Sacroiliac Joint Injection
This section provides a comprehensive procedural report for sacroiliac joint injection procedure with up-to-date explanatory notes, synopsis of the indications and contraindications and potential complications in an organized and practical format.
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INTRODUCTION Like other joints, the sacroiliac (SI) joint may develop degenerative or traumatic arthritis, which can lead to significant pain and disability. Lower back pain from the SI joint can be a diagnostic challenge, and is usually a diagnosis of exclusion. Injection of anesthetic with or without corticosteroids into the SI joint under fluoroscopic or CT guidance can confirm the diagnosis and provide the patient with pain relief [1].
COMMON INDICATIONS • Sacroiliitis due to spondyloarthropathies • Sacroiliac joint osteoarthritis not responding to non-steroidal anti-inflammatory drugs • Diagnosis of sacroiliac joint arthritis when it is unclear
COMMON CONTRAINDICATIONS [1] • Known bleeding disorder or currently on anticoagulation/antiplatelet
K. Masrouha (&) Department of Surgery, Division of Orthopedic Surgery, American University of Beirut Medical Center, Riad Elsolh, Beirut 1107 2020, Lebanon e-mail: [email protected]
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• Allergies to local anesthetic agents or corticosteroids • Ongoing systemic infection • Infection or loss of integrity of skin around injection site • Uncontrolled hypertension, diabetes, coronary artery disease, or congestive heart failure • Inability to lay in the prone position
POSSIBLE COMPLICATIONS • Infection • Hematoma • Neurapraxia
PREOPERATIVE ASSESSMENT AND PLANNING [2–5] • History, indications, and physical examination (Appendix 1 in Chap. 149) • Evaluation of diagnostic imaging studies • Periprocedural management of coagulation status (Appendices 2 in Chap. 150 and 3 in Chap. 151) • Antibiotic prophylaxis: Not routinely recommended • Imaging modality for guidance: Fluoroscopy, CT or Ultrasound [2, 3] • Positioning: Prone
© Springer International Publishing Switzerland 2016 B. Taslakian et al. (eds.), Procedural Dictations in Image-Guided Intervention, DOI 10.1007/978-3-319-40845-3_59
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PROCEDURE NOTE Procedure: Image-guided left/right sacroiliac joint infiltration Staff: [_] Fellow: [_] Resident: [_] Clinical Information: Describe history and list indications Allergies: None known/Allergic to [specify/type of allergy] Anesthesia: Local anesthesia/conscious sedation Medications: List any relevant medications used (sedation, local anesthesia, corticosteroids) Contrast Material: (0.5 mL) of [type] contrast media for intra-articular injection Field: Sterile Procedure classification: Clean Position: Prone Monitoring: Intravenous access line was secured and vital signs were continuously monitored by nursing staff/anesthesia team throughout the procedure Total fluoroscopy time: (_) minutes Cumulative radiation dose: (_) mGy Description of Procedure The risks, benefits, alternatives, and procedure itself were explained to the patient/patient’s Power of Attorney/patient’s legal guardian, and informed written consent was obtained. The site of the procedure was identified and marked. Time out was performed to confirm the correct patient, procedure and site. The distal 1 cm of the sacroiliac joint was identified under fluoroscopy/after obtaining planning CT images and marked. The s
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