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CompletedNCT01719081Updated Dec 23, 2016

Sacroiliac Joint Injection: Comparison of Xray Versus Ultrasound

An interventional study of Sacroiliac Joint Injection in Sacroiliac Joint Arthritis Causing Low Back Pain, sponsored by University Health Network, Toronto. Completed at 1 site in Canada. Open to participants aged 18 Years to 85 Years. Per ClinicalTrials.gov, last updated 2016-12-23.

Sponsored by University Health Network, Toronto · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
40
Allocation
Randomized
Ages
18 Years to 85 Years
Sex
All
01

Study summary

This project involves the assessment of the efficacy of two different image guided techniques in patients with low back pain due to arthritis of the sacroiliac joint (SIJ). Intra-articular injection of local anesthetics and steroids is performed to relieve pain originating from the SIJ. Fluoroscopy has been used traditionally for image guidance for this procedure but there is a growing interest in use of ultrasound (US) for this procedure. US avoids radiation exposure to the patient and the health care team (HCT) and is less expensive. We aim to compare procedural efficacy related outcomes for SIJ injections performed using these image-guided modalities.

Read the detailed description

The study is a prospective, randomized trial. Patients with low back pain which is diagnosed secondary to SIJ disease will be identified beforehand in clinic and offered a therapeutic joint injection. Informed consent will be obtained. Patients will be randomized for SIJ block with 3 mL of 0.25% bupivacaine with 1:200,000 epinephrine and 40 mg depomedrol using guidance with ultrasound or fluoroscopy. In both groups, confirmation of needle placement will be obtained using contrast injection imaging before the injection is performed. Record will be made of the number of times the needle is correctly placed into the articular space, as well as the number of attempts to do so. The final position of the needle will be recorded. Pain scores will be assessed before the procedure, as well as post-procedure at 24 and 72 hours, as well as 1 week, 1 month, and 3 months. Patients will keep a pain diary and will be followed up at 3 months time in clinic.

02

Conditions studied

  • Sacroiliac Joint Arthritis Causing Low Back Pain

Keywords

  • Sacroiliac Joint
  • Ultrasound
  • Fluoroscopy
  • Chronic Pain
03

Who can participate

Ages eligible
18 Years to 85 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Suspicion of SIJ disease on history: pain below the lumbo-sacral junction; pain with full weight-bearing on one leg; pain worse going down hills or inclines; very low back pain associated with groin pain and absence of lumbar symptoms
  • Two positive responses to the following maneuver: FABER (flexion abduction and external rotation of hip), POSH (posterior shear test), REAB (resisted abduction)
  • Baseline NRS pain score > or = to 4
  • Refractory to oral analgesic therapy

Exclusion criteria

Exclusion Criteria:

  • ongoing litigation issues related to the patient's pain
  • pregnancy
  • allergy to steroids or local anesthetics
  • multiple comorbidities
  • BMI > 35
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Participant)
Enrollment
40 participants (actual)

Study arms

  • Experimental
    Ultrasound Guided SIJ Injection

    Needle placement will be performed under US guidance. Fluoroscopy will be used to confirm needle placement prior to medication injection.

    Procedure: Sacroiliac Joint Injection

  • Active comparator
    Xray Guided SIJ Injection

    Needle placement will be performed under fluoroscopy.

    Procedure: Sacroiliac Joint Injection

Interventions

  • ProcedureSacroiliac Joint Injection

    Medication injected into the sacroiliac joint: Bupivicaine 3ml 0.25% with epinephrine 1/200,000 and Depo-Medrol 40mg.

05

What researchers measure

Primary outcomes

  1. Incidence of needle placement into SIJ

    Time frame: Assessed at time of injection

  2. Pain - Numeric Rating Scale Score at 1 month

    Time frame: One month from time of injection

Secondary outcomes

  1. Improvement of functional ability at 1 month

    Oswestry Disability Index completed at 1 month to determine level of disability

    Time frame: 1 month from time of injection

  2. Patient Satisfaction

    Time frame: 1 month from time of injection

  3. Average daily consumption of opioids at 1 month

    Time frame: 1 month from injection

  4. Patient discomfort with procedure

    Time frame: Measured at time of procedure

  5. Number of needle readjustments

    Time frame: Measured at time of procedure

Other outcomes

  1. Assessment of complications

    Complications assessed at any point until 3 months after procedure

    Time frame: Until 3 months after procedure

06

Study locations

1 site
  • Toronto Western Hospital
    Toronto, Ontario M5T 2S8, Canada
07

Registry details

Key details

Study ID
NCT01719081
Lead sponsor
University Health Network, Toronto
Responsible party
Sponsor
First posted
Nov 1, 2012
Start date
Jan 2012
Primary completion
Aug 2013
Completion
Aug 2013
Last update
Dec 23, 2016

Study contacts

Anuj Bhatia, MD, FRCPC
principal investigator · University Health Network, Toronto

Oversight

Data monitoring committee
Yes
View the source record on ClinicalTrials.gov ↗

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This study is completed, as verified in Dec 2013. You cannot join it, but the record below documents what was studied.

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