Outcomes of Intra-articular Steroid Injection Via Ultrasound Guidance Versus Fluoroscopic Guidance in the Sacroiliac Joint in Patients With Sacroiliitis

The sacroiliac joint (SIJ) is increasingly recognized as a contributor to low back pain(LBP), with epidemiological estimates attributing approximately 10‐30 % of mechanical lowback pain cases to SIJ pathology1. Anatomically, the SIJ is a synovial‐type (inferiorportion) or syndesmosis‐type (superior portion) joint between the sacrum and the ilium,supported by substantial interosseous, posterior and anterior ligaments and innervated bydorsal sacral rami and lower lumbar dorsal rami2. Inflammatory involvement of the SIJoccurs in conditions such as axial spondyloarthritis and may also arisepost‐traumatically or degeneratively3.NSAIDs and physical therapies are used to treat sacroiliitis. However, intraarticularcorticosteroid injections administered locally to the SI joint might result in rapid andsignificant clinical improvements in extremely painful instances4,5. Fluoroscope guided(FL) is usually employed to increase the precision of this treatment, however CT and MRIhave also been used in recent years. These imaging techniques have a number of drawbacks,such as radiation exposure, expense, and the need for suitable infrastructure6. A newalternative technique for guiding SIJ injection is ultrasound (US) guidance. Theadvantages of US‐guided injection over FL include that it eliminates radiation exposure,is more accessible, and is less expensive when used alone. Additionally, the US permits"real‐time" visualisation of the injectate distribution and needle tip duringinjection.7,8.