A sacroiliac joint injection is a “cortisone shot” for the sacroiliac joint. The sacroiliac joints are two joints (right and left) which connect the lower spine or coccyx to the pelvis. These joints do not move much, but they can become inflamed and painful, especially after trauma. The only way to determine if a sacroiliac joint is causing pain is to fill the joint with anesthetic and see if the pain disappears. If the joint is inflamed, the anti-inflammatory steroid (the “cortisone”) can provide long term pain relief. If the injection is effective, but does not last long, radiofrequency neurotomy can be performed to provide longer lasting pain relief.
Can I be “put out” for it? You will first get local anesthetic to numb your back. Depending on where the injection is performed, you may also request intravenous sedation to put you in a “twilight” sleep for the procedure. You may feel a pinch in the back for the local anesthetic and pressure or tingling in the back or leg as the medication goes in. At any time during the procedure, more anesthetic can be given to make you more comfortable.
The actual injection usually takes 15 to 20 minutes, but you will need to be at the hospital or surgery center for about 60 to 90 minutes from check-in and check-out.
The medication injected is usually a combination of a local anesthetic (lidocaine or bupivicaine) and an anti-inflammatory steroid (betamethasone, or triamcinalone).
Will I gain weight? No. Anti-inflammatory steroids are totally different than the anabolic steroids that athletes use to get bigger and stronger. It will not make you gain weight.
The local anesthetic will usually start immediately and provide pain relief for the six to eight hours after the procedure. The steroids may take anywhere from one day to two weeks to reach peak effectiveness. In some cases the pain will return the day after the injection and then gradually improve again over the next week.
Every case is different and it is impossible to predict how effective the injection will be. Sometimes one injection will relieve the pain forever. Sometimes repeat injections are needed every six months or yearly. If the injection is effective, but lasts only a few days or weeks, a radiofrequency neurotomy may provide longer lasting relief.
Side effects are rare, but may include a temporary increase in pain, hot flashes or sweating for 1-2 days, vasovagal reaction (fainting), headache, or hiccups. Some injections may also cause mild numbness or weakness in the leg(s) for 30 to 40 minutes after the injection.
There are four main complications: bleeding, infection, allergic reaction, or puncture of the large intestine. These are all very rare when the appropriate precautions are taken. When properly performed, the needle does not enter the spinal canal during a sacroiliac joint injection, and therefore risk of complication is much less than in other types of spinal procedures. Fluoroscopy (low power x-ray) is used for safety and to verify appropriate needle placement.
You must stop any blood thinning medication 7 to 10 days before the procedure to prevent bleeding. This includes aspirin (and 81mg “baby aspirin”), coumadin, plavix, advil, motrin, aleve, naprosyn/naproxen, ibuprofen, excedrin, any cold or sinus medication containing these, and other anti-inflammatory medications. If you are not sure if you need to stop a medication, you should ask. Diabetes medication may need to be held the morning of the procedure if you do not eat breakfast. Blood pressure and other heart medications should be continued.
When can I go back to work? You should take the day off from work for the injection. You don’t need to be in bed, but you should “take it easy” for the rest of the day after the injection. You may return to work the day after the procedure.
Depending on the type of injection, you should avoid submerging you back in water for 2-3 days after the injection. This includes a bath, hot tub, swimming pool, or the ocean. You may shower the night after the injection, unless told not to by the doctor.
You should not travel long distance for one week after the injection.
Dr. Baker has many years of experience performing these injections and has performed over 1,000 injections. Dr. Baker is a member of the International Spine Intervention Society and regularly attends meetings, conferences, and workshops to remain up to date on the latest innovations in spine care.