Download PDF
Ultraschall Med 2016; 37(04): 393-398
DOI: 10.1055/s-0034-1399145
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Feasibility of Ultrasound-Guided Sacroiliac Joint Injections in Children Presenting with Sacroiliitis

Durchführbarkeit und Effizienz von ultraschallgezielten Injektionen ins Iliosakralgelenk bei Kindern mit Sakroilitis
A. S. Klauser
1   Diagnostic Radiology Department, Medical University of Innsbruck, Innsbruck, Austria
,
M. Sailer-Hoeck
2   Pediatrics Department, Medical University of Innsbruck, Innsbruck, Austria
,
M. M. H. Abdellah
1   Diagnostic Radiology Department, Medical University of Innsbruck, Innsbruck, Austria
3   Diagnostic Radiology Department, South Egypt Cancer Institute, Assiut, University, Assiut, Egypt
,
M. S. Taljanovic
4   Medical Imaging, University of Arizona Health Network, Arizona, United States
,
C. Siedentopf
1   Diagnostic Radiology Department, Medical University of Innsbruck, Innsbruck, Austria
,
T. Auer
1   Diagnostic Radiology Department, Medical University of Innsbruck, Innsbruck, Austria
,
J. Brunner
2   Pediatrics Department, Medical University of Innsbruck, Innsbruck, Austria
,
W. R. Jaschke
1   Diagnostic Radiology Department, Medical University of Innsbruck, Innsbruck, Austria
› Author Affiliations
Further Information

Publication History

29 August 2014

23 January 2015

Publication Date:
27 March 2015 (online)

Also available at
    Permissions and Reprints

Abstract

Purpose: To evaluate the feasibility and effectiveness of US-guided sacroiliac joint injection in the treatment of sacroiliitis in children.

Materials and Methods: This study was approved by the institutional review board and informed oral and written consent was obtained from the patients and their parents. In 13 patients (7 females and 6 males), 9 – 16 years (mean +/– std 11.39 +/–1.98), 18 sacroiliac joint (SI joint) injections were performed under US guidance. All patients suffered from severe sacroiliitis. US scanning was performed using a linear-array transducer operating at 5 – 18 MHz. Rating of the patients pain using a 0 – 10 dolorimetry scale on a visual analog score (VAS) was recorded before, immediately after and 3 months after injection to monitor severity and therapeutic response.

Results: Injection could be performed in all patients without complication and showed good response immediately and 3 months after the injection with a decrease of the VAS (from mean +/– std 9.44 +/– 1.097 to 3.89 +/– 3.82, p < 0.001 and to 0.56 +/– 1.097, p < 0.05, respectively).

Conclusion: US-guided SI joint injection was feasible in all children, relatively quick and easy to perform and appeared effective in the treatment of children with sacroiliitis.

Zusammenfassung

Einleitung: Es sollte die Durchführbarkeit und Effizienz von ultraschallgezielten Injektionen zur Behandlung von Sakroiliitis bei Kindern evaluiert werden.

Material und Methoden: Für diese von der ortsansässigen Ethikkommission für unbedenklich erklärten Studie wurde eine mündliche und schriftliche Einverständniserklärung aller Patienten und ihrer Eltern eingeholt. 13 Patienten (7 weiblich und 6 männlich) zwischen 9 – 16 Jahren (Mittelwert +/– Standardabweichung 11,39 +/–1,98) wurden in die Studie eingeschlossen. 18 Iliosakralgelenke (ISG) wurden ultraschallgezielt infiltriert. Alle Patienten litten unter einer schweren Sakroilitis. Die Ultraschalluntersuchung wurde mit einem Linearschallkopf mit 5 – 18 MHz durchgeführt. Die Schmerzen der Patienten wurden mithilfe einer Schmerzskala von 0 – 10 (VAS) erfasst, unmittelbar vor und nach der Injektion sowie 3 Monate später, um das Ausmaß der Schmerzen und das therapeutische Ansprechen zu überwachen.

Ergebnisse: Die Injektionen konnten bei allen Patienten ohne Komplikationen durchgeführt werden und zeigten unmittelbar und 3 Monate nach der Injektion gute Ergebnisse mit einer Verminderung des VAS (Mittelwert +/– Standardabweichung vor der Injektion 9,44 +/– 1,097, direkt nach der Injektion 3,89 +/– 3,82 p < 0,001 sowie 3 Monate nach der Injektion 0,56 +/– 1,097, p < 0,05).

Schlussfolgerung: Die ultraschallgezielte ISG-Injektion war bei allen Kindern möglich, relativ zügig und einfach durchzuführen und zeigte sich effizient in der Behandlung bei Kindern mit Sakroilitis.

