Sacroiliac joint injection is used to treat inflammation of the sacroiliac joints secondary to trauma, rheumatoid arthritis, degenerative joint disease, or stress secondary to mechanical changes in posture or gait.
After informed consent is obtained, the patient is placed in the prone position. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure. A 6-in. (16-cm), 22-gauge needle is inserted. The needle is advanced under fluoroscopy to the joint. After negative aspiration, joint penetration is confirmed with 1 mL of diatrizoate meglumine injection USP 60% (Renografin-60). After needle location is confirmed, a 1.5 to 2.0 mL (64) mixture of 40 mg of methylprednisolone acetate (or equivalent) and local anesthetic is injected (Fig. 67-48).
FIGURE 67-48. Sacroiliac joint injection. A: Fluoroscopic approach for right sacroiliac joint. B: Approach for sacroiliac joint injection.
The sacroiliac joint is difficult to aspirate, owing to the depth and bony structures. Fluoroscopic guidance with the use of contrast media is recommended. It is rare to aspirate fluid from this joint.
Serious complications are uncommon with appropriate needle placement.