Sacroiliac joint injection

Sacroiliac joint injections can be performed using a posterior approach into the sacroiliac (SI) joint under fluoroscopic or CT guidance. It is often performed bilaterally.

  • diagnostic: relief of pain after injection of local anesthetic
  • therapeutic: to relieve pain from degenerative or inflammatory conditions of the SI joints 3-5

There are no specific absolute contraindications, but relative contraindications include 3-5:

  • systemic infection or cutaneous infection over the injection site
  • coagulopathy
  • contrast reaction or other medication allergies
  • pregnancy
  • history of presenting complaint: type, nature, severity, duration and location of back pain
  • relevant medical and surgical history
  • review relevant laboratory results
  • review prior imaging
  • counseling patient about onset, length and likelihood of pain relief
  • gaining informed consent
  • the patient is typically in a prone position
  • sterile dressing pack; sterile gown and gloves
  • 10 mL syringe, hypodermic needle and local anesthetic (e.g. lidocaine) for subcutaneous infiltration
  • long spinal needle (typically 22 G), 3 mL syringe, steroid (e.g. betamethasone), long-acting local anesthetic (e.g. ropivacaine, bupivacaine) for intra-articular injection
  • low osmolar contrast
  1. The target SI joint is localized, with a slight rotation of the fluoroscope (20-30°) to optimally visualize the inferior component of the articular space.
  2. Aiming about 1 cm above the lower end of the articular space.
  3. Sterile preparation and draping.
  4. Advance a 22G spinal needle in the posteroinferior aspect of the SI joint.
  5. Optional intra-articular injection of a small amount of contrast to confirm intra-articular position.
  6. Injection of 1 mL steroid and 1 mL long-acting local anesthetic.
  1. Perform a preliminary CT of the SI joints.
  2. The target SI joint is localized, with an aim at about 1 cm above the lower end of the articular space.
  3. Sterile preparation and draping.
  4. Advance a 22G spinal needle in the posteroinferior aspect of the SI joint.
  5. Optional intra-articular injection of a small amount of contrast to confirm intra-articular position.
  6. Injection of 1 mL steroid and 1 mL long-acting local anesthetic.
Post-procedure care
  • pain score assessed immediately and 15-20 minutes post procedure
  • observe for 20-30 minutes for any immediate complications

Complications are rare 3-5:

  • infection
  • allergic/anaphylactic reaction
  • local reaction to steroid injection (usually >48 hours)
  • transient numbness/paralysis (should resolve in minutes)
  • transient difficulty voiding
  • bleeding
  • 50-80% of patients have immediate pain relief
  • 90% of patients without previous spine surgery have pain relief at 12 hours
  • symptomatic relief is of 10 months duration, on average 4,5
Interventional procedures
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Article information

rID: 2012
Synonyms or Alternate Spellings:
  • SI joint injection
  • SIJ injection

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Cases and figures

  • Case 1: normal sacroiliac joint injection
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