title: Fluoroscopically Guided Diagnostic and Therapeutic Intra-Articular Sacroiliac Joint Injections: A Systematic Review.
abstract: OBJECTIVE
  To assess the validity of fluoroscopically guided diagnostic intra-articular injections of local anesthetic and effectiveness of intra-articular steroid injections in treating sacroiliac joint (SIJ) pain.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Ten reviewers independently assessed 45 publications on diagnostic validity or effectiveness of fluoroscopically guided intra-articular SIJ injections.
  
  
  METHODS
  For diagnostic injections, the primary outcome was validity; for therapeutic injections, analgesia. Secondary outcomes were also described.
  
  
  RESULTS
  Of 45 articles reviewed, 39 yielded diagnostic data on physical exam findings, provocation tests, and SIJ injections for diagnosing SIJ pain, and 15 addressed therapeutic effectiveness. When confirmed by comparative local anesthetic blocks with a high degree of pain relief, no single physical exam maneuver predicts response to diagnostic injections. When at least three physical exam findings are present, sensitivity, and specificity increases significantly. The prevalence of SIJ pain is likely 20-30% among patients that have suspected SIJ pain based on history and physical examination. This estimate may be higher in certain subgroups such as the elderly and fusion patients. Two randomized controlled trials and multiple observational studies supported the effectiveness of therapeutic sacroiliac joint injections.
  
  
  CONCLUSIONS
  Based on this literature, it is unclear whether image-guided intra-articular diagnostic injections of local anesthetic predict positive responses to therapeutic agents. The overall quality of evidence is moderate for the effectiveness of therapeutic SIJ injections.
authors.affiliation: Department of Orthopaedics, Stanford University, Redwood City, California, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Kennedy
authors.affiliation: Affordable Pain Management, Chicago, Illinois, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Engel
authors.affiliation: Ahwatukee Sports and Spine, Phoenix, Arizona, USA.
authors.forename: D Scott
authors.initials: DS
authors.lastname: Kreiner
authors.affiliation: Department of Rehabilitation Medicine, NYU School of Medicine, New York, New York, USA.
authors.forename: Devi
authors.initials: D
authors.lastname: Nampiaparampil
authors.affiliation: International Spine Intervention Society, San Rafael, California, USA.
authors.forename: Belinda
authors.initials: B
authors.lastname: Duszynski
authors.affiliation: Southern Rehabilitation, Christchurch, New Zealand.
authors.forename: John
authors.initials: J
authors.lastname: MacVicar
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005471:Fluoroscopy; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods*; D017116:Low Back Pain / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D012446:Sacroiliac Joint / Q000000981:diagnostic imaging*; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D013256:Steroids
keywords: Fluoroscopy; Injection; Local Anesthetic; Sacroiliac Joint; Steroids