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

Steven Cohen, Mark 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. Fischer, Paul F. Pasquina, Yakov Vorobeychik

Research output: Contribution to journalArticle

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)
JournalMayo Clinic proceedings
DOIs
StatePublished - Jan 1 2019

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

ASJC Scopus subject areas

  • Medicine(all)

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

In: Mayo Clinic proceedings, 01.01.2019.

Research output: Contribution to journalArticle

Cohen, S, Bicket, M, Kurihara, C, Griffith, SR, Fowler, IM, Jacobs, MB, Liu, R, Anderson White, M, Verdun, AJ, Hari, SB, Fischer, RL, Pasquina, PF & Vorobeychik, Y 2019, 'Fluoroscopically Guided vs Landmark-Guided Sacroiliac Joint Injections: A Randomized Controlled Study', Mayo Clinic proceedings. https://doi.org/10.1016/j.mayocp.2018.08.038
Cohen, Steven ; Bicket, Mark ; Kurihara, Connie ; Griffith, Scott R. ; Fowler, Ian M. ; Jacobs, Michael B. ; Liu, Richard ; Anderson White, Mirinda ; Verdun, Aubrey J. ; Hari, Sunil B. ; Fischer, Rick L. ; Pasquina, Paul F. ; Vorobeychik, Yakov. / Fluoroscopically Guided vs Landmark-Guided Sacroiliac Joint Injections : A Randomized Controlled Study. In: Mayo Clinic proceedings. 2019.
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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.",
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T2 - A Randomized Controlled Study

AU - Cohen, Steven

AU - Bicket, Mark

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 - Fischer, Rick L.

AU - Pasquina, Paul F.

AU - Vorobeychik, Yakov

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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.

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