Serial Therapeutic Sacroiliac Joint Injections: A Practice Audit

[Justin]

Pain Medicine
Volume 10 Issue 5, Pages 850 - 853
Published Online: 6 Jul 2009

SPINE SECTION
Original Research Article

Serial Therapeutic Sacroiliac Joint Injections: A Practice Audit

James Hawkins, MD,* and Jerome Schofferman, MD †
*Arizona Spine Care, Phoenix, Arizona; † SpineCare Medical Group, San Francisco Spine Institute, San Francisco, California, USA
Correspondence to Jerome Schofferman, MD, SpineCare Medical Group, 1850 Sullivan Ave, Daly City, CA 94015, USA.
© 2009 American Academy of Pain Medicine

Objective. To determine the long-term response to serial sacroiliac joint (SIJ) corticosteroid injections.

Design. Retrospective practice audit.

Setting and Patients. Tertiary care spine center. Review of charts of all patients in a single practice who underwent diagnostic and therapeutic fluoroscopically guided SIJ injections with combined local anesthetic, long-acting corticosteroid, and contrast.

Measures. Response was evaluated at 1 hour and again at follow-up clinic visits. Response to injection was graded as positive if there was ≥50% relief of the targeted pain during the local anesthetic phase and at least 2 weeks of ≥50% relief afterward. If pain recurred, patients had to have been sufficiently satisfied with the relief to request repeat injection.

Results. There were 164 patients; 5 had incomplete records, 4 had <2 year follow-up. Of the 155 patients, 120 (77%) were positive responders; 45 were men and 75 were women; and the mean age was 48 (27–91) years. Sixty-nine had prior lumbar surgery. Mean duration of follow-up was 44 months (26–101). Two were lost to follow-up. The 118 positive responders received a mean of 2.7 injections per patient. Forty patients required 1 injection only, 29 required two, 22 required three, and 27 required four or more. The mean duration of response for those receiving >1 injection was 9.3 months per injection (1–58). There were no adverse events.

Conclusions. SIJ corticosteroid injections appear to be an effective palliative treatment for selected patients with SIJ pain. Most patients whose pain is responsive to SIJ steroid injections improved sufficiently and remained well after 1 to 3 injections, but some required frequent injections on a long-term basis.

[Terry Newton]

Justin:

This is such great research here. I have been concerned about the long term effects of receiving these types of injections. Are there any side effects noted? I have heard about possible issues concerning bone density issues after these injections. Old wives tales? Worth having bone density tests to be on the safe side?

I have had two sets of injections this year. The first was in April and the second set was this past Friday. They typically take a few weeks for me to get the maximum benefit and last for several months.

Thank-you for posting such relevant research articles.

You da man!

[Justin]

Justin:

This is such great research here. I have been concerned about the long term effects of receiving these types of injections. Are there any side effects noted? I have heard about possible issues concerning bone density issues after these injections. Old wives tales? Worth having bone density tests to be on the safe side?

There was a great review article recently published on sacroiliac joint injections and side effects (decreased bone density, etc.). I will pull it up and post it later today.

Thank-you for posting such relevant research articles.

You da man!

Sure thing, Terry. Knowledge is power.

[Greg]

Conclusions. SIJ corticosteroid injections appear to be an effective palliative treatment for selected patients with SIJ pain. Most patients whose pain is responsive to SIJ steroid injections improved sufficiently and remained well after 1 to 3 injections, but some required frequent injections on a long-term basis.

I just wish I could be one the people who had positive results from this injection. They did 3 in my sacroilliic joints after having 3 done for my S1 areas. The general rule is supposed to be no more than 3 in a year but I ended up with 6 in 3.5 months. Doctors said I was healthy enough and not having any adverse reactions to the steroids. I guess this just shows that my problems are not related to inflamation that hasnt already subsided as much as it will. It was worth a shot though. I couldnt believe the cost being charged. Somewhere between 2-3000 dollars. But this is healthcare in America so what can you do?

[Justin]

I just wish I could be one the people who had positive results from this injection. They did 3 in my sacroilliic joints after having 3 done for my S1 areas. The general rule is supposed to be no more than 3 in a year but I ended up with 6 in 3.5 months. Doctors said I was healthy enough and not having any adverse reactions to the steroids. I guess this just shows that my problems are not related to inflamation that hasnt already subsided as much as it will. It was worth a shot though. I couldnt believe the cost being charged. Somewhere between 2-3000 dollars. But this is healthcare in America so what can you do?

Hey Greg,

I understand about the cost. I did a series of two injections last year and I paid about $3000, which is a huge chunk of change no matter how you look at it.

BTW Terry: the publication I have is about recommendations / quality of evidence for sacroiliac joint injections. I'll keep an eye out for new publications for you.

[Sara]

Wow,

What that price with or without health insurance? I just got my first one done last Wednesday so I haven't seen the bill yet...

Thank you

[Justin]

Wow,

What that price with or without health insurance? I just got my first one done last Wednesday so I haven't seen the bill yet...

Thank you

With insurance.