Sacroiliac Injection

What are sacroiliac injections?

The sacroiliac joints are found in your lower back on the left and right hand sides. These joints are located in the pelvis between the ilium of the pelvis (number 2 in Figure 1) and the sacrum (number 1 in Figure 1). The sacroiliac joint can be the cause of your pain; as a result of osteoarthritis for example. A needle can be inserted into the sacroiliac joint (number 3 in Figure 1) in order to inject drugs. There are also small nerves that are important in passing on pain signals from the sacroiliac joint. By injecting anaesthetic these small nerves can be blocked so that the sacroiliac joint is no longer painful.

pelvisN

Figure 1. The pelvis seen from the back (see text).

What should I be aware of before undergoing sacroiliac injections?

Any of the following situations should be reported to your pain specialist if he proposes sacroiliac injections:

  • If you are pregnant: since X-ray equipment is used, pregnant women may not undergo sacroiliac injections.
  • If you are ill or have fever on the day of treatment you cannot undergo sacroiliac injections and a new appointment has to be made.
  • If you are allergic to iodine, bandages, anaesthetics or contrast fluids, you should notify your pain specialist before the appointment for treatment is made.
  • If you are taking blood thinners, you should notify that your pain specialist before the appointment for treatment is made. He will then consider whether the use of certain medications should be ceased temporarily.

How should I prepare for sacroiliac injections?

  • No special preparations, such as an overnight bag, are necessary because the treatment is carried out on an outpatient basis.
  • You may eat before treatment and take your normal medication.
  • N.B.: this does not include blood thinners, as mentioned above.
  • Make sure you have someone to take you home, because you may not drive for 24 hours.

How do the sacroiliac injections work?

  • The treatment will be performed in the surgical day-care centre, where you will be asked to change into a surgical gown. This gown closes at the back.
  • A nurse will escort you to the treatment room, where there is a treatment table, an X-ray machine and television monitors.
  • For a sacroiliac injection you will positioned on the treatment table on your stomach.
  • With the help of the X-ray machine and a metal ruler, the exact location of the sacroiliac injection will be determined.
  • This place is marked on the skin with a felt pen.
  • The area around this site is then disinfected with a cold, red liquid.
  • The pain specialist covers the area with sterile drapes.
  • After local anesthesia of the skin the pain specialist will bring under fluoroscopy (via television monitor) the needles in the correct place.
  • In sacroiliac injections small amounts of local anesthetics are injected in the joint together with corticosteroids.
  • This numbness may last for several hours, and then return to the same pain level as before the sacroiliac injection.
  • You will then be asked to get dressed and to make an appointment with your own pain specialist to evaluate the effect of the treatment and discuss further treatment possibilities.
  • On the day of the treatment you should slow down and is advised not to participate for 24 hours in traffic.

What are dangers and side effects of sacroiliac injections?

After sacroiliac injections, the following complications or side effects can occur:

  • Sometimes an allergic reaction for the injected substances can occur.
  • In case you have diabetes your blood sugar level can become deregulated.
  • It is of importance to inform your pain specialist before the treatment is planned.
  • After a sacroiliac injection your blood sugar level has to be controlled by your GP or treating internist.
  • In women, due to the corticosteroids, hot flashes can occur and the menstrual cycle may be become disrupted briefly.

When can I expect pain relief after the treatment?

  • After pains can occur following sacroiliac injections. These may last for several weeks but will eventually disappear.
  • The optimum results of treatment are seen after two to three weeks.
  • Around this time, a new appointment with your pain specialist will be made.