Sacroiliac Joint Arthritis Causing Low Back Pain
Conditions
Keywords
Sacroiliac Joint, Ultrasound, Fluoroscopy, Chronic Pain
Brief summary
This project involves the assessment of the efficacy of two different image guided techniques in patients with low back pain due to arthritis of the sacroiliac joint (SIJ). Intra-articular injection of local anesthetics and steroids is performed to relieve pain originating from the SIJ. Fluoroscopy has been used traditionally for image guidance for this procedure but there is a growing interest in use of ultrasound (US) for this procedure. US avoids radiation exposure to the patient and the health care team (HCT) and is less expensive. We aim to compare procedural efficacy related outcomes for SIJ injections performed using these image-guided modalities.
Detailed description
The study is a prospective, randomized trial. Patients with low back pain which is diagnosed secondary to SIJ disease will be identified beforehand in clinic and offered a therapeutic joint injection. Informed consent will be obtained. Patients will be randomized for SIJ block with 3 mL of 0.25% bupivacaine with 1:200,000 epinephrine and 40 mg depomedrol using guidance with ultrasound or fluoroscopy. In both groups, confirmation of needle placement will be obtained using contrast injection imaging before the injection is performed. Record will be made of the number of times the needle is correctly placed into the articular space, as well as the number of attempts to do so. The final position of the needle will be recorded. Pain scores will be assessed before the procedure, as well as post-procedure at 24 and 72 hours, as well as 1 week, 1 month, and 3 months. Patients will keep a pain diary and will be followed up at 3 months time in clinic.
Interventions
PROCEDURESacroiliac Joint Injection
Medication injected into the sacroiliac joint: Bupivicaine 3ml 0.25% with epinephrine 1/200,000 and Depo-Medrol 40mg.
Sponsors
University Health Network, Toronto
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Suspicion of SIJ disease on history: pain below the lumbo-sacral junction; pain with full weight-bearing on one leg; pain worse going down hills or inclines; very low back pain associated with groin pain and absence of lumbar symptoms * Two positive responses to the following maneuver: FABER (flexion abduction and external rotation of hip), POSH (posterior shear test), REAB (resisted abduction) * Baseline NRS pain score \> or = to 4 * Refractory to oral analgesic therapy
Exclusion criteria
* ongoing litigation issues related to the patient's pain * pregnancy * allergy to steroids or local anesthetics * multiple comorbidities * BMI \> 35
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Pain - Numeric Rating Scale Score at 1 month | One month from time of injection |
| Incidence of needle placement into SIJ | Assessed at time of injection |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Average daily consumption of opioids at 1 month | 1 month from injection | — |
| Patient discomfort with procedure | Measured at time of procedure | — |
| Improvement of functional ability at 1 month | 1 month from time of injection | Oswestry Disability Index completed at 1 month to determine level of disability |
| Number of needle readjustments | Measured at time of procedure | — |
| Patient Satisfaction | 1 month from time of injection | — |
Other
| Measure | Time frame | Description |
|---|---|---|
| Assessment of complications | Until 3 months after procedure | Complications assessed at any point until 3 months after procedure |
Countries
Canada
Outcome results
None listed