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Sacroiliac Joint Injections Performed With Sonographic Guidance

Mehmet Zekai Pekkafal, MD, Mehmet Zeki Kralp, MD, Chat Çinar Baekim, MD, Emir ilit, MD, Hakan Mutlu, MD, Ersin Öztürk, MD, Eref Kzlkaya, MD and Hasan Dursun, MD

Departments of Radiology (M.Z.P., C.Ç.B., E.S., H.M., E.Ö., E.K.) and Physical Medicine and Rehabilitation (M.Z.K., H.D.), Gülhane Military Medicine Academy, Haydarpaa Training Hospital, Istanbul, Turkey.

Address correspondence and reprint requests to Mehmet Zekai Pekkafal, MD, Department of Radiology, Gülhane Askeri Tip Akademisi Haydarpaa Training Hospital, Kadköy, 81327 Istanbul, Turkey; e-mail: zekai_p{at}yahoo.com.

Objective. To investigate the feasibility and effectiveness of sonographic guidance for therapeutic intra-articular sacroiliac joint injections in patients with sacroiliitis. Methods. Thirty-four consecutive patients with sacroiliitis were enrolled in this study. The synovial portions of 60 sacroiliac joints received injections under sonographic guidance. For treatment, a mixture of a corticosteroid and a local anesthetic was injected intra-articularly. Fluoroscopic spot images were obtained to assess the accuracy of the sonographically guided technique. Results. Of the 60 sonographically guided injections, 46 (76.7%) were successful (i.e., intra-articular), and 14 (23.3%) were missed. The successful intra-articular injection rate was 60% in the first 30 injections, and it gradually improved, reaching 93.5% in the last 30 injections. The mean procedure time was 9 minutes. Conclusions. Our initial experience suggests that sonographically guided therapeutic injections to sacroiliac joints could be valuable alternatives to other guidance modalities in patients with sacroiliitis. In the hands of experienced radiologists, this technique is safe, rapid, and reproducible.

Key Words: intra-articular injection • sacroiliac joint • sonographic guidance

Abbreviations: CT, computed tomography • MRI, magnetic resonance imaging • SI, sacroiliac

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