title: Comparison of Fluoroscopy and Ultrasound Guidance for Sacroiliac Joint Injection in Patients with Chronic Low Back Pain.
abstract: Sacroiliac joint (SIJ) arthritis is a common cause of chronic mechanical low back pain (LBP) that is often treated with injection of local anesthetic and steroids. Ultrasound (US) has emerged as a viable alternative to fluoroscopy (FL) to guide SIJ injections; however, few studies have compared these modalities. In this prospective randomized, controlled trial, we compared both accuracy and efficacy of US and FL guidance for SIJ injections.
  
  
  
  Forty patients with chronic moderate-to-severe LBP secondary to SIJ arthritis were randomized to receive US- or FL-guided unilateral SIJ injections. Primary outcomes included pain at 1 month measured by numerical rating scale (NRS) scores. Secondary outcomes included NRS scores at 24 hours, 72 hours, 1 week, and 3 months after injection, physical functioning at 1 month after the procedure, procedure time, incidence of intra-articular and peri-articular needle placement, patient discomfort, overall patient satisfaction, and daily opioid consumption.
  
  
  
  There was no significant difference in NRS pain scores between the 2 groups at 1 month or at any other follow-up points. A significant reduction from baseline mean NRS scores was observed in both groups at 1 month after injection (US 22.7%, P = 0.025; FL 37.3%, P < 0.001). There was no significant difference in procedure-related variables, physical functioning, discomfort, opioid utilization, and patient satisfaction between the 2 groups.
  
  
  
  Ultrasound-guided SIJ injection with fluoroscopic confirmation has similar accuracy and efficacy to fluoroscopy alone for SIJ injections in patients with chronic low back pain secondary to SIJ arthritis.
authors.affiliation: Department of Anesthesia and Pain Management, University Health Network-Toronto Western Hospital, Mount Sinai Hospital Wasser Pain Management Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Neilesh
authors.initials: N
authors.lastname: Soneji
authors.affiliation: Department of Anesthesia and Pain Management, University Health Network-Toronto Western Hospital, Mount Sinai Hospital Wasser Pain Management Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Anuj
authors.initials: A
authors.lastname: Bhatia
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.
authors.forename: Rachael
authors.initials: R
authors.lastname: Seib
authors.affiliation: Department of Anesthesia and Pain Management, University Health Network-Toronto Western Hospital, Mount Sinai Hospital Wasser Pain Management Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Tumber
authors.affiliation: Department of Anesthesia and Pain Management, University Health Network-Toronto Western Hospital, Mount Sinai Hospital Wasser Pain Management Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Melanie
authors.initials: M
authors.lastname: Dissanayake
authors.affiliation: Department of Anesthesia and Pain Management, University Health Network-Toronto Western Hospital, Mount Sinai Hospital Wasser Pain Management Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Philip W H
authors.initials: PW
authors.lastname: Peng
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007267:Injections / Q000009:adverse effects / Q000379:methods*; D017116:Low Back Pain / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009339:Needles; D018710:Pain Clinics; D010147:Pain Measurement; D011446:Prospective Studies; D015641:Radiography, Interventional; D012446:Sacroiliac Joint / Q000000981:diagnostic imaging*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000701:Analgesics, Opioid
keywords: X-ray; back pain; fluoroscopy; injection; pain; randomized controlled trial; sacroiliac joint; ultrasound