A sacroiliac joint (SIJ) injection is an injection of an anesthetic with a long lasting steroid (“cortisone”) in the Sacroiliac joint(s.) The sacroiliac joints are located in the back where the lumbosacral spine joins the pelvis. They are paired (right and left) and are surrounded by a joint capsule like the finger joints.
This is one of the major “wear and tear” joints in the body. It is one of the weight-bearing joints in the body and it is a movable joint as well. Therefore it is subject to degeneration or “wearing down” like other joints in the body, such as your knees and elbows. The steroid injected reduces the inflammation in the joint space. This can reduce pain, and other symptoms caused by inflammation.
The pain physician uses a fluoroscope (live x-ray), to assist in precisely placing a needle into the sacroiliac joint/joints. Once the needle is in place, two medications are injected, local anesthetic and steroid medication. The local anesthetic provides immediate pain reduction for up to 6 hours after the procedure. The procedure usually takes about 15-20 minutes to perform. Patients generally do not notice significant discomfort after this procedure. You may notice mild soreness at the injection site. Unless you are currently taking pain medication you will not need to have pain medication prescribed. If you are currently taking pain medication it may be continued until you are seen at your post-op visit.
The actual injection takes only a few minutes. The injection consists of a mixture of local anesthetic (like novocaine) and the steroid medication. Many times prior to injecting the medicine, a small volume of contrast dye is used to confirm proper needle placement.
The procedure is done with the patient lying on the stomach with fluoroscopic (x-ray) guidance (see photo). The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. The skin in the back is cleaned with antiseptic solution and then the injection is carried out. After the injection, you are placed on your back or on your side.
Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last for a few hours. Your pain may return and you may have a sore back or neck for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation from the steroid itself. You should start noticing pain relief starting the 3rd to 5th day. Therefore, the patient’s pain is likely to return by the evening of the procedure. It may take 3-5 days for the steroid medication to decrease the inflammation that is within the joint. It usually takes patients up to one week after the procedure to notice a significant decrease in their pain level.
After the procedure, you should have a ride home. We advise patients to take it easy for the day of the procedure. You may want to apply ice to the affected area. After the first day, you can perform activities, as tolerated.
Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is soreness in the neck or back.
The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The cortisone starts working in about 5 to 7 days and its effect can last for several days to many months.
If the first injection does not relieve your symptoms in about a week to two weeks, you may be recommended to have one more injection. In a six-month period, we generally do not perform more than three injections. Giving more than three injections will increase the likelihood of side effects from cortisone. Also, if three injections with fluoroscopic guidance have not helped you much, it is very unlikely that you will get any further benefit from additional injections. It is very difficult to predict if the injection will help you or not. Usually, patients who have recent onset of pain may respond better than the ones with long-standing, or chronic pain. Your physician chose this procedure for you because he/she believes that the potential benefits of an injection outweigh any potential risks. This procedure is safe when performed in a controlled setting (procedure room with sterile equipment, and the use of live x-ray.) However, with any procedure, there are risks, side effects, and the possibility of complications. The most common side effect is discomfort – which is temporary. The other risks involve, infection, bleeding, worsening of symptoms. As with other types of injections, you should not have the procedure if you are currently taking the blood-thinning medicine (Coumadin.) Side effects related to cortisone include: fluid retention, weight gain, increased blood sugar (mainly in diabetics,) elevated blood pressure, mood swings, irritability, insomnia, and suppression of body’s own natural production of cortisone. Fortunately, the serious side effects and complications are uncommon. You should discuss any specific concerns with your physician.