Journal of Pain Research (Feb 2024)
Efficacy of Lateral View Needle Placement for Sacroiliac Joint Injections
Abstract
Phillip Mitchell Johansen,1,* Alan M Nguyen,2,* Ali Ahmed Mohamed,1,* Natasha Mehta,2,* Julie Georgia Pilitsis,1,* Benjamin Westerhaus,2,* Anthony Giuffrida2,* 1Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA; 2Cantor Spine Institute, Fort Laderdale, FL, USA*These authors contributed equally to this workCorrespondence: Phillip Mitchell Johansen, Charles E. Schmidt College of Medicine Florida Atlantic University, 777 Glades Road, BC 71, Room 235, Boca Raton, FL, 33431, USA, Tel +1 (561) 297-4341, Email [email protected]: Sacroiliac joint (SIJ) pathology is typically diagnosed and treated with fluoroscopy-guided intraarticular injections. Most practitioners use only an anteroposterior (AP) or oblique view. Although injection into the periarticular space may yield adequate pain relief, intraarticular needle placement is imperative to identify SIJ pathology and plan future management. This study highlights the importance of obtaining an additional lateral view during fluoroscopy to better evaluate SIJ disease.Methods: A retrospective review of 38 patients who underwent fluoroscopy guided SIJ injection was conducted, for which IRB approval was granted by the MetroWest Medical Center Institutional Review Board. Patient demographics (age, sex, BMI) and pre- and post-operative numerical rating scale (NRS) scores were collected, and initial needle location was reviewed. Patients were placed into groups according to initial needle location. Statistical analysis was conducted using a Mann–Whitney U-test with significance defined as p < 0.05.Results: The 21 females and 17 males had a mean age and BMI of 70.5 years and 27.8 kg/m2, respectively. Thirty-one patients had initial intraarticular needle placement confirmed with lateral arthrogram, and 7 patients had initial periarticular needle placement, requiring needle readjustment in lateral confirmatory view. Both groups had similar demographic characteristics. No statistically significant differences were found between the two groups’ mean NRS score improvement (p=0.108).Conclusion: Using only the AP or oblique view during needle placement results in miss rates of nearly 20% while adding a lateral view can lower miss rates to near 0%. While pain relief may be adequate in either case, proper diagnosis and future management relies upon accurate needle placement.Keywords: corticosteroid injections, fluoroscopy, intraarticular, periarticular
