SI joint fluoro positioning?
Started by CarabinerSD
CLO, caudal tilt. Y view. ALign anterior and posterior limbs of inferior third of the joint. Touch os medially on sacrum before heading laterally to enter joint.
Look at a model as you read the above. It gets easier.
Look at a model as you read the above. It gets easier.
CLO until anterior and posterior aspects line up, generally between 15-25 degrees
Agree. I start with AP, then CLO if necessary. Not everybody's anatomy needs a CLO at the inferior tip. Here's the first two random CTs in my PACS.
You won’t always get a perfect arthrogram. I think the SIJ CSI is little more complicated than what most ppl think.
What would you say your rate of IA is? From what I've seen about 50% pure IA and the rest mixed IA with Extravasation or purely peri. Can't say the results differ
This is what I do as well. Can't think of many issues
I've tried a bunch of different approaches and never have found any I'm 100% satisfied with on everyone.
These days is different for everyone. I often try to separate the joint lines (usually by going a little non-CLO oblique) to ensure the posterior joint line is medial. But sometimes I overlay them if I need too. I'm probably 80% of patients wirh obvious intraarticular pattern, but I also spend too much time on these injections.
I also am weird and additionally hit the deep ligaments (interosseous and posterior sacroiliac) that exist way deep to the PSIS. Usually I hit these from the AP (or slight CLO), with the needle entering skin at about S1 sacral spinous process, and drive without a trajectory view.
Would love to hear others!
These days is different for everyone. I often try to separate the joint lines (usually by going a little non-CLO oblique) to ensure the posterior joint line is medial. But sometimes I overlay them if I need too. I'm probably 80% of patients wirh obvious intraarticular pattern, but I also spend too much time on these injections.
I also am weird and additionally hit the deep ligaments (interosseous and posterior sacroiliac) that exist way deep to the PSIS. Usually I hit these from the AP (or slight CLO), with the needle entering skin at about S1 sacral spinous process, and drive without a trajectory view.
Would love to hear others!
Good question, impossible to say. I don’t think the outcomes are any different either.
Who is to say it has to be IA to help? Probably doesn’t need to be.
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studies show us that intranarricular and peri articular have the same outcomes
Stopped using fluoro for SIJ about 3 years ago unless the patient BMI is 50.
Yes, I mostly use US. I think it’s the same outcomes
Stopped using fluoro for SIJ about 3 years ago unless the patient BMI is 50.
Yes, I mostly use US. I think it’s the same outcomes
How are you billing because 20796 specifically requires fluoro or CT.
I also prefer US but coding it as a trigger point injection sucks.
Yes how?
I usually go AP or slight oblique so I can clearly see the medial joint line. Lining up the joints I find you end up too medial at times.
I don't go crazy, maybe two redirections max before just taking it periarticular. Some joints you can see on CT are ossified and you can't get in. IPSIS has a good case study on SIJ injections.
I don't go crazy, maybe two redirections max before just taking it periarticular. Some joints you can see on CT are ossified and you can't get in. IPSIS has a good case study on SIJ injections.
Trigger point coding
Sounds like fraud, no?
i dont think its fraud. a trigger point is simply a targetted injection. it just doesnt pay as much as SIJ (with fluoro).
It is fraud unequivocally
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Unequivocally it is fraud
