Non-image Guided, In-Office SI Joint Injections

Research Objectives: The purpose of this retrospective cohort study was to examine the efficacy and clinical application of landmark-guided injections for the treatment of SIJ pain.

Design: Retrospective chart review

Setting: Single center, ambulatory

Participants: 311 subjects, male and female 18 years of age and older.

Interventions: 3-year retrospective chart review of 311 patients. Four patients with a history of image-guided or fluoroscopy-guided SIJ injections were excluded. Of these 311 patients, 191 patients returned for follow-up and reported the degree and duration of relief from injection treatment. Patients’ self-reported measures to the provider's common follow-up questions were assessed in the electronic medical record from their follow-up visits. The two outcomes of interest are the length of relief, measured in weeks, and percent relief. Secondary outcomes include adverse side effects reported.

Main Outcome Measures: Subject self-reported measures to include length of relief measured in weeks and percentage of relief. Secondary outcomes include adverse side effects reported.

Results: The mean length of relief reported was 8.88 weeks. The average percent relief reported was 53.55%. No comparisons between outcomes and covariates were statistically significant. Adverse side effects reported included: two patients with increased low back pain, one patient reported an irregular menstrual cycle, and one patient reported vaginal bleeding unrelated to menstruation. No other adverse side effects were reported.

Conclusions: Landmark-guided SIJ injections are a reasonable and safe treatment option for SIJ-derived low back pain, as our patient population had on average greater than 50% sustained relief for over 2 months. A previous case-controlled study comparing fluoroscopy-guided SIJ injections to landmark-guided SIJ injections found no significant difference in positive diagnostic injections and comparable benefits on most measures for SIJ pain relief. These landmark-guided SIJ injections are an affordable and accessible option that can be done quickly in the clinic. Future prospective studies are necessary to further evaluate the effectiveness of landmark-guided injections. Further studies should also investigate patients’ degree and length of relief from multiple subsequent periarticular injections.

Author(s) Disclosures: Claudia Bale
William Bader, PA-C
Joshua Herzog, MD
Erin Brown, LPN