title: Feasibility of ultrasound-guided sacroiliac joint injection considering sonoanatomic landmarks at two different levels in cadavers and patients.
abstract: OBJECTIVE
  Sacroiliitis is often caused by rheumatic diseases, and besides other therapeutic options, treatment consists of intraarticular injection of corticosteroids. The purpose of this study was to assess the feasibility of ultrasound (US)-guided sacroiliac joint (SI joint) injection at 2 different puncture levels in cadavers and patients when defined sonoanatomic landmarks were considered.
  
  
  METHODS
  After defining sonoanatomic landmarks, US-guided needle insertion was performed in 10 human cadavers (20 SI joints) at 2 different puncture sites. Upper level was defined at the level of the posterior sacral foramen 1 and lower level at the level of the posterior sacral foramen 2. In 10 patients with unilateral sacroiliitis, injection at the most feasible level was attempted.
  
  
  RESULTS
  Computed tomography confirmed correct intraarticular needle placement in cadavers by showing the tip of the needle in the joint and intraarticular diffusion of contrast media in 16 (80%) of 20 SI joints (upper level 7 [70%] of 10; lower level 9 [90%] of 10). In all 4 cases in which needle insertion failed, intraarticular SI joint injection at the other level was successful. In patients, 100% of US-guided injections were successful (8 lower level, 2 upper level), with a mean pain relief of 8.6 after 3 months.
  
  
  CONCLUSIONS
  US guidance of needle insertion into SI joints was feasible at both levels when defined sonoanatomic landmarks were used. If SI joint alterations do not allow for direct visualization of the dorsal joint space of the lower level, which is easier to access, the upper level might offer an appropriate alternative.
authors.affiliation: Medical University Innsbruck, Innsbruck, Austria. andrea.klauser@i-med.ac.at
authors.forename: Andrea
authors.initials: A
authors.lastname: Klauser
authors.forename: Tobias
authors.initials: T
authors.lastname: De Zordo
authors.forename: Gudrun
authors.initials: G
authors.lastname: Feuchtner
authors.forename: Peter
authors.initials: P
authors.lastname: Sögner
authors.forename: Michael
authors.initials: M
authors.lastname: Schirmer
authors.forename: Johann
authors.initials: J
authors.lastname: Gruber
authors.forename: Norbert
authors.initials: N
authors.lastname: Sepp
authors.forename: Bernhard
authors.initials: B
authors.lastname: Moriggl
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D002102:Cadaver; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010361:Patients; D012216:Rheumatic Diseases / Q000188:drug therapy; D012446:Sacroiliac Joint / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones