Structural problems within the sacroiliac joints are a common cause of lower back pain. In some cases, pain can also be felt in the legs, buttocks, and groin. What is the solution? When arthritis is the cause, sacroiliac injection is a good option. It is a better option when guided by medical imaging, like fluoroscopy.
Lone Star Pain Medicine is a Weatherford, TX pain clinic that offers sacroiliac injections among their many pain treatments. They explained that medical imaging is one of the keys to performing successful injections. The reason is fairly simple: needle placement determines where medicine goes when injected. Improper placement could mean inadequate pain relief.
The Basics of Sacroiliac Injections
The joint found where the spine connects with the pelvis is known as the sacroiliac joint. There are actually two of them. Unfortunately, sacroiliac joints are highly susceptible to arthritis and degeneration. This is because they take a lot of abuse via walking, standing, and even sitting.
Sacroiliac joint injections offer pain relief through a combination of anesthesia and steroids. Long term relief is a matter of two processes. First, the anesthetic provides immediate pain relief in much the same way Novocain provides relief from tooth pain. Meanwhile, the steroids gradually reduce inflammation. Between the two, many patients enjoy long term pain relief that can last for several months at a time.
Needle Placement Is Key
One of the goals of sacroiliac injections is to treat a very targeted area. You are not looking at a large volume of medicine with a single injection, so doctors neither want to waste that medicine nor put it in the wrong place. Therefore, needle placement is key.
Doctors tend to rely on fluoroscopy to guide needle placement. Fluoroscopy utilizes tried-and-true x-ray technology to produce real-time images that can account for movement. If you can imagine combining ultrasound with x-ray, you have a basic understanding of how it works.
During a typical treatment, a doctor will turn to fluoroscopy to show exactly where the needle is in relation to the joint in question. If placement is not exactly right, the needle might have to be adjusted. Fortunately, doctors also use a topical anesthetic to minimize the pain of needle insertion.
Doctors Do Miss
As helpful as fluoroscopy is to guide needle placement, doctors do miss from time to time. How often? A 2023 research study published in the Pain journal suggests that the miss rate when doctors utilize an oblique only view is about 20%. That is the bad news.
The good news is that researchers found a way to reduce the miss rate to near zero: add a lateral view to the equation. Combining both oblique and lateral views gives a doctor a clearer understanding of needle placement in relation to the affected joint.
Here is something else to consider: if the miss rate with the oblique view only is as high as 20%, imagine what it must be among doctors who do not utilize fluoroscopy. They are out there. Some pain management doctors rely exclusively on their own experience and understanding of human anatomy.
Placement Affects Pain Relief
It makes sense that needle placement affects pain relief among patients receiving sacroiliac injections. If the needle lands nowhere near the affected joint, the medicine may never reach its intended destination. It is useless. Get the medicine where it’s supposed to go, and you get pain relief as a result.
To improve needle placement, growing numbers of pain management doctors are utilizing fluoroscopy. The medical imaging procedure shows them exactly where to place the needle for maximum sacroiliac injection effectiveness.
