Sacroilliac (SI) Joint Injections

WHAT ARE SI JOINTJOINT INJECTIONS?

Sacroiliac (SI) joint injections contain a local anesthetic for pain relief and may also include a corticosteroid to reduce inflammation. These injections are used to help diagnose and relieve pain originating from the SI joint, which connects the sacrum (lower spine) to the pelvis.

SI joint dysfunction can cause pain in the lower back, buttocks, hips, groin, and sometimes the legs. Pain and inflammation of the SI joint may occur due to:

• Degenerative Changes: Arthritis, age-related wear and tear, or deterioration of the SI joint.

• Previous Spinal Surgery: Changes in biomechanics and increased stress on the SI joint following lumbar fusion or other spinal procedures.

• Trauma or Injury: Falls, motor vehicle accidents, or other injuries that place excessive stress on the SI joint.

• Pregnancy and Childbirth: Hormonal changes and increased joint mobility that can contribute to SI joint instability and pain.

• Repetitive Stress or Abnormal Joint Movement: Activities or conditions that place excessive strain on the SI joint, resulting in irritation, inflammation, or dysfunction.

HOW ARE SI JOINT  INJECTIONS PERFORMED?
Sacroiliac (SI) joint injections are administered directly into the SI joint, which connects the sacrum (the triangular bone at the base of the spine) to the ilium (pelvic bone). There are two SI joints, one on each side of the pelvis. These joints provide stability, support the weight of the upper body, and help transfer forces between the spine and lower extremities.

SI joint injections are performed using imaging guidance to ensure accurate needle placement. They may be used to identify the source of pain or provide temporary relief from inflammation and discomfort.

INDICATIONS
SI joint injections may be recommended based on a patient's symptoms, physical examination, and clinical evaluation. They are commonly used to diagnose or treat pain associated with:

1. SI Joint Dysfunction: Pain caused by abnormal movement, irritation, or inflammation of the SI joint.

2. Sacroiliac Arthritis: Degenerative or inflammatory changes affecting the SI joint.

3. Lower Back and Buttock Pain: Persistent pain below the lumbar spine that may extend into the buttocks, hips, groin, or legs.

4. Post-Lumbar Fusion Pain: Increased stress on the SI joint following lumbar spinal fusion or other spinal procedures.

5. Trauma or Repetitive Stress: Injuries or activities that place excessive strain on the SI joint.

These injections can help determine whether the SI joint is the primary source of pain and, when corticosteroids are used, may reduce inflammation and provide temporary relief.

WHAT HAPPENS DURING THE PROCEDURE?
You will be taken to the preoperative area, where trained nursing staff will prepare you for the procedure by checking your vital signs and reviewing your medical history and medications. Your blood sugar or coagulation status may also be evaluated if necessary.

Once in the procedure room, you will typically lie face down on a procedure table.
The injection site over the lower back and pelvis is thoroughly cleansed, and a local anesthetic is administered to numb the skin and surrounding tissues to minimize discomfort.

Using fluoroscopic (real-time X-ray) guidance, your physician carefully advances a thin, hollow needle into the SI joint. Fluoroscopy allows the physician to visualize the needle's position and guide accurate placement.
A small amount of contrast dye may be injected to confirm proper needle placement within the joint.
Once the needle is correctly positioned, the physician injects the prescribed medication:

• Diagnostic SI Joint Injection: A local anesthetic is injected to temporarily numb the joint and help determine whether the SI joint is responsible for your pain.

• Therapeutic SI Joint Injection: A local anesthetic and corticosteroid are typically injected to help reduce inflammation and provide temporary pain relief.
   

You may experience mild pressure or discomfort during the injection, but the procedure is generally well tolerated.
After the medication is administered, the needle is removed, and a small sterile bandage is placed over the injection site.
Depending on your symptoms and clinical evaluation, your physician may inject one or both SI joints. The procedure typically takes approximately 15–30 minutes, although the actual injection may take only a few minutes.
Following a diagnostic injection, your physician may ask you to monitor and document your pain relief during the hours immediately after the procedure. This information can help confirm whether the SI joint is the primary source of your pain and guide further treatment recommendations.