Hasoon Jamal, Chung Matthew, Yazdi Cyrus, Robinson Christopher L
Department of Anesthesiology, Critical Care, and Pain Medicine The University of Texas Health Science Center at Houston.
Department of Pain Medicine The University of Texas MD Anderson Cancer Center.
Orthop Rev (Pavia). 2025 Aug 20;17:143090. doi: 10.52965/001c.143090. eCollection 2025.
Sacroiliac joint (SIJ) dysfunction is a frequently underdiagnosed contributor to chronic low back pain. Although fluoroscopic-guided SIJ injections remain the gold standard for both diagnostic and therapeutic purposes, their availability may be limited by insurance barriers or logistical constraints. In such cases, alternative approaches such as ultrasound-guided or landmark-based injections may offer practical, rapid solutions in outpatient settings. This case series aims to compare outcomes between landmark-based and fluoroscopic-guided SIJ injections in patients presenting with clinical findings suggestive of SIJ-related pain.
Ten patients with suspected SIJ-related pain were identified based on a positive Fortin's Finger Test and FABERs examination. Five patients underwent landmark-based SIJ injections, performed by palpating the posterior superior iliac spine (PSIS) and directing the needle slightly inferior to this landmark. The remaining five patients received fluoroscopic-guided SIJ injections using standard imaging protocols. All injections consisted of 2 mL of 0.25% bupivacaine combined with 40 mg of triamcinolone. Pain relief was assessed at a 2-week follow-up using patient-reported percentage improvement.
Among patients who underwent landmark-based injections, reported pain relief at two weeks was 50%, 40%, 50%, 90%, and 50%, with an average relief of 56%. In contrast, patients receiving fluoroscopic-guided injections reported pain relief of 80%, 50%, 75%, 100%, and 75%, with an average relief of 76%. No procedural complications were reported in either group.
Fluoroscopic-guided SIJ injections were associated with greater and more consistent pain relief at short-term follow-up. However, landmark-based injections provided meaningful clinical benefit in the majority of patients and may serve as a practical option when immediate intervention is needed, particularly when imaging resources are unavailable or delayed due to insurance approval. The absence of complications in either group supports the relative safety of both approaches when performed by trained interventionalists. Notably, we maintain that fluoroscopic-guided injections remain the gold standard and should be utilized to confirm sacroiliac joint pain or when assessing patients for potential advanced interventions.
While fluoroscopic guidance offers superior accuracy and therapeutic efficacy for SIJ injections, landmark-based techniques can be a viable solution in specific clinical scenarios. Fluoroscopic-guided injections remain the gold standard and should be utilized to confirm sacroiliac joint pain or when assessing patients for potential advanced interventions.
骶髂关节（SIJ）功能障碍是慢性下腰痛的一个经常被漏诊的病因。尽管透视引导下的骶髂关节注射仍然是诊断和治疗的金标准，但其应用可能受到保险限制或后勤制约。在这种情况下，诸如超声引导或基于体表标志的注射等替代方法可能在门诊环境中提供实用、快速的解决方案。本病例系列旨在比较基于体表标志和透视引导的骶髂关节注射在有提示骶髂关节相关疼痛临床发现的患者中的疗效。
根据阳性的福廷指试验和“4”字试验，确定10例疑似骶髂关节相关疼痛的患者。5例患者接受基于体表标志的骶髂关节注射，通过触诊髂后上棘（PSIS）并将针头指向该标志稍下方来进行。其余5例患者接受使用标准成像方案的透视引导下的骶髂关节注射。所有注射均由2 mL 0.25%布比卡因与40 mg曲安奈德组成。在2周随访时使用患者报告的改善百分比评估疼痛缓解情况。
在接受基于体表标志注射的患者中，报告的2周时疼痛缓解率分别为50%、40%、50%、90%和50%，平均缓解率为56%。相比之下，接受透视引导注射的患者报告的疼痛缓解率为80%、50%、75%、100%和75%，平均缓解率为76%。两组均未报告操作并发症。
透视引导下的骶髂关节注射在短期随访中与更大且更一致的疼痛缓解相关。然而，基于体表标志的注射在大多数患者中提供了有意义的临床益处，并且在需要立即干预时，特别是当由于保险批准而无法获得或延迟影像资源时，可能是一种实用的选择。两组均未出现并发症，这支持了由训练有素的介入医生进行这两种方法时的相对安全性。值得注意的是，我们坚持认为透视引导注射仍然是金标准，应用于确认骶髂关节疼痛或在评估患者是否适合潜在的高级干预措施时使用。
虽然透视引导为骶髂关节注射提供了更高的准确性和治疗效果，但基于体表标志的技术在特定临床场景中可能是一种可行的解决方案。透视引导注射仍然是金标准，应用于确认骶髂关节疼痛或在评估患者是否适合潜在的高级干预措施时使用。
