SIJ

 

What is the Sacroiliac Joint?

The sacroiliac joint is located between the sacrum (at the base of the spine) and the pelvis. This joint may cause pain in the lower back, buttocks and thighs with degenerative changes or arthritis.

 

What is a Sacroiliac Joint Injection?

A sacroiliac joint injection works to help diagnose and treat pain and inflammation around the area of discomfort. The goal of the injection is to confirm that the sacroiliac joint is the source of the pain, and to temporarily help alleviate the pain in the joint.

Local anaesthetic, with or without steroid, is injected into the sacroiliac joint. If necessary, it is sometimes also injected around the nerves that supply the joint. This helps to determine the source of the pain. This is a diagnostic test, with the effect only lasting hours to days.

 

What is a Radiofrequency Neurotomy or Ablation?

Radiofrequency neurotomy is an injection procedure which interrupts the nerve supply to the joints. This allows for a decrease in the pain signals being sent to your brain. This is done by placing a needle next to the nerve and having a computer heat the tip of the needle to about 85 degrees using a radiofrequency electric current generator.

You may be offered this procedure after a positive response to sacroiliac joint injections or nerve blocks.

 

How long will the pain relief last after a sacroiliac joint radiofrequency neurotomy?

After the procedure, patients can expect pain relief for 3 – 24 months. However, success rates after the procedure vary. On average, 60% of patients will experience pain relief for at least 12 months. After this time period, the nerves will recover and pain can return. If necessary, the procedure can then be repeated.

 

Will I be awake during the procedure?

Sedation is an option that is offered to all our patients. The majority of people choose to be sedated. This reduces any discomfort that may occur during the procedure, and increases the chance of amnesia. It is likely that you will have little to no memory of the procedure.

 

Is the procedure painful?

At the start of the procedure, you will be administered a local anesthetic to numb the area. If you are sedated you will also receive an intravenous painkiller. Slight discomfort may be experienced during the procedure, and you might experience short-lived pain once the numbing injection wears off.

 

How do I prepare for the procedure?

Prior to the procedure taking place, you are advised to notify medical specialists if you are:

  • Taking blood thinners (these can usually be continued)
  • Diabetic
  • Pregnant, or any chance of being pregnant
  • Allergic to iodine, latex, shellfish, local anaesthetics or any other allergy
  • Unwell or suffering from an infection
  • Implanted with a medical device.

To prepare for the procedure, you should:

  • Avoid eating for 6 hours before the procedure. Medical staff will advise patients of when to start fasting.
  • Continue to drink clear fluids only until 3 hours prior to the procedure.
  • Unless otherwise advised, patients can continue taking usual medications.
  • Arrange for a family member or friend to accompany you home after the procedure.
  • If you have a neurostimulator or pacemaker you should let staff know as precautions may need to be taken.

 

What does the procedure involve?

On the day of the procedure, you will arrive and complete the necessary paperwork. The procedure involves:

  • Changing into a hospital gown
  • Speaking to an anaesthetist if you are having sedation
  • You may have a small cannula inserted into one of your veins
  • You may be given a small sedative
  • Your heart rate, oxygen levels and blood pressure will be monitored throughout the procedure.
  • Once lying face down on the x-ray table, the skin over the area to be injected will be cleaned with an antiseptic solution. Sterile drapes will also be applied.
  • Local anaesthetic will be injected into your skin.
  • Using an x-ray machine, a needle will be guided toward the target. If necessary, x-ray dye may be used to confirm the needle is in the correct position.
  • Prior to the needle tip being heated, further local anaesthetic will be injected.
  • Using a radiofrequency generator, the temperature of the tip of the needle is raised, as well as the surrounding tissue.
  • If required, there will be multiple injections.
  • A final injection of anaesthetic and steroid may be administered into the S2 sacral foramen. This aims to reduce any risk of pain flare.
  • Generally the procedure takes between 40-60 minutes, with additional recovery time.

 

What are potential complications?

While this procedure is generally very safe, every invasive procedure carries the risk of complications.

While the risk is low, potential complications include:

  • Pain or discomfort at the site of injection
  • A pain flare (when the local anaesthetic wears off)
  • Infection
  • Bruising
  • Temporary muscle weakness
  • Bleeding
  • Allergic reactions to medication
  • Failure of the procedure to reduce pain.
  • Temporary nerve damage. This may result in a burning sensation or numbness to a patch of skin. This is very rare and only occurs in 5% of cases. When this occurs, symptoms may last several weeks.
  • Side effects caused by steroids can include transient flushing, mood swings, high blood sugar levels (especially in diabetic patients). The manufacturer did not specifically design most steroid solutions for this procedure. Despite this, these medications have been widely used, over many years, for this procedure without significant complications.

Please discuss with your pain specialist, doctor or anaesthetist about extremely rare or more serious side effects and the risk of sedation.

 

What happens after the procedure?

  • Until you are ready to go home, you will be placed in a recovery area and monitored. This is usually for 60-90 minutes.
  • You will be required to have someone accompany you home and stay with you overnight.
  • Effects of sedation may last for up to 24 hours. A normal side effect of sedation is to be unable to remember some information given to you during the procedure. For the next 24 hours, you should avoid driving a motor vehicle, consuming alcohol, operating machinery, making important decisions, signing legal documents or travelling unaccompanied.
  • When you wash the following day, remove the dressing.
  • Once local anaesthetic wears off, pain may return. It is normal to experience a temporary increase in pain and stiffness. This can often continue for several days. If you experience pain or stiffness, apply an ice pack to the area for 10 minutes at a time for the following few days after the procedure. Paracetamol will also help to ease any discomfort.
  • If steroids were injected during the procedure, it may take several days for benefits to be noticed. This can also cause you to feel flushed or experience mood changes for the following few days. Diabetic patients may also experience a rise in their blood sugar levels.
  • Following the procedure, it is important to avoid rapidly partaking in strenuous activities. Instead, gradually increase your daily physical activities.
    It is important to contact QPain, your General Practitioner, or the Emergency Department at your local hospital if you experience any severe pain, swelling, discharge or bleeding from the site, or are having any other concerns.

 

Consent

Before undertaking the procedure, it is important that you are fully informed and are aware of what is involved, and potential risks and side effects. If you have any concerns or questions, please discuss these with your doctor or read our information sheet.

Once you have requested to undertake this procedure, you will be asked to sign a consent form. This form states you understand the potential benefits, risks, alternatives and what will occur if you do not go ahead with the procedure. You are free to withdraw consent at any stage up until the start of the procedure.

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