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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


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
Pages (from-to)628-642
Number of pages15
JournalMayo Clinic Proceedings
Issue number4
StatePublished - Apr 2019
Externally publishedYes


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