What is a sacroiliac injection?

A sacroiliac injection is an injection of a steroid or other medication into a sacroiliac joint. The sacroiliac joints are located on either side or the sacrum or tailbone. They connect the tailbone to the pelvis.

What is the purpose of a sacroiliac injection?

The steroid injected reduces the inflammation and swelling of tissue in and around the joint space. This may in turn reduce pain, and other symptoms caused by inflammation or irritation of the joint and surrounding structures.

How long does the sacroiliac injection take?

The actual injection takes about 5 to 10 minutes.

What is actually injected?

The injection consists of a mixture of local anesthetic and a steroid medication. Occasionally, phenol is placed in the injection.

Will the sacroiliac injection hurt?

The sacroiliac injection involves inserting a needle through skin and deeper tissues. So, there is some pain involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the needle into the joint. Some patients also receive sedation that can make the procedure easier to tolerate.

Will I be “put out” for the sacroiliac injection?

No. This procedure is done under local anesthesia. Some patients also choose to receive some sedation, which can make the procedure easier to tolerate. The amount of sedation given generally depends upon the patient tolerance.

How is the sacroiliac injection performed?

It is typically done with the patient lying on the stomach and usually done under x-ray. Some thinner patients can sometimes be injected without x-ray. Patients receiving intravenous sedation 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 skin may be numbed with local anesthetic. The injection needle is then placed under X-ray guidance. Once in place, the injection is carried out. After the injection, the needle is removed and a Band Aid is applied.

What should I expect after the sacroiliac injection?

Immediately after the sacroiliac injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last only for a few hours. Your pain may return and you may have soreness at the injection site 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 or so.

What should I do after the sacroiliac injection?

You should have a ride home because the injection could cause some temporary weakness in the legs if the medication spreads to the sciatic nerve in front of the joint. All patients receiving sedation must have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. You should perform only those activities you can reasonably tolerate.

Can I go to work to work the next day?

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 at the injection site.

How long does the effect of the medication last?

The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The steroid starts working in about three to five days and its effect can last for several days to a few months.

How many sacroiliac injections do I need to have?

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. If you respond to the injections and still have residual pain, you may be recommended for a third injection.

Can I have more than three sacroiliac injections?

In a six-month period, we generally do not perform more than three injections. If three injections have not helped you much, it is very unlikely that you will get any further benefit from more injections in such a short time period. Also, giving more injections will increase the likelihood of side effects from the steroids.

Will the sacroiliac injection help me?

It is sometimes difficult to predict if the injection will indeed help you or not. The patients who have recent onset of pain may respond much better than the ones with longstanding pain.

What are the risks and side effects of a sacroiliac injection?

Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects and possibility of complications. The most common side effect is temporary pain at the injection site. Uncommon risks involve infection, bleeding or worsening of symptoms. The other uncommon risks are related to the side effects of steroids, including weight gain, increase in blood sugar in diabetics, water retention, and suppression of body’s own natural production of cortisone. Fortunately, the serious side effects and complications are uncommon.

Who should not have a sacroiliac injection?

If you are allergic to any of the medications to be injected, if you are on a blood thinning medication, if you have an active infection going on, or if you have poorly controlled diabetes or heart disease, you should not have the injection or at least consider postponing it if postponing it would improve your medical condition.

Adapted: http://www.medcentral.org/body.cfm?id=353, July 25th, 2010