Analgesic Effect of Sacral Submultifidus Block as an Adjunct to Sacroiliac Joint Injection

Sacroiliac joint (SIJ) pain is an under‐recognized significant contributor to chronic lowback pain, with estimates indicating that it accounts for approximately 10‐30% ofmechanical low back pain presentations . The SIJ is a complexdiarthrodial‐amphiarthrodial articulation between the sacrum and ilium that functionswithin the weight‐bearing system of the pelvis and lumbosacral spine, stabilized by adense ligamentous network and influenced by surrounding musculature . Pain originatingfrom the SIJ often manifests as deep aching discomfort that can radiate to the buttocks,groin, or lower extremity and may be difficult to differentiate from lumbar or hippathology based on clinical features alone .The intricate innervation of the SIJ contributes to diagnostic challenges. Abundantanatomical evidence suggests that pain signals from both intra‐articular andextra‐articular structures, including the posterior sacroiliac ligaments and dorsalsacral rami, converge to produce symptomatology, underscoring the potential utility oftargeted neural blockade . Image‐guided intra‐articular injections with local anestheticand corticosteroids are commonly used for both diagnostic confirmation and therapeuticpain relief, yet responses to these interventions are variable and often short‐lived .Systematic reviews have demonstrated modest analgesic effects of SIJ injections overalland highlight significant heterogeneity in procedural techniques and outcomes,emphasizing the ongoing need for optimized interventional strategies .Given the limitations of conventional SIJ injections, interest has grown in adjunctiveregional blockade techniques that more comprehensively target periarticular neuralpathways . Fascial plane and lateral branch blocks aimed at disrupting nociceptive inputfrom the posterior sacral nerve supply have shown physiological efficacy in cadaver andclinical studies, though high‐quality randomized data remain limited . The sacralsubmultifidus block is a novel regional anesthetic technique that targets the dorsal ramibeneath the multifidus muscle, potentially augmenting pain control when combined with SIJinjection by addressing extra‐articular and posterior nociceptive sources .So addition of ultrasound‐guided sacral submultifidus block to SIJ injection producessuperior pain relief and functional improvement compared with SIJ injection alone .Some patients may only require one injection, while others may require severalinjections. As a general guideline, injections may be administered once every 2 weeks,and no more than 3 injections may be given per year In general, if the first injectionprovides significant relief, additional injections may be recommended. However, the exacttiming can vary based on the doctor's guidance, the patient's response to the treatment,and the type of injection The long‐term outcomes of SI joint injections can varydepending on a number of factors, including the underlying cause of the pain, thepatient's overall health, the patient's response to the injection, and the type ofinjection used.