1350 - Outcomes of Proximal Sacroiliac Joint Injections for Relief of Mechanical Back Pain

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

AS

Alan I. Shain, MD

Resident Physician
Northwell Health Long Island Jewish Forest Hills Hospital
New York, New York, United States

Corresponding Author(s)

ZY

Zhiyan Yang, MSc

Research Assistant
Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.
New York, New York, United States

Presenting Author(s)

WX

William Xiang, MD

Resident Physician
Department of Physical Medicine and Rehabilitation, Weill Cornell Medicine and Columbia University/New York-Presbyterian Hospital, New York, NY, USA
New York, New York, United States
SK

Sohyun Kang, MD

Resident Physician
Department of Physical Medicine and Rehabilitation, Weill Cornell Medicine and Columbia University/New York-Presbyterian Hospital, New York, NY, USA
New York, New York, United States

Co-Author(s)

JS

Jaspal R. Singh, MD

Associate Professor
Department of Physical Medicine and Rehabilitation, Weill Cornell Medicine and Columbia University/New York-Presbyterian Hospital
New York, New York, United States

Submitter(s)

AS

Alan I. Shain, MD

Boston University School of Medicine
New York, New York, United States

Objectives: To evaluate the efficacy of the proximal (upper one-third) sacroiliac joint (SIJ) injection technique in patients with mechanical low back pain (LBP) who failed to achieve relief from prior technically adequate distal (lower one-third) SIJ injections.

Design: Retrospective observational cohort study of 22 adult patients with mechanical LBP, who had previously failed to achieve therapeutic relief from technically adequate distal SIJ injections performed by outside providers, underwent fluoroscopy-guided proximal SIJ injections by a single interventional physiatrist. Procedures targeted the upper third of the SIJ using a therapeutic injection of corticosteroid and local anesthetic. Baseline and post-injection pain scores were recorded using the Visual Analog Scale (VAS) within 30 minutes pre- and post-injections. The primary outcome was the proportion of patients achieving ≥50% pain reduction. Secondary outcomes included complete pain resolution, associations with age or sex, and complications.

Results: All patients underwent technically successful proximal SIJ injections, as confirmed by intra-procedural contrast dye patterns. The baseline VAS score (mean ± SD) was 4.86 ± 2.75, and post-injection score was 1.14 ± 1.42, yielding an average pain improvement of 79.6% ± 25.8% (p < 0.001). Twenty patients (90.9%) achieved ≥50% reduction in pain, and 10 patients (45.5%) experienced complete resolution. No complications were reported. There were no statistically significant differences in outcomes by age or sex. Baseline VAS scores were not predictive of response.

Conclusions: Proximal SIJ injections yielded high rates of pain relief in patients who initially failed technically adequate distal injections. These findings suggest anatomical and therapeutic advantages of the proximal approach, supporting its use not merely as a salvage maneuver, but also as a potentially superior standard for image-guided treatment of mechanical SIJ pain.