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Fluoroscopy-guided Sacroiliac Joint Injections¹

¹ From the Department of Radiology, University of Virginia Health System, Lee St, Box 170, Charlottesville, VA 22908. Received November 19, 1998; revision requested December 21; final revision received April 16, 1999; accepted June 28 1999. Address reprint requests to R.G.D. (e-mail: rgd6q@virginia.edu).

View larger version (170K): [in a new window]   Figure 1a. Posteroanterior fluoroscopic radiographs depict technique for SI joint injection, with patient prone. In a-d, R = right. (a) With the x-ray tube perpendicular to the fluoroscopic table, a localization probe (arrows) is centered over the distal 1 cm of the right SI joint, and the skin is marked. (b) With the x-ray tube angled 20° cephalad, the posterior aspect of the inferior SI joint (arrows) is clearly depicted caudally. (c) Straight needle (arrow) is advanced perpendicular to the fluoroscopic table into the posterior portion of the SI joint. (d) The x-ray tube is angled 25° cephalad, and the SI joint is opacified with contrast material (arrows).

View larger version (185K): [in a new window]   Figure 1b. Posteroanterior fluoroscopic radiographs depict technique for SI joint injection, with patient prone. In a-d, R = right. (a) With the x-ray tube perpendicular to the fluoroscopic table, a localization probe (arrows) is centered over the distal 1 cm of the right SI joint, and the skin is marked. (b) With the x-ray tube angled 20° cephalad, the posterior aspect of the inferior SI joint (arrows) is clearly depicted caudally. (c) Straight needle (arrow) is advanced perpendicular to the fluoroscopic table into the posterior portion of the SI joint. (d) The x-ray tube is angled 25° cephalad, and the SI joint is opacified with contrast material (arrows).

View larger version (156K): [in a new window]   Figure 1c. Posteroanterior fluoroscopic radiographs depict technique for SI joint injection, with patient prone. In a-d, R = right. (a) With the x-ray tube perpendicular to the fluoroscopic table, a localization probe (arrows) is centered over the distal 1 cm of the right SI joint, and the skin is marked. (b) With the x-ray tube angled 20° cephalad, the posterior aspect of the inferior SI joint (arrows) is clearly depicted caudally. (c) Straight needle (arrow) is advanced perpendicular to the fluoroscopic table into the posterior portion of the SI joint. (d) The x-ray tube is angled 25° cephalad, and the SI joint is opacified with contrast material (arrows).

View larger version (164K): [in a new window]   Figure 1d. Posteroanterior fluoroscopic radiographs depict technique for SI joint injection, with patient prone. In a-d, R = right. (a) With the x-ray tube perpendicular to the fluoroscopic table, a localization probe (arrows) is centered over the distal 1 cm of the right SI joint, and the skin is marked. (b) With the x-ray tube angled 20° cephalad, the posterior aspect of the inferior SI joint (arrows) is clearly depicted caudally. (c) Straight needle (arrow) is advanced perpendicular to the fluoroscopic table into the posterior portion of the SI joint. (d) The x-ray tube is angled 25° cephalad, and the SI joint is opacified with contrast material (arrows).

View larger version (153K): [in a new window]   Figure 2a. Fluoroscopic radiographs of a prone dry skeletal specimen of the pelvis demonstrate the effect of tube angulation. (a) With the x-ray tube perpendicular to the fluoroscopic table, a medial metallic dot (solid arrow, P) is positioned on the posteroinferior SI joints. Two slightly larger metallic dots located more laterally (open arrow, A) are affixed to the anteroinferior aspect of the SI joints. (b) With the x-ray tube angled 20° cephalad, the posterior aspects of the SI joints (solid arrow, P) project inferiorly and are now well outlined. The anterior aspects of the SI joints (open arrow, A) project superiorly and are more difficult to identify.

View larger version (155K): [in a new window]   Figure 2b. Fluoroscopic radiographs of a prone dry skeletal specimen of the pelvis demonstrate the effect of tube angulation. (a) With the x-ray tube perpendicular to the fluoroscopic table, a medial metallic dot (solid arrow, P) is positioned on the posteroinferior SI joints. Two slightly larger metallic dots located more laterally (open arrow, A) are affixed to the anteroinferior aspect of the SI joints. (b) With the x-ray tube angled 20° cephalad, the posterior aspects of the SI joints (solid arrow, P) project inferiorly and are now well outlined. The anterior aspects of the SI joints (open arrow, A) project superiorly and are more difficult to identify.

View larger version (205K): [in a new window]   Figure 3a. Fluoroscopic radiographs were obtained with the x-ray tube angled 25° cephalad in a 91-year-old woman with right SI pain and a radiographically normal SI joint. No pain relief was obtained after injection of local anesthetic. (a) The intraarticular needle (arrowheads) is in position. (b) Contrast material (arrowheads) outlines the SI joint.

View larger version (204K): [in a new window]   Figure 3b. Fluoroscopic radiographs were obtained with the x-ray tube angled 25° cephalad in a 91-year-old woman with right SI pain and a radiographically normal SI joint. No pain relief was obtained after injection of local anesthetic. (a) The intraarticular needle (arrowheads) is in position. (b) Contrast material (arrowheads) outlines the SI joint.

View larger version (137K): [in a new window]   Figure 4a. Fluoroscopic radiographs depict left SI joint injection in a 24-year-old woman with ankylosing spondylitis. In a and b, L = left. (a) With the x-ray tube angled 20° cephalad, the SI joint space (arrows) is very narrow but clearly depicted. (b) With the x-ray tube perpendicular to the fluoroscopic table and the needle angled slightly cephalad, intraarticular contrast material is seen to fill articular erosions (arrows).

View larger version (134K): [in a new window]   Figure 4b. Fluoroscopic radiographs depict left SI joint injection in a 24-year-old woman with ankylosing spondylitis. In a and b, L = left. (a) With the x-ray tube angled 20° cephalad, the SI joint space (arrows) is very narrow but clearly depicted. (b) With the x-ray tube perpendicular to the fluoroscopic table and the needle angled slightly cephalad, intraarticular contrast material is seen to fill articular erosions (arrows).