Treatment of pain by Infiltration in the Sacroiliac Joint

The sacroiliac joint, a crucial connection point between the spine and pelvis, is often underestimated when it comes to low back pain.
However, problems in this joint can be a significant source of discomfort and limitations in daily life.
Pain in the sacroiliac joint can be debilitating, affecting the ability to perform daily activities, and can be due to a variety of causes, such as natural wear and tear, injury or inflammatory disorders.
In 2024, sacroiliac joint infiltration treatment remains one of the most effective options for managing sacroiliac joint pain, and here’s why.

What is the Sacroiliac Joint and its Importance in the Human Body?

The sacroiliac joint (SIJ) is located between the sacrum, which is the lower part of the spine, and the iliac bones of the pelvis.
This joint has limited movement, but plays an essential role in the stability of the body, acting as a shock absorber for the forces transmitted between the upper body and the legs.
Any disturbance in its function can trigger pain, not only in the lumbar region, but also in the hip, buttocks and even in the legs.

Pain in SIJ is often confused with other types of low back pain, which can delay correct diagnosis.
However, with modern diagnostic techniques, such as MRI and provocative testing, specialists can accurately identify whether ISA is the source of the pain.

Common Causes of Sacroiliac Joint Pain

Sacroiliac joint pain can have multiple origins:

• Degeneration and aging: With age, the cartilage that lines the joint can wear down, leading to sacroiliac osteoarthritis.
  This condition is especially common in older people and can cause chronic pain.
• Traumatic injuries: Accidents, falls or direct impacts can damage the ISA, causing acute or chronic pain.
• Pregnancy and hormonal changes: During pregnancy, the relaxation of ligaments to facilitate childbirth can destabilize the ISA, causing pain that may persist after delivery.
• Inflammatory diseases: Disorders such as ankylosing spondylitis, a form of inflammatory arthritis, can affect the ASI, causing pain and stiffness.

What is Sacroiliac Joint Infiltration?

Sacroiliac joint infiltration is a medical procedure in which medication is injected directly into the joint to relieve pain.
This treatment is especially useful when pain has not responded to other forms of conservative treatment, such as physical therapy or oral analgesics.
Medications used in infiltration typically include:

• Corticosteroids: These potent anti-inflammatory drugs help reduce inflammation in ISA, providing long-lasting pain relief.
• Local anesthetics: They are used to provide immediate pain relief and help confirm the diagnosis.

The combination of these drugs not only relieves pain, but also reduces inflammation, improving the patient’s mobility and quality of life.

Indications for Sacroiliac Joint Infiltration

This treatment is indicated for patients who present:

• Localized pain in the lower lumbar region, hips or buttocks, which may radiate to the legs.
• Tenderness in the sacroiliac area detected by physical examination.
• Diagnosis of ISA dysfunction confirmed by imaging tests or diagnostic blocks.
• Lack of response to conservative treatments such as physical therapy, exercise or anti-inflammatory drugs.

Infiltration is also a diagnostic option: if the injection significantly relieves the pain, it is a confirmation that the ASI is the source of the problem.

How is Sacroiliac Joint Infiltration Performed?

The infiltration procedure is minimally invasive and is performed on an outpatient basis.
The process is described below:

1. Preparation of the patient: The patient is asked to lie face down on an examination table.
   The lumbar and pelvic area is cleaned with an antiseptic solution to minimize the risk of infection.
2. Image guidance: Fluoroscopy (real-time X-ray) or ultrasound is used to accurately guide the needle into the sacroiliac joint.
   This precision is crucial to ensure that the medication is correctly delivered into the joint.
3. Injection of the medications: Once the needle is in place, the anesthetics and corticosteroids are injected.
   The patient may feel slight pressure or discomfort during the procedure, but it is generally well tolerated.
4. Observation and recovery: After the injection, the patient is monitored for a short period to ensure that there are no adverse reactions.
   Most patients can go home the same day and resume normal activities with certain temporary limitations.

Benefits of the Infiltration Procedure

Sacroiliac joint infiltration offers several benefits:

• Rapid and lasting pain relief: Many patients experience a significant reduction in pain within a few hours, and the effect can last for several weeks or months.
• Minimally invasive procedure: Compared to surgery, infiltration is less risky, has fewer complications and requires a much shorter recovery time.
• Improved quality of life: By reducing pain, patients can return to their daily activities, such as walking, sitting and sleeping, without the limitations imposed by chronic pain.

Risks and Procedural Considerations

Although generally safe, ISA infiltration carries certain risks:

• Infection: Although rare, it is a possibility, so strict aseptic standards must be followed.
• Allergic reactions: Some patients may be allergic to the injected drugs.
• Temporary increase in pain: In some cases, pain may worsen briefly before improving.
• Procedure failures: Not all patients experience pain relief, and in those cases, other treatments may need to be considered.

It is important that patients discuss these risks with their physician and evaluate whether the benefits outweigh the potential risks.

Treatment Effectiveness in 2024

In 2024, infiltration in ISA remains a highly effective treatment, backed by medical research and clinical experience.
Recent studies have shown that, when performed correctly, it can provide significant and long-lasting pain relief.
However, long-term effectiveness varies among patients.
Some may require repeated injections at regular intervals, while others may benefit from additional treatments, such as physical therapy or radiofrequency.

Conclusion

Sacroiliac joint infiltration is a safe and effective option for pain management in patients who have not responded to other treatments.
As we move forward in 2024, it is critical that patients are well informed about the options available and work closely with their physicians to develop a personalized treatment plan.
This approach not only improves quality of life, but also minimizes the need for more invasive procedures.