Success Rate of Ultrasound Guided Sacroiliac Joint Injection in Sacroiliitis
Condition: Sacroiliitis
MeSH terms: Sacroiliitis
Study type: Interventional

Summary: 
      To re-investigate the success rate of Ultrasound guided sacroiliac joint steroid injection in
      depositing the drug inside the joint capsule (confirmed by contrast spread in fluoroscopy)
      and if there is a difference in clinical outcome between injections done strictly inside the
      joint and injections done periarticular.
    

Detailed description: 
      An IV cannula will be inserted, and basic ASA monitors applied, then the patients will be
      positioned in prone position. After disinfection of the skin, Ultra sonography will be used
      to Guide Needle Placement in SIJ (the hypoechoic cleft between the surface of the sacrum and
      the ilium) under complete a sepsis as the technique previously described in the literature.

      A low frequency (2-5 Hz) curvilinear transducer will be used in a sterile cover, the
      posterior superior iliac spine, lateral borderof sacrum, and ilium will be identified in
      transverse orientation. Subsequently, the probe will be moved caudally until the superior
      part of the posterior SIJ is identified. The SIJ will be traced caudally until the distal
      third of the SIJ is visualized as evident by the flat contour of the iliac crest and the
      presence of the second sacral foramen on the medial aspect of the sacrum.

      After local anesthetic infiltration of skin and subcutaneous tissues using Lidocaine 1%, a
      21-gauge spinal needle will be advanced from a medial to lateral direction using an in-plane
      technique. After reaching the joint, a total volume of 4 ml of injectate will be injected
      which consists of: 1 ml 40 mg of methylprednisoloneacetate (Depo-Medrol®, Pfizer), 2 ml
      Lidocaine 2%, 1 ml Iohexol (Omnipaque 300®, GE Healthcare).

      Control fluoroscopy

      After injection of the drug and withdrawal of the needle, a antero-posterior fluoroscopy
      image will be obtained and recorded for the injected joint to detect the spread pattern of
      the contrast and whether its pre-dominantly intra or periarticular. (N.B: Periarticular
      injection is any injection done near the joint as evidenced by US but on fluoroscopy no
      contrast is detected inside the joint). Then a sterile patch will be applied to the puncture
      site and patient discharged to the recovery room for follow-up for 30 minutes before
      discharge to home.

      Measurement tools

        -  Total number of intraarticular and periarticular drug injections as evidenced by
           contrast spread in fluoroscopy.

        -  Patient's pain score rated from 0-10 (Numeric Pain Rating Scale, NRS) before the
           procedure, 10 minutes after the procedure (in the recovery room), 1 week and 1 month
           post-procedure.

        -  Demographic data (including age, sex, BMI, ASA score).

        -  Limitation of physical functioning as measured by the Oswestry Disability Index (ODI) at
           1 month after the procedure .

        -  Procedure-related variables (time, complications, patient satisfaction.
    

Intervention name(s): Ultrasonography, fluoroscopy
Intervention type(s): Device
Intervention description(s): success rate of Ultrasound guided SIJ steroid injection confirmed by contrast spread in fluoroscopy
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment