Purpose To ensure effective therapeutic management of sacroiliac (SI) joint pain, precise needle placement during diagnostic SI joint injection is essential. The reported accuracy of diagnostic SI pain assessment using single or dual blocks is highly variable, with false positive rate of 10–30%. CT guidance for sacroiliac joint injection has been the preferred imaging technique for needle guidance due to the complex 3 dimensional anatomy of the SI joint, frequent encounter of covering osteophytes and occasionally encountered extremely narrowed SI joint. However, the technique has been challenged due to relatively prolonged procedure time and risk of increased radiation exposure. We evaluated the technical feasibility of the 3D-CBCT guided diagnostic SI joint injection technique.
Materials and methods Four patients (5 SI joints) with clinically suspected SI joint pain syndrome were enrolled. The procedure was performed under local anesthesia in a bi-plane neuroangiography suite (AlluraXper®, Philips, Netherlands), but only AP plane was used for the procedure. Using the integrated image guidance system (XperGuide®, Philips, Netherlands), the target and needle trajectory were selected based on 3D-CBCT images. Subsequently, the selected images were fused with real-time fluoroscopy for the needle guidance. Post needle placement and post contrast injection 3D-CBCTs were also obtained before the injection of local anesthetics (approximately 0.5–1.0 ml) into the target SI joint.
Results The needle placement and diagnostic injection for the target SI joint were successful in all 4 cases (5 SI joints). Median fluoroscopy time per SI joint was 5.2 min (range: 4.6 min – 6.7 min) and total DAP was 87,445.2 mGycm2(range: 32,864 mGycm2 – 199,303 mGycm2). Pre-procedure mean pain level was 7.5/10 and immediate post-procedure mean pain level was 0/10.
Conclusion 3D-CBCT guided diagnostic SI joint injection is technically feasible, effective, reasonably fast and can be performed with relatively low radiation exposure. In addition, the real-time, interactive nature of the guidance system may provide more confidence to the operator.
Disclosures S. Lee: None. S. Ali: None. J. Mok: None.
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