Fluoroscopically Guided vs Landmark-Guided Sacroiliac Joint Injections: A Randomized Controlled Study

Steven P. Cohen, Mark C. Bicket, Connie Kurihara, Scott R. Griffith, Ian M. Fowler, Michael B. Jacobs, Richard Liu, Mirinda Anderson White, Aubrey J. Verdun, Sunil B. Hari, Rick L. Fisher, Paul F. Pasquina, Yakov Vorobeychik

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Abstract

Objectives: To determine the prevalence of intra- and extra-articular sacroiliac joint (SIJ) pain, which injection is more beneficial, and whether fluoroscopy improves outcomes. Patients and Methods: This patient- and evaluator-blinded comparative effectiveness study randomized 125 participants with SIJ pain from April 30, 2014, through December 12, 2017, to receive fluoroscopically guided injections into the joint capsule (group 1) or “blind” injections to the point of maximum tenderness using sham radiographs (group 2). The primary outcome was average pain on a 0 to 10 scale 1 month after injection. A positive outcome was defined as at least a 2-point decrease in average pain score coupled with positive (>3) satisfaction on a Likert scale from 1 to 5. Results: For the primary outcome, no significant differences were observed between groups (mean ± SD change from baseline, –2.3±2.4 points in group 1 vs –1.7±2.3 points in group 2; 95% CI, –0.33 to 1.36 points for adjusted difference; P=.23), nor was there a difference in the proportions of positive blocks (61% vs 62%) or 1-month categorical outcome (48% vs 40% in groups 1 and 2, respectively; P=.33). At 3 months, the mean ± SD reductions in average pain (–1.8±2.1 vs –0.9 ± 2.0 points; 95% CI, 0.11 to 1.58 points for adjusted difference; P=.02) and worst pain (–2.2±2.5 vs –1.4±2.0 points; 95% CI, 0.01 to 1.66 points for adjusted difference; P=.049) were greater in group 1 than 2, with other outcome differences falling shy of statistical significance. Conclusion: Although fluoroscopically guided injections provide greater intermediate-term benefit in some patients, these differences are modest and accompanied by large cost differences. Trial Registration: clinicaltrials.gov Identifier: NCT02096653.

Original languageEnglish (US)
Pages (from-to)628-642
Number of pages15
JournalMayo Clinic Proceedings
Volume94
Issue number4
DOIs
StatePublished - Apr 2019

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Sacroiliac Joint
Injections
Pain
Arthralgia
Accidental Falls
Joints
Joint Capsule
Fluoroscopy
Costs and Cost Analysis

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Cohen, Steven P. ; Bicket, Mark C. ; Kurihara, Connie ; Griffith, Scott R. ; Fowler, Ian M. ; Jacobs, Michael B. ; Liu, Richard ; Anderson White, Mirinda ; Verdun, Aubrey J. ; Hari, Sunil B. ; Fisher, Rick L. ; Pasquina, Paul F. ; Vorobeychik, Yakov. / Fluoroscopically Guided vs Landmark-Guided Sacroiliac Joint Injections : A Randomized Controlled Study. In: Mayo Clinic Proceedings. 2019 ; Vol. 94, No. 4. pp. 628-642.
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title = "Fluoroscopically Guided vs Landmark-Guided Sacroiliac Joint Injections: A Randomized Controlled Study",
abstract = "Objectives: To determine the prevalence of intra- and extra-articular sacroiliac joint (SIJ) pain, which injection is more beneficial, and whether fluoroscopy improves outcomes. Patients and Methods: This patient- and evaluator-blinded comparative effectiveness study randomized 125 participants with SIJ pain from April 30, 2014, through December 12, 2017, to receive fluoroscopically guided injections into the joint capsule (group 1) or “blind” injections to the point of maximum tenderness using sham radiographs (group 2). The primary outcome was average pain on a 0 to 10 scale 1 month after injection. A positive outcome was defined as at least a 2-point decrease in average pain score coupled with positive (>3) satisfaction on a Likert scale from 1 to 5. Results: For the primary outcome, no significant differences were observed between groups (mean ± SD change from baseline, –2.3±2.4 points in group 1 vs –1.7±2.3 points in group 2; 95{\%} CI, –0.33 to 1.36 points for adjusted difference; P=.23), nor was there a difference in the proportions of positive blocks (61{\%} vs 62{\%}) or 1-month categorical outcome (48{\%} vs 40{\%} in groups 1 and 2, respectively; P=.33). At 3 months, the mean ± SD reductions in average pain (–1.8±2.1 vs –0.9 ± 2.0 points; 95{\%} CI, 0.11 to 1.58 points for adjusted difference; P=.02) and worst pain (–2.2±2.5 vs –1.4±2.0 points; 95{\%} CI, 0.01 to 1.66 points for adjusted difference; P=.049) were greater in group 1 than 2, with other outcome differences falling shy of statistical significance. Conclusion: Although fluoroscopically guided injections provide greater intermediate-term benefit in some patients, these differences are modest and accompanied by large cost differences. Trial Registration: clinicaltrials.gov Identifier: NCT02096653.",
author = "Cohen, {Steven P.} and Bicket, {Mark C.} and Connie Kurihara and Griffith, {Scott R.} and Fowler, {Ian M.} and Jacobs, {Michael B.} and Richard Liu and {Anderson White}, Mirinda and Verdun, {Aubrey J.} and Hari, {Sunil B.} and Fisher, {Rick L.} and Pasquina, {Paul F.} and Yakov Vorobeychik",
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Cohen, SP, Bicket, MC, Kurihara, C, Griffith, SR, Fowler, IM, Jacobs, MB, Liu, R, Anderson White, M, Verdun, AJ, Hari, SB, Fisher, RL, Pasquina, PF & Vorobeychik, Y 2019, 'Fluoroscopically Guided vs Landmark-Guided Sacroiliac Joint Injections: A Randomized Controlled Study', Mayo Clinic Proceedings, vol. 94, no. 4, pp. 628-642. https://doi.org/10.1016/j.mayocp.2018.08.038