Key words

pelvis - interventional procedures - ultrasound - inflammation
 

  • References

  • 1 Braun J, Bollow M, Remlinger G et al. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum 1998; 41: 58-67
    CrossrefPubMedGoogle Scholar
  • 2 Andersson GB. Juvenile arthritis--who gets it, where and when? A review of current data on incidence and prevalence. Clin Exp Rheumatol 1999; 17: 367-374
    PubMedGoogle Scholar
  • 3 Saraux A, Guedes C, Allain J et al. Prevalence of rheumatoid arthritis and spondyloarthropathy in Brittany, France. Societe de Rhumatologie de l'Ouest. J Rheumatol 1999; 26: 2622-2627
    PubMedGoogle Scholar
  • 4 Fernandez-Sueiro JL, Alonso C, Blanco FJ et al. Prevalence of HLA-B27 and subtypes of HLA-B27 associated with ankylosing spondylitis in Galicia, Spain. Clin Exp Rheumatol 2004; 22: 465-468
    PubMedGoogle Scholar
  • 5 Petty RE, Southwood TR, Manners P et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 2004; 31: 390-392
    PubMedGoogle Scholar
  • 6 Burgos-Vargas R, Rudwaleit M, Sieper J. The place of juvenile onset spondyloarthropathies in the Durban 1997 ILAR classification criteria of juvenile idiopathic arthritis. International League of Associations for Rheumatology. J Rheumatol 2002; 29: 869-874
    PubMedGoogle Scholar
  • 7 Harjacek M. The classification of juvenile spondyloarthritides. Reumatizam 2011; 58: 44-66
    PubMedGoogle Scholar
  • 8 Pekkafahli MZ, Kiralp MZ, Basekim CC et al. Sacroiliac joint injections performed with sonographic guidance. J Ultrasound Med 2003; 22: 553-559
    CrossrefPubMedGoogle Scholar
  • 9 Rosenberg JM, Quint TJ, de Rosayro AM. Computerized tomographic localization of clinically-guided sacroiliac joint injections. Clin J Pain 2000; 16: 18-21
    CrossrefPubMedGoogle Scholar
  • 10 Van der Linden S, van der Heijde D. Ankylosing spondylitis. Clinical features. Rheum Dis Clin North Am 1998; 24: 663-676, vii
    CrossrefPubMedGoogle Scholar
  • 11 Zochling J, van der Heijde D, Burgos-Vargas R et al. ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2006; 65: 442-452
    CrossrefPubMedGoogle Scholar
  • 12 Hartung W, Ross CJ, Straub R et al. Ultrasound-guided sacroiliac joint injection in patients with established sacroiliitis: precise IA injection verified by MRI scanning does not predict clinical outcome. Rheumatology (Oxford) 2010; 49: 1479-1482
    CrossrefPubMedGoogle Scholar
  • 13 Klauser A, De Zordo T, Feuchtner G et al. Feasibility of ultrasound-guided sacroiliac joint injection considering sonoanatomic landmarks at two different levels in cadavers and patients. Arthritis Rheum 2008; 15;59: 1618-1624
    PubMedGoogle Scholar
  • 14 Puhakka KB, Melsen F, Jurik AG et al. MR imaging of the normal sacroiliac joint with correlation to histology. Skeletal Radiol 2004; 33: 15-28
    CrossrefPubMedGoogle Scholar
  • 15 Wittram C, Whitehouse GH, Williams JW et al. A comparison of MR and CT in suspected sacroiliitis. J Comput Assist Tomogr 1996; 20: 68-72
    CrossrefPubMedGoogle Scholar
  • 16 Saenz-Navarro I, Moller I, Iagnocco A et al. Ultrasound assessment of the sacroiliac joint. J Clin Ultrasound 2011; 39: 93-94
    CrossrefPubMedGoogle Scholar
  • 17 Dougados M, van der Linden S, Juhlin R et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 1991; 34: 1218-1227
    CrossrefPubMedGoogle Scholar
  • 18 Van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984; 27: 361-368
    CrossrefPubMedGoogle Scholar
  • 19 Tse SM, Laxer RM. New advances in juvenile spondyloarthritis. Nat Rev Rheumatol 2012; 8: 269-279
    CrossrefPubMedGoogle Scholar
  • 20 Braun J, Bollow M, Seyrekbasan F et al. Computed tomography guided corticosteroid injection of the sacroiliac joint in patients with spondyloarthropathy with sacroiliitis: clinical outcome and followup by dynamic magnetic resonance imaging. J Rheumatol 1996; 23: 659-664
    PubMedGoogle Scholar
  • 21 Pereira PL, Gunaydin I, Trubenbach J et al. Interventional MR imaging for injection of sacroiliac joints in patients with sacroiliitis. Am J Roentgenol Am J Roentgenol 2000; 175: 265-266
    PubMedGoogle Scholar
  • 22 Hendrix RW, Lin PJ, Kane WJ. Simplified aspiration or injection technique for the sacro-iliac joint. J Bone Joint Surg Am 1982; 64: 1249-1252
    PubMedGoogle Scholar
  • 23 Fischer T, Biedermann T, Hermann KG et al. Sacroiliitis in children with spondyloarthropathy: therapeutic effect of CT-Guided intra-articular corticosteroid injection. Rofo 2003; 175: 814-821
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Hartung W, Kellner H, Strunk J et al. Development and evaluation of a novel ultrasound score for large joints in rheumatoid arthritis: one year of experience in daily clinical practice. Arthritis Care Res (Hoboken) 2012; 64: 675-682
    CrossrefPubMedGoogle Scholar
  • 25 Klauser AS, Bollow M. Comment on: Ultrasound-guided sacroiliac joint injection in patients with established sacroiliitis: precise IA injection verified by MRI scanning does not predict clinical outcome. Rheumatology (Oxford) 2012; 51: 1137-1138
    CrossrefPubMedGoogle Scholar
  • 26 Jee H, Lee JH, Park KD et al. Ultrasound-guided versus fluoroscopy-guided sacroiliac joint intra-articular injections in the noninflammatory sacroiliac joint dysfunction: A prospective, randomized, single-blinded study. Arch Phys Med Rehabil 2014; 95: 330-337
    CrossrefPubMedGoogle Scholar
  • 27 Hansen HC. Is fluoroscopy necessary for sacroiliac joint injections?. Pain Physician 2003; 6: 155-158
    PubMedGoogle Scholar