64451 Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)

Name of the Procedure:

Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography). Common names include SI Joint Injection, Sacroiliac Joint Injection with Image Guidance.

Summary

This procedure involves injecting anesthetic or steroid medication into the nerves that supply the sacroiliac (SI) joint, using imaging techniques like fluoroscopy or computed tomography (CT) to guide the needle precisely.

Purpose

This procedure is used to diagnose and treat pain originating from the sacroiliac joint. The goal is to reduce inflammation and provide pain relief, which can help improve mobility and function.

Indications

• Persistent lower back pain suspected to originate from the SI joint
• SI joint dysfunction due to conditions like arthritis, injury, or inflammation
• Diagnostic purposes to confirm SI joint as the pain source
• Patients who have not found relief through conservative treatments like physical therapy or medication

Preparation

• Patients may need to fast for a few hours before the procedure
• Blood tests or imaging studies (like MRI or X-rays) might be done prior
• Medication adjustments, such as stopping blood thinners, may be required

Procedure Description

1. The patient is positioned on a procedure table, usually lying face down.
2. The skin over the SI joint is cleaned and sterilized.
3. A local anesthetic is administered to numb the skin and deeper tissues.
4. Using fluoroscopy or CT, the physician guides a needle to the target area around the SI joint.
5. Contrast dye may be injected first to ensure correct placement.
6. Anesthetic and/or steroid medication is injected slowly into the region.
7. The needle is removed and a small bandage is applied.

Duration

The procedure typically takes 30-45 minutes.

Setting

The procedure is usually performed in an outpatient clinic, hospital, or a specialized surgical center.

Personnel

• Interventional pain specialist or radiologist
• Nurse or medical assistant
• Radiologic technologist
• Anesthesiologist (if sedation is needed)

Risks and Complications

• Common: Temporary soreness at the injection site, bleeding, or bruising
• Rare: Infection, allergic reaction, nerve damage, temporary or permanent increase in pain
• Management: Most risks are managed with observation, medications, or rarely, additional procedures

Benefits

• Expected benefits include reduced pain and inflammation in the SI joint
• Improved function and mobility
• Pain relief may last from several weeks to months

Recovery

• Patients are usually monitored for a short period after the injection and can often go home the same day
• Instructions typically include rest, avoiding heavy lifting, and monitoring for signs of infection
• Recovery time varies; patients may resume normal activities within a few days
• Follow-up appointments may be scheduled to assess progress and need for further treatment

Alternatives

• Physical therapy
• Oral or topical medications
• Radiofrequency ablation
• Surgery (e.g., SI joint fusion)
• Pros: Non-invasive options like physical therapy reduce procedural risks
• Cons: Alternative treatments may not provide the same level of pain relief or duration of effectiveness

Patient Experience

• During the procedure: Mild discomfort or pressure when the needle is inserted and medication injected
• After the procedure: Some soreness at the injection site, pain relief could take a few days to be noticeable
• Pain management: Over-the-counter pain relievers can be used as needed, comfort measures like ice packs may help