Fluoroscopically Guided vs Landmark-Guided Sacroiliac Joint Injections : A Randomized Controlled Study. / Cohen, Steven P.; Bicket, Mark C.; Kurihara, Connie; Griffith, Scott R.; Fowler, Ian M.; Jacobs, Michael B.; Liu, Richard; Anderson White, Mirinda; Verdun, Aubrey J.; Hari, Sunil B.; Fisher, Rick L.; Pasquina, Paul F.; Vorobeychik, Yakov.

In: Mayo Clinic Proceedings, Vol. 94, No. 4, 04.2019, p. 628-642.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Fluoroscopically Guided vs Landmark-Guided Sacroiliac Joint Injections

T2 - A Randomized Controlled Study

AU - Cohen, Steven P.

AU - Bicket, Mark C.

AU - Kurihara, Connie

AU - Griffith, Scott R.

AU - Fowler, Ian M.

AU - Jacobs, Michael B.

AU - Liu, Richard

AU - Anderson White, Mirinda

AU - Verdun, Aubrey J.

AU - Hari, Sunil B.

AU - Fisher, Rick L.

AU - Pasquina, Paul F.

AU - Vorobeychik, Yakov

PY - 2019/4

Y1 - 2019/4

N2 - Objectives: To determine the prevalence of intra- and extra-articular sacroiliac joint (SIJ) pain, which injection is more beneficial, and whether fluoroscopy improves outcomes. Patients and Methods: This patient- and evaluator-blinded comparative effectiveness study randomized 125 participants with SIJ pain from April 30, 2014, through December 12, 2017, to receive fluoroscopically guided injections into the joint capsule (group 1) or “blind” injections to the point of maximum tenderness using sham radiographs (group 2). The primary outcome was average pain on a 0 to 10 scale 1 month after injection. A positive outcome was defined as at least a 2-point decrease in average pain score coupled with positive (>3) satisfaction on a Likert scale from 1 to 5. Results: For the primary outcome, no significant differences were observed between groups (mean ± SD change from baseline, –2.3±2.4 points in group 1 vs –1.7±2.3 points in group 2; 95% CI, –0.33 to 1.36 points for adjusted difference; P=.23), nor was there a difference in the proportions of positive blocks (61% vs 62%) or 1-month categorical outcome (48% vs 40% in groups 1 and 2, respectively; P=.33). At 3 months, the mean ± SD reductions in average pain (–1.8±2.1 vs –0.9 ± 2.0 points; 95% CI, 0.11 to 1.58 points for adjusted difference; P=.02) and worst pain (–2.2±2.5 vs –1.4±2.0 points; 95% CI, 0.01 to 1.66 points for adjusted difference; P=.049) were greater in group 1 than 2, with other outcome differences falling shy of statistical significance. Conclusion: Although fluoroscopically guided injections provide greater intermediate-term benefit in some patients, these differences are modest and accompanied by large cost differences. Trial Registration: clinicaltrials.gov Identifier: NCT02096653.

AB - Objectives: To determine the prevalence of intra- and extra-articular sacroiliac joint (SIJ) pain, which injection is more beneficial, and whether fluoroscopy improves outcomes. Patients and Methods: This patient- and evaluator-blinded comparative effectiveness study randomized 125 participants with SIJ pain from April 30, 2014, through December 12, 2017, to receive fluoroscopically guided injections into the joint capsule (group 1) or “blind” injections to the point of maximum tenderness using sham radiographs (group 2). The primary outcome was average pain on a 0 to 10 scale 1 month after injection. A positive outcome was defined as at least a 2-point decrease in average pain score coupled with positive (>3) satisfaction on a Likert scale from 1 to 5. Results: For the primary outcome, no significant differences were observed between groups (mean ± SD change from baseline, –2.3±2.4 points in group 1 vs –1.7±2.3 points in group 2; 95% CI, –0.33 to 1.36 points for adjusted difference; P=.23), nor was there a difference in the proportions of positive blocks (61% vs 62%) or 1-month categorical outcome (48% vs 40% in groups 1 and 2, respectively; P=.33). At 3 months, the mean ± SD reductions in average pain (–1.8±2.1 vs –0.9 ± 2.0 points; 95% CI, 0.11 to 1.58 points for adjusted difference; P=.02) and worst pain (–2.2±2.5 vs –1.4±2.0 points; 95% CI, 0.01 to 1.66 points for adjusted difference; P=.049) were greater in group 1 than 2, with other outcome differences falling shy of statistical significance. Conclusion: Although fluoroscopically guided injections provide greater intermediate-term benefit in some patients, these differences are modest and accompanied by large cost differences. Trial Registration: clinicaltrials.gov Identifier: NCT02096653.

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