Sacroiliac Joint Injection

Patient Position: Prone on the fluoroscopy table.

Indications: Sacroiliac pain syndrome.

Needle Size: 22-gauge, 88-mm spinal needle.

Medication/Volume: 0.5% bupivacaine 2 mL plus 40 mg methylprednisolone.

Anatomic Landmarks: Posterior superior iliac spine and sacrum.

Approach and Technique: After sterile preparation of the region, the sacroiliac joint is identified under fluoroscopy in the anteroposterior view (Fig. 70-1A).
To gain access to this joint space, the fluoroscopic beam must be
rotated approximately 15° to 30° to the opposite side of the joint to
locate the posterior face of the sacroiliac joint, and then 20° to 30°
cephalad and caudad (Ferguson view; Fig. 70-1B).
Two separate injections can be performed. The first injection is aimed
at the inferior one-third of the joint. Accordingly, the 22-gauge
spinal needle is aimed in the same direction as the fluoroscopic beam
to gain access to the joint. A loss of resistance is often felt as the
joint space is entered. Next, the superior one-third of the joint space
is entered in a similar fashion. To help confirm the joint space
location, 0.5 to 1.0 mL of contrast dye can be injected prior to the
injection of the local anesthetic mixture.