Presented at the 2013 AAPM Annual Meeting « Back

Ultrasound for Sacroiliac Joint Injection: Evaluation of the Efficacy of Two Image-Guided Techniques for Sarcoiliac Joint Injection

Neilesh Soneji, MD FRCPC, neilesh.soneji@mail.utoronto.ca¹, Rachael Seib, MD², Anuj Bhatia, MBBS MD FRCA FRCPC FIPP EDRA¹, Paul Tumber, MD FRCPC², Philip Peng, MBBS FRCPC¹, (1) Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada, (2) University of Toronto, Toronto, Ontario, Canada

Introduction: Fluoroscopy is commonly utilized to guide sarcroiliac joint (SIJ) injections for patients with suspected sacroiliitis. However, fluoroscopy is associated with potential disadvantages including radiation exposure, expense, and lack of availability resulting in prolonged wait times. Ultrasound guidance (US) for needle placement has been used as an alternative in recent studies. Although clinical outcomes have been promising, more data is required to effectively compare the efficacy of fluoroscopy and US for SIJ injection. Materials and Methods: This was a prospective, single blinded, randomized controlled trial in which the follow up assessor was blinded. Patients were randomized to receive either fluoroscopy or US guided SIJ injection. In both groups confirmation of needle placement was obtained using contrast. Subsequently 3 mL of 0.25% bupivacaine with 1:200,000 epinephrine and 40mg of depomedrol was administered. The primary outcome was comparison of the numeric pain rating scale (NRS) prior to the procedure and at 1 month. Secondary outcomes included incidence of intra-articular injections using the two techniques, number of needle adjustments required, improvement in functional outcome at 1 month and NRS at 3 months. This study was approved by the local UHN Research Ethics Board. Results: Thus far 23 patients have been enrolled in the study with full follow up results available. Target recruitment of 40 patients to detect a 30% difference in NRS pain scores at 1 month will be complete by December 2012 and full analysis of results will be completed by February 2013. Conclusions: Final conclusions will be presented at the AAPM meeting. References: 1) Pekkafahli MZ, Kiralp MZ, Basekim CC, et al. Sacroiliac joint injections performed with sonographic guidance. J Ultrasound Med 2003;22:553-9 2) Klauser A, De Zordo T, Feuchtner G, et al. Feasibility of ultrasound-guided sacroiliac joint injection considering sonoanatomic landmarks at two different levels in cadavers and patients. Arthritis and Rheumatism 2008;59(11):1618-24.

Funding: None

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