Sacroiliac joint injection (SIJI)

December 11, 2020


What are the disks?

The disks are soft, cushion-like pads which separate the hard vertebral bones of your spine. A disk may be painful when it bulges, herniates, tears or degenerates and may cause pain in your neck, mid-back, low back and arms, chest wall, abdomen and legs. Other structures in your spine may also cause similar pain such as the muscles, joints and nerves. Usually, we have first determined that these other structures are not your sole pain source (through history and physical examination, review of x-rays, CT’s/MRI’s and/or other diagnostic injection procedures such as facet and sacroiliac joint injections and nerve root blocks) before performing diskography.

What is diskography and why is it helpful?

As with other types of back pain, determining the exact cause can be quite challenging. Often times more than one disk is degenerated. In addition, there are other factors which may be contribute to a patient’s back pain, including facet disease, referred pain, as well as psychological factors. This can make the exact site and level responsible for the disk pain more challenging to localize and diagnose.

Sacroiliac joint injection (SIJI)
Imaging studies (X-Rays, MRI and CT scans) are helpful in help in identifying and characterizing the extent of disk degeneration. However, the extent of degeneration doesn’t necessarily correlate with the amount of pain. In other words, some patients may show severely degenerated disks on imaging studies, but be relatively asymptomatic. Conversely, some patients experiencing severe pain from disk disease (diskogenic pain) may show relatively mild degenerative findings on imaging studies. Diskography confirms or denies the disk(s) as a source of your pain. This procedure utilizes the placement of a needle into the disks themselves and injecting contrast (dye). CT’s & MRI scans only demonstrate anatomy and cannot absolutely prove your pain source. In many instances, the disks may be abnormal on MRI or CT scans but not be a source of pain. Only diskography, can tell if the disk itself is a source of your pain. Therefore diskography is done to identify painful disk(s) and help the surgeon plan the correct surgery or avoid surgery that may not be beneficial. Can I go to sleep for the procedure? Since this is a procedure to diagnose, not a treat a problem, it is very important for you to be able to talk to the doctor and tell him the type of pain you are experiencing. You will receive enough medication to keep you comfortable but you will not go to sleep. What will happen to me during the procedure? The test has two main components. The first and most important is to assess the response to the patient’s pain when the contrast is injected into the disk. This part is done with fluoroscopy. The second is to determine the shape and condition of the disk, which is done with a CT scan or MRI, following the fluoroscopic procedure.  The second part of the test is not always performed in evocative diskography Diskograms are generally performed as an outpatient procedure. We require the patient have a driver with them for after the procedure. It is most helpful for patients to stop taking their medication for back pain (if they are taking any) the day of the procedure, as it allows increased diagnostic accuracy. The diskogram is a diagnostic, not a therapeutic procedure. In other words, the critical question to answer is whether the pain produced by the diskogram at a given disk level matches the patient’s typical pain (concordant) or is different from the patient’s pain (discordant). Reproducing the patient’s pain increases the diagnostic accuracy of the examination. An IV may be started so that antibiotics (to prevent infection) and relaxation medication can be given or you may be given high dose oral antibiotics. You will lie on your back for cervical diskography and on your stomache for both thoracic and lumbar diskography. The skin will be scrubbed using 2 types of sterile scrub (soap). Next, the physician will numb a small area of skin with numbing medicine. This medicine stings for several seconds. After the numbing medicine has been given time to be effective, your doctor will direct a small needle using x-ray guidance into the disk(s) space. You may feel temporary diskomfort as the needle passes through the muscle or near a nerve root. Your doctor may perform this at more than one disk level. After the needles are in their proper locations, a small amount of contrast (dye) is then injected into each disk.  Your doctor will ask you a series of questions, regarding your symptoms, and if any of the injections exactly reproduces your symptoms.  It is very important to let your physician know if  and exactly when your pain is reproduced.  Several disks are always tested, to compare normal to abnormal. What will happen after the procedure? Depending upon the results of the diskogram, it may be necessary to have a  CT Scan where additional pictures may be taken. Then, you will go back to the recovery area where you will be monitored for 30-60 minutes. You may be given a prescription for pain medication over the next 2-3 days, for muscle diskomfort that may exist after this procedure. You will not be able to drive the day of the procedure.  You will be given a prescription for antibiotics.  It is very important to completely take all of the antibiotic medication, exactly as directed.  If you do not take the medication, you may get an infection, which is extremely dangerous. General Pre/Post Instructions You should eat a light meal within a few hours before your procedure. If you are an insulin dependent diabetic, do not change your normal eating pattern prior to the procedure. Please take your routine medications (i.e. high blood pressure and diabetic medications). If you are on Coumadin, Heparin, Plavix or any other blood thinners (including Aspirin), or the diabetic medication Glucophage you must notify this office so the timing of these medications can be explained. You will either be at clinic facility or hospital for approximately 2-3 hours for your procedure. You will need to bring a driver with you. You may return to your normal activities 1-2 days after the procedure, including returning to work.  Drink plenty of clear liquids after the procedure to help remove the dye from the kidneys. You may experience an increase in your usual pain including muscle soreness in your back where the needles were inserted. Use ice packs three or four times a day and take your usual pain medications. Do not apply heat or soak in water (i.e. tub, pool, jacuzzi, etc.) for the remainder of the day. What are the risks of Diskography? The main risk, though it happens less than 1% of the time, is diskitis, an infection in the disk that can lead to an infection in the spine.  You may experience what is called paresthesia. This is a shooting, “electric-shock” type pain that may occur when medicine is injected into the disk and more pressure is put on the nerve. Paresthesia usually passes quickly but on rare occasion, it continues. As with most procedures, there is a small risk of bleeding, infection, nerve injury, or allergic reaction to the medications used.  If you experience severe back pain, new numbness, or weakness of your legs, a headache that will not go away or signs of infection in the area of the injection, you should call the doctor right away.