identified. The cleft between both bony contours represented the sacroiliac joint. This was found at 4.5 cm depth. Real-time imagingwas used to direct a 22G spinal needle into the SIJ, where solution was injected under direct vision.The patient’s pain intensity decreased to a 2 out of 10 (numerical rating scale). Function improved and the patient was able to return to work. These improvementswere maintained at 16 weeks. Ultrasound guidance does not expose patients andpersonnel to radiation and is readily accessible.Ultrasound-guided SIJ injections may have particular applications in the management of chronic lower back pain in certain clinical scenarios (e.g. pregnancy). Futurestudies to demonstrate efficacy and reproducibility are needed.Key words: Technique, visualization, real-time, ultrasound, sacroiliac joint.