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MRI-guided sacroiliac joint injections in children and adults: current practice and future developments

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Abstract

Common etiologies of low back pain include degenerative arthrosis and inflammatory arthropathy of the sacroiliac joints. The diagnostic workup revolves around identifying and confirming the sacroiliac joints as a pain generator. Diagnostic sacroiliac joint injections often serve as functional additions to the diagnostic workup through eliciting a pain response that tests the hypothesis that the sacroiliac joints do or do not contribute to the patient’s pain syndrome. Therapeutic sacroiliac joint injections aim to provide medium- to long-term relief of symptoms and reduce inflammatory activity and, ultimately, irreversible structural damage. Ultrasonography, fluoroscopy, computed tomography, and magnetic resonance imaging (MRI) may be used to guide sacroiliac joint injections. The populations that may benefit most from MRI-guided sacroiliac joint procedures include children, adolescents, adults of childbearing age, and patients receiving serial injections due to the ability of interventional MRI to avoid radiation exposure. Most clinical wide-bore MRI systems can be used for MRI-guided sacroiliac joint injections. Turbo spin echo pulse sequences optimized for interventional needle display visualize the needle tip with an error margin of < 1 mm or less. Published success rates of intra-articular sacroiliac joint drug delivery with MRI guidance range between 87 and 100%. The time required for MR-guided sacroiliac joint injections in adults range between 23–35 min and 40 min in children. In this article, we describe techniques for MRI-guided sacroiliac joint injections, share our practice of incorporating interventional MRI in the care of patients with sacroiliac joint mediated pain, discuss the rationales, benefits, and limitations of interventional MRI, and conclude with future developments.

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Funding

This work was in part funded by National Institutes of Health grants R01 EB025179 and R01 CA118371.

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Authors and Affiliations

  1. Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, KT18 7EG, London, UK

    Danoob Dalili

  2. School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK

    Amanda Isaac

  3. Department of Diagnostic and Interventional Radiology, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK

    Amanda Isaac

  4. Department of Radiology, New York University Grossman School of Medicine, 660 1st Ave, 3rd Floor, Rm 313, New York, NY, 10016, USA

    Jan Fritz

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Correspondence to Jan Fritz.

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Key points

The sacroiliac joints are a substantial source of spinal and low back pain, with the most common etiologies including degenerative arthrosis and inflammatory arthropathy.

Selective sacroiliac joint injections serve as functional additions to the diagnostic workup to test the hypothesis that the sacroiliac joints do or do not contribute to the patient’s pain syndrome.

The populations that may benefit most from MRI-guided sacroiliac joint procedures include children, adolescents, adults of childbearing age, and patients receiving serial injections due to the avoidance of radiation exposure.

Success rates of intra-articular sacroiliac joint drug delivery with MRI guidance range between 87 and 100%, with procedure times ranging from 23 to 40 min for children and adults.

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Dalili, D., Isaac, A. & Fritz, J. MRI-guided sacroiliac joint injections in children and adults: current practice and future developments. Skeletal Radiol 52, 951–965 (2023). https://doi.org/10.1007/s00256-022-04161-y

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