Name of the Procedure:

Common Name: Sacroiliac Joint Injection
Technical Term: Injection procedure for sacroiliac joint; provision of anesthetic, steroid, and/or other therapeutic agent, with or without arthrography (HCPCS Code: G0260)

Summary

A sacroiliac joint (SI joint) injection is a minimally invasive procedure in which an anesthetic, steroid, or other therapeutic agent is introduced into the sacroiliac joint to alleviate pain and inflammation. It can also include an arthrogram—an imaging technique designed to enhance the diagnostic accuracy of the injection.

Purpose

Medical Conditions Addressed:

• Lower back pain
• Sacroiliitis (inflammation of the sacroiliac joint)
• Ankylosing spondylitis
• Other SI joint-related conditions

Goals:

• Relieve pain and inflammation in the SI joint
• Improve joint function and mobility
• Aid in the diagnosis and differentiation of SI joint pain from other sources of lower back pain

Indications

Symptoms or Conditions:

• Persistent lower back pain not relieved by conservative treatments
• Pain that radiates to the buttocks, hips, or thighs
• Limited mobility due to joint pain
• Inflammation identified through imaging studies

Patient Criteria:

• Positive response to diagnostic SI joint block
• Patients who did not respond to physical therapy, medication, or other non-invasive treatments

Preparation

Pre-Procedure Instructions:

• Fasting for at least 6 hours prior to the procedure
• Adjustments to medications, particularly blood thinners, as directed by your healthcare provider
• Complete any necessary blood tests or imaging studies

Diagnostic Tests:

• MRI, CT scan, or other imaging studies to confirm the source of pain

Procedure Description

1. Positioning and Sterilization: The patient will lie on their stomach, and the area around the sacroiliac joint will be sterilized.
2. Local Anesthesia: A local anesthetic may be administered to numb the injection site.
3. Needle Insertion: Using fluoroscopy (X-ray guidance), a needle is carefully inserted into the sacroiliac joint.
4. Contrast Injection (if arthrography is performed): A contrast dye may be injected to confirm correct needle placement.
5. Therapeutic Injection: The therapeutic agent (anesthetic, steroid) is injected into the joint.
6. Removal and Bandaging: The needle is removed, and a small bandage is applied.

Tools and Technology:

• Fluoroscope for imaging guidance
• Sterile needle and syringes
• Anesthetic, steroid, contrast dye for arthrography

Anesthesia:

• Local anesthesia at the injection site

Duration

The procedure typically takes about 30 minutes.

Setting

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

Personnel

• Interventional radiologist or pain management specialist
• Nurses
• Radiology technicians (if fluoroscopy or arthrography is used)

Risks and Complications

Common Risks:

• Temporary increase in pain at the injection site
• Bleeding or bruising

Rare Risks:

• Infection
• Allergic reaction to the anesthetic or contrast dye
• Nerve damage

Management:

• Monitoring for adverse effects
• Antibiotics for infection
• Additional medical treatments as needed for complications

Benefits

• Pain relief that can last for weeks to months
• Improved mobility and joint function
• Greater ability to perform daily activities

Recovery

Post-Procedure Care:

• Rest for the remainder of the day
• Avoid strenuous activities for 24-48 hours
• Apply an ice pack to reduce swelling

Expected Recovery Time:

• Most patients can resume normal activities within a few days
• Follow-up appointments may be necessary to assess the effectiveness and decide on further treatment

Alternatives

Other Treatment Options:

• Physical therapy
• Oral pain medications
• Radiofrequency ablation
• Surgical intervention

Pros and Cons of Alternatives:

• Physical therapy and medications are less invasive but may not provide sufficient relief.
• Radiofrequency ablation offers longer-lasting pain relief but is more invasive.
• Surgery is a last resort due to higher risks and longer recovery time.

Patient Experience

During the Procedure:

• Mild discomfort from the needle insertion
• Pressure sensation during the injection

After the Procedure:

• Possible soreness or mild pain at the injection site
• Pain relief typically begins within a few days
• Ice packs and over-the-counter pain relief can help manage discomfort