SI joint fluoro positioning?

[CarabinerSD]

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For SI joint injections what is your typical starting fluoro view? AP or slight contralateral oblique? Ran into a few less ideal SIJ contrast spread recently so looking for clinical tips to improve my SIJ approach.

 

[lobelsteve]

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.

 

[mdo1738]

CLO until anterior and posterior aspects line up, generally between 15-25 degrees

 

[clubdeac]

Trained in CLO however after 17 yrs of doing this I've found I can hit the inferior posterior opening much more consistently in straight AP. That's just me

 

[RoloTomassi]

Trained in CLO however after 17 yrs of doing this I've found I can hit the inferior posterior opening much more consistently in straight AP. That's just me

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.

 

[MitchLevi]

For SI joint injections what is your typical starting fluoro view? AP or slight contralateral oblique? Ran into a few less ideal SIJ contrast spread recently so looking for clinical tips to improve my SIJ approach.

You won’t always get a perfect arthrogram. I think the SIJ CSI is little more complicated than what most ppl think.

 

[interjectionreflection]

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

 

[mille125]

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.

This is what I do as well. Can't think of many issues

 

[FSQT]

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!

 

[MitchLevi]

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

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.

 

[MD87]

Easiest injection that is sometimes impossible. Can check old CT scans for access angle. I don't do this, though.

 

[oreosandsake]

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

 

[Baron S]

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

How are you billing because 20796 specifically requires fluoro or CT.

I also prefer US but coding it as a trigger point injection sucks.

 

[DODOCSS]

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?

 

[bubaghanush]

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.

 

[mille125]

Yes how?

Trigger point coding

 

[DODOCSS]

Trigger point coding

Sounds like fraud, no?

 

[Ducttape]

i dont think its fraud. a trigger point is simply a targetted injection. it just doesnt pay as much as SIJ (with fluoro).

 

[clubdeac]

There are a couple in my practice that I don’t think have ever successfully gotten into the joint 🤔

 

[DODOCSS]

Sounds like fraud, no?

It is fraud unequivocally

 

[DODOCSS]

i dont think its fraud. a trigger point is simply a targetted injection. it just doesnt pay as much as SIJ (with fluoro).

Unequivocally it is fraud