Sacro-iliac joint injections are used primarily as a diagnotistic tool but also can be used as a treatment. The steroid part of the injection helps to reduce pain and inflammation in the sacro-iliac joints. The local anaesthetic part of the injection serves as the diagnostic tool and helps to confirm, or exclude, whether all or part of your pain is originating from the sacro-iliac joint and this allows to plan for approriate further treatment.
Mr Hilton performs all sacro-iliac joint injections in theatre and under X-ray guidance. Most patients have the procedure performed under sedation as manipulation of the joint is required and that can be quite painful. However if you prefer, then of course you can have the procedure performed under local anaesthetic .
Sacro-iliac joint injections are primarily a diagnostic procedure. However in some patients, the injections can be used as a treatment to relieve low back, groin and leg pain which is caused by inflammation within the joint. Sacro-iliac joint injections have relatively few risks and complications (see below) and are minimally invasive.
One question that is always asked: How long will it last?
Remember! This is primarily a diagnostic tool.
Therefore it is very important to note any pain relief/changes in the first 8 hours. If the benefit is only short-lived or you gain no benefit at all, at anytime (especially in the first 8 hours), it maybe very disappointing but do not worry; it has not failed. It has been diagnostically very useful to help determine whether the pain is originating from the sacro-iliac joint or not. It can also help determine whether there is a combination of the SI joint and the spine or hip causing the pain. This is extremely useful when surgery is being considered.
If you have a good response the injection, no matter how long it lasts for, the injection will be repeated a second time if surgery is to be considered; two positive results are required to confirm the diagnosis.
Post-injection pain reduction:
≥ 50% SI Joint is likely to be the source of the pain
< 50% SI Joint may be part of the cause of the pain (ie. dual pathology) but other causes should be looked at.
After you have had the procedure, it is very helpful if you can keep a note as to how your symptoms change especially in the first few hours after the injection and over the next few days.
Questions to ask yourself are:
1) Has the procedure taken my back pain away? For example, has it taken 100%, 75% or 50% of the pain away? Or, alternatively, how much of of the pain is left?
2) If you have leg and groin pain as well, do either of these pains go away?
3) Does your mobility, sitting, sleeping improve?
4) If you also have reduced sensation or pins and needles, does the injections relieve them?
5) What symptoms are still left?
Bring your answers with you to your follow-up appointment.
How are Sacro-Iliac Joint Injections Performed?
Mr Hilton performs all sacro-iliac joint injections under X-ray guidance to guarantee the injection is in exactly the right place. Patients are taken into the operating suite; as already mentioned most patients have the procedure under sedation however you can choose to have it under local anaesthetic. Either way, patients have the procedure lying on their front on the operating table. The image intensifier (X-ray machine) is used to guide a special needle into the correct position in the joint and then a special dye is injected to confirm the correct position on the X-ray before the local anaesthetic and steroid is injected into the joint. The sacro-iliac joint is then manipulated.
Recovery
How long your recovery takes mainly depends on whether you have been sedated or not.
Following the injection you will be taken into the recovery suite where you will monitored until it is safe for you to return to the ward. You will discharged home when comfortable on the day of the procedure.
Following sacro-iliac joint injections, patients should not drive for 24 hours. You should return to normal activity and exercise as you feel comfortable.
Risks and Complications of Scaro-iliac Joint Injections
(about 1 in 5000)
Infection, bleeding, DVT/PE, facial flushing, allergic reaction, nerve damage, CVA (stroke), recurrence or failure to relieve symptoms.
Occasionally, after the sacro-iliac joint injection, patients experience temporary decreased sensation or numbness in their legs or perineum. Do not be alarmed this is due to local anaesthetic and will usually recover in 6 – 8 hours.