How are sacroiliac joint blocks administered for pain management?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Answer

Answer

Sacroiliac joint blocks are challenging because the joint cavity lies deep to the corrugated interosseous surfaces of the sacrum and ilium and is joined by the dense interosseous sacroiliac ligament. Entry into the joint is most practical below the interosseous ligament deep to the gluteus maximus muscle along the upper margin of the greater sciatic notch. Using the technique described by Bogduk et al, the patient is placed in the prone position and a 25-gauge spinal needle is inserted through a skin wheal into the gluteus maximus and advanced until it engages the posterior aspect of the sacrum.

The operator must be cautious to avoid the greater sciatic foramen and redirect the needle toward the lower end of the joint space. Once the needle enters this slitlike opening, it is wedged between the sacrum and ilium and should be in the correct position. Penetration should be just deep enough to engage the slit; further penetration may cause the needle to emerge from the ventral surface of the joint. Contrast medium is then injected to verify placement and pain concordance. LA with or without supplementary agents may be injected for diagnostic and therapeutic purposes.


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