Sacroilliac Joint Injection

What is a Sacroiliac Joint injection?

Sacroiliac joint blocks (SI) are injections that are used for diagnosing and treating the low back pain associated with sacroiliac (SI) dysfunction. The SI lies next to the spine and connects the sacrum (bottom of the spine) with the pelvis (hip).

How does it work?

The steroid injected reduces the inflammation and/or swelling of tissue in the joint space.  This may in turn reduce pain, and other symptoms caused by inflammation/irritation of the joint and surrounding structures.

How long does the injection take?

The actual injection takes only a few minutes.

What medications are used for the injection?

The injection consists of a mixture of local anesthetic (lidocaine or bupivicaine) and the steroid medication  (triamcinolone-Kenalog or methylprednisolone-Depo-Medrol)

Does the injection hurt?

The procedure involves inserting a needle through the skin and deep tissue. So, there is some discomfort involved.  But, we will numb the skin and deep tissues with a local anesthetic (lidocaine) before inserting the block needle into the joint.  Some of our patients also receive intravenous sedation and pain medication, which makes the procedure easier to tolerate.

Will I be put to sleep for this procedure?

No.  This procedure is done under local anesthesia.  Some of the patients also receive intravenous sedation and pain medication, which makes the procedure easier to tolerate.  The amount of sedation given usually depends upon the patient’s tolerance.

How is the injection done?

It is done with the patient lying on their stomach, under fluoroscopy (live x-ray).  All of our patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device (pulse oximeter). The skin on your back is cleaned with antiseptic solution and then the injection is done.

What should I expect after the injection?

Shortly after the injection, you may feel that your pain is gone or much less.  This is due to the local anesthetic that was injected.  This will last for only a couple hours.  Your pain will probably return and you will have a “sore back” for a day or two.  This is caused by the mechanical process of the needle insertion as well as initial irritation from the steroid. You should start having some pain relief anywhere from 2 days up to one week, but some patients may take up to 10 days.

What should I do after the procedure?

You need to have a ride home.  Make sure that you have something to eat or drink within an hour or two after the block.  We advise our patients to take it easy for a day or so after the procedure. You may use ice at the injection to keep swelling down and help with pain. Perform your normal daily activities as tolerated.

When can I go back to work?

If there are no complications, you should be able to return to your work the next day.  The most common thing you may feel is a sore back.

How long will the block work?

The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The cortisone starts working in about 3 to 7 days and its effects can last for several days to a few months. 

How many injections will I need to have?

If the first injection does not relieve your symptoms in about a week to two weeks, you may be recommended for another injection.  If you respond to the injections and still have residual pain, you may be recommended for a third injection.

Can I have more than three injections?

In a six-month period, we usually do not perform more than three injections.  If three injections have not helped you much, it is very unlikely that you will get any benefit from more injections. Also, giving more injections will increase the likelihood of side effects from cortisone.

Does the sacroiliac joint injection help everyone?

No.  It is very difficult to predict if the injection will help or not.  Usually, the patients who have recent onset of pain tend to do better than the ones with long standing pain.

What are the risks and side effects?

The procedure is safe.  But, with any procedure there are risks, side effects, and possibility of complications.  The most common side effect is pain- which is temporary.  The other risks involve infection, bleeding, worsening of symptoms, spinal block, epidural block etc.  The other risks are related to the side effects of cortisone: these include weight gain, increase in blood sugar (mainly in diabetics), water retention, suppression of the body’s own natural production of cortisone etc. Fortunately, the serious side effects and complications are rare.

Who should not have this injection?

If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (i.e. Coumadin, Plavix, aspirin or aspirin containing medications, or of you have an active infection, you should not have the injection.  Be aware that herbs Ginseng, Garlic and Gingko Baloba and Vitamin E are blood thinning.

* DO NOT STOP ANY OF YOUR MEDICATIONS BEFORE CONSULTING WITH YOUR DOCTOR *