Background & Aims

Lumbar pain with or without irradiation to the lower limbs continues to be a frequent reason for medical attention in the consultation of health professionals, and the dilemma of alterations of the lumbar spine, which cause pain, continues to be an important challenge for medical doctors, who face patients on a daily basis.
The dysfunction of the sacroiliac joint, is estimated to be the cause of 15 to 30% of low back pain¹, which can become disabling and where the origin can be degenerative, inflammatory, due to osteoarthritis, traumatic injury or pregnancy.
The objective of the research study is to demonstrate an ultrasound-guided sacral parahiatal approach as a new technique for the diagnosis and treatment of sacroiliac joint dysfunction, as well as its effectiveness in terms of post-procedure pain control.

Methods

A review of the clinical records of the Pain Management Clinic – Dolomedic Alta Especialidad en Manejo Del Dolor in the city of H. Matamoros, Tamaulipas, Mexico was carried out.
Where the information was extracted, the patients treated with a presumptive diagnosis of sacroiliac joint dysfunction, presenting low back pain with or without irradiation to the lower limb and who on physical examination had 2 positive tests (Gillet, Yeoman, posterior shear, Gaenslen) and treated by injection with an ultrasound-guided sacral parahiatal approach, in a period from July 2019 to July 2023.

Results

A total of 87 patients were treated, of which 63 were female (72.4%) and 24 were male (27.6%).
By age range within the female sex, the following were attended: 16 (20 to 39 years), 30 (40 to 59 years), 13 (60 to 79 years), 4 (80 to 99 years).
Among the male sex, the following were attended: 6 (20 to 39 years old), 9 (40 to 59 years old), 9 (60 to 79 years old).
Pain relief was evaluated using a Visual Analogue Scale, starting from their initial pain, 20 days after the injection, obtaining the following information: Of the 87 patients in total, 9 had pain relief of 50 to 74%, 32 had 75 to 89% pain relief and 46 had 90 to 99% pain relief.
6 patients presented as a side effect, transient paresthesia in the form of numbness in the lateral and posterior area of the leg ipsilateral to the injection.
No complications occurred in any of the patients.

Conclusions

Although the approach described above seems promising, more studies are needed, as well as studies using anatomical dissection in cadavers to objectively demonstrate the distribution of the injection with the ultrasound-guided sacral parahiatal approach.
If in the future, the distribution of the injected solution described in the hypothesis could be objectively demonstrated, it could give rise to a regenerative medicine approach, rather than the destruction of tissues by thermal ablation or surgical fixations in the sacroiliac joint.

References

1.- Camacho-Galindo J, Gallegos TAG. Disfunción de articulación sacroilíaca. An Med ABC. 2021; 66 (2): 120-127. https:// dx.doi.org/10.35366/100481.
2.- Cohen SP, Chen Y, Neufeld NJ. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert Rev Neurother. 2013; 13 (1): 99-116. doi: 10.1586/ern.12.148. PMID: 23253394.
3.- Thawrani DP, Agabegi SS, Asghar F. Diagnosing sacroiliac joint pain. J Am Acad Orthop Surg. 2019; 27 (3): 85-93. doi: 10.5435/JAAOS-D-17-00132. PMID: 30278010.
4.- Nejati P, Sartaj E, Imani F, Moeineddin R, Nejati L, Safavi M. Accuracy of the diagnostic tests of sacroiliac joint dysfunction. J Chiropr Med. 2020; 19 (1): 28-37. doi: 10.1016/j.jcm.2019.12.002. Epub 2020 Sep 12. PMID: 33192189; PMCID: PMC7646135.
5.- Schneider BJ, Rosati R, Zheng P, McCormick ZL. Challenges in diagnosing sacroiliac joint pain: a narrative review. PM R. 2019; 11 Suppl 1: S40-S45. doi: 10.1002/pmrj.12175. Epub 2019 Jul 3. PMID: 31020770.

Presenting Author

Francisco Javier Machuca Vigil

Poster Authors

Francisco Javier Machuca Vigil

MD, MPM, FIPP

Dolomedic México

Lead Author

Rafael Orlando Vallejo Estrella MD

MPM

Dolomedic México

Lead Author

Roberto Jameson Rosales MD

MPM.

Dolomedic México

Lead Author

Francesca Dolciami

Medical Student

University of Perugia, Italy.

Lead Author

Gabriela Stephanie Romero

Registered Nurse

Dolomedic México

Lead Author

Topics

  • Assessment and Diagnosis