What is a sacroiliac joint arthrogram and why is it helpful?

The sacroiliac joints are paired joints occurring at the junction of sacrum and iliac bones. The sacroiliac joints are robust, powerful joints, which serve to distribute the weight of the upper body across the bony pelvis. The joints are located deep in the body at about the level of your buttocks. Several medical conditions can cause pain or inflammation in the sacroiliac joints. Pain deriving from the sacroiliac joints may radiate to your buttocks, low back, or posterior thighs. Unfortunately, pain arising from the sacroiliac joints cannot be accurately diagnosed by imaging or physical examination alone. In order to determine if a particular sacroiliac joint is painful a fluoroscopically guided diagnostic injection must be performed.

What will happen during the procedure?

All injections provided at the Kaiser Fremont/Hayward Spinal Diagnostics Center are performed by specialty-trained spine physicians under fluoroscopic (x-ray) guidance. Using fluoroscopy allows the physician performing the injection to place the medicine precisely into the sacroiliac joint. Immediately prior to the procedure an IV will be started and you will be positioned on the exam table. A nurse may administer some intravenous medication to help you relax during the procedure but you will be awake at all times. Next, while lying on a table, the skin over your buttocks will be well cleaned. The physician will numb a small area of skin with an anesthetic, which stings for a few seconds. Once your skin has been anesthetized the physician will use x-ray guidance to direct a very small needle into the sacroiliac joint. He will then inject contrast material into the joint to confirm that the medicine flows in the proper distribution. This may increase your usual pain for about 30 seconds. Lastly, a small amount of numbing medicine and, perhaps, cortisone will be injected.

What should I do after the procedure?

Twenty to thirty minutes after the procedure, you will try to provoke your usual pain. You will report your percentage of pain relief and also record the relief you experience during the next several hours on a "pain diary" which we will provide. You should bring the completed pain diary with you when you see your referring physician. You will wait 30-60 minutes before going home. You may develop some weakness in the leg muscles as the numbing agent placed into the joint leaches out into the surrounding tissues. Because of this you may not drive for 8 hours after the injection. If you received sedation you may not drive for 12 hours after your injection.

Potential Complications

With any procedure there are potential complications. You and your doctor should discuss these before being referred for an epidural. We believe that in carefully selected patients the potential benefits from an epidural outweigh the potential harms. Potential complications or risks may include, but are not limited to:

1. If you are a diabetic your blood sugar will increase for 48 hours after the cortisone injection and you will need to monitor this.
2. Infection is a remote possibility whenever a needle is introduced under the skin. To prevent this complication your skin will be disinfected and carefully prepared using strict sterile technique. If an infection in the hip joint develops, this is a serious complication and it will require intensive antibiotic treatment and possibly surgery.
3. Local bleeding may rarely be serious and require further treatment.
4. There is a remote potential for nerve injury which can lead to permanent pain and /or weakness.
5. You may have allergic/adverse reactions to medications and substances used during the procedure: Betadine (contain iodine), anesthetics, contrast agents, corticosteroids. Side effects of corticortisteroids include increased blood sugar, increased blood pressure, mood swings, fluid retention that can exacerbate existing heart failure, local fat atrophy, facial flushing, skin discoloration, gastritis or peptic ulcer disease, bone demineralization and necrosis of the hip.
6. Risk of conscious sedation, which include, but not limited to allergic reactions to medications, post-procedure psychological problems such as hallucination, potential for over sedation, potential breathing problems, lack of blood flow and oxygen to vital organs such as the brain and the heart, which creates the risk of major complications such as stroke, heart attack or potentially even death.
7. Although most patients will benefit from the procedure, there is no guarantee of the desired results. Some patients will have a severe flare up in their pain for 1-2 weeks after an injection. In some individuals, this increase in pain can last longer, or in rare cases, even be permanent.

General Pre/Post Procedure Instructions

1. You should REFRAIN FROM EATING AND DRINKING 8 HOURS prior to the procedure EXCEPT for taking sips of plain water with medication (see below).
2. If you are taking oral (pill form) diabetes medication, DO NOT take this medication the morning of the procedure.
3. Take all other routine medications before the procedure (such as high blood pressure medication and insulin injection), including the morning of the procedure, with sips of water. If you are taking insulin injection, inject only HALF of the usual scheduled dose the morning of the procedure.
4. STOP ASPIRIN and any medication that contains aspirin, such as Excedrin, 7 DAYS PRIOR to the prodecure.
5. STOP ALL ANTI-INFLAMMATORY MEDICATIONS (e.g. Motrin/Ibuprofen, Naprosyn/Naproxen, Aleve, Relafen/nabumetone, Lodine/etodolac, Daypro, Indocin, Celebrex, Trilisate, Feldene etc.) 5 DAYS PRIOR to the procedure.
6. If you are taking St. John’s Wort, Ginkgo, Ginseng, or Garlic supplements, you will need to stop these 5 days prior to the procedure. All of your routine medicines and supplements can be re-started after the procedure on the same day. You may take your regular pain medicine as needed before/after the procedure.
7. If you are taking Coumadin/Warfarin, heparin, Lovenox/Enoxaparin, please call the Coumadin Clinic at your local Kaiser facility or the physician who prescribed the medication prior to your visit.
8. If you are taking Plavix/Clopidogrel, Ticlid/Ticlopidine, or Pletal/Cilostazol, you must notify our office no later than 2 weeks prior to the procedure so that the timing of stopping these medicines can be explained.
9. You will need to bring a driver with you who is available to wait for you during the procedure. You may return to your current level of activities the next day, including return to work.
10. If you are on antibiotics, please notify our office, we may postpone the procedure until you have finished the medicine.
11. If you have an active infection or fever, we will not perform the procedure.
12. If you are a woman of childbearing age and you know or suspect that you may be pregnant, we will not perform the procedure.
13. If you have a known allergy – rash, hives, or anaphylaxis – to iodinated contrast agents, please contact our office 1week prior to your procedure.
14. You will be in the hospital for 2-3 hours even though you will see the physician for only 20 to 30 minutes.
15. You may return to your current level of activities the next day, including return to work.
16. If you have a recent spine MRI which was performed outside Kaiser Permanente you must hand carry it with you to your visit. Failure to do so may result in rescheduling of the procedure.

Cortisone inhibits the body’s response to fight infection. Cortisone injections should not be given if there is an active infection elsewhere in your body. This is an elective procedure. If you have fever, chills, have a cold or flu or any infection, you should call to cancel the procedure. You should also call to cancel the procedure if you have recent (since booking this procedure) exacerbation of heart failure, heart attack, stroke or transient ischemic attack.

For cancellation or rescheduling procedures: Call (510) 675-4540

IF YOU NEED TO CANCEL THE PROCEDURE THE DAY OF YOUR APPOINTMENT, PLEASE CALL THE KAISER FREMONT AMBULATORY SURGERY CENTER DIRECTLY AT (510) 248-5650.

Place of Procedure

Your procedure will be performed at the Kaiser Fremont Ambulatory Surgery Center, located on the ground floor of the Embarcadero Building, Kaiser Fremont Hospital, 39400 Paseo Padre Parkway, Fremont, CA 94538.

Appointment Date:_____________________________________________________

Appointment Time:_____________________________________________________

Physician: ____________________________________________________________

NOTE: Please arrive ONE HOUR PRIOR to the appointment time to allow necessary preparation for the procedure. Failure to do so will result in rescheduling of the procedure.