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
N1 - Publisher Copyright:
© 2018 Mayo Foundation for Medical Education and Research
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.
UR - http://www.scopus.com/inward/record.url?scp=85062449931&partnerID=8YFLogxK
U2 - 10.1016/j.mayocp.2018.08.038
DO - 10.1016/j.mayocp.2018.08.038
M3 - Article
C2 - 30853260
AN - SCOPUS:85062449931
SN - 0025-6196
VL - 94
SP - 628
EP - 642
JO - Mayo Clinic Proceedings
JF - Mayo Clinic Proceedings
IS - 4
ER -