Is fluoroscopy necessary for sacroiliac joint injections?

The use of sacroiliac joint injection has been a steadily increasing for therapeutic and diagnostic purposes in the United States. Because of the conceivably easy accessibility of sacroiliac joint and reported low incidence of morbidity, the sacroiliac joint injection is felt to be a procedure that maybe performed easily in the office based setting. While this procedure may be common, the sacroiliac joint injection is not performed accurately without the aide of imaging. Further complicating the issue of sacroiliac joint injections is the lack of specific and reliable diagnostic testing. Clinical evaluation and imaging studies are often unreliable and practitioners often mistakenly assume that pain over the posterior superior iliac spine is pathognomonic for sacral joint pain. In addition, referral patterns are unreliable and bedside testing is often non-diagnostic. Sixty patients undergoing sacroiliac joint injections were studied. Sacroiliac joint injections were placed blindly then examined under fluoroscopy for accurate needle placement. The needle was placed by a single this experienced spinal injectionist. Results of blind needle placement revealed that only 5 of 60 patients were felt to have needle placement approximating a therapeutic point of contact with the sacroiliac joint. Furthermore, the posterior superior iliac spine, was found to be a poor indicator of sacroiliac joint anatomic access. The results of this study show that accurate placement of sacroiliac joint injections is successful without fluoroscopy in only 12% of the patients, even in experienced hands.