Patient Position: Prone on the fluoroscopy table.

Indications: Sacroiliac pain syndrome.

Needle Size: 22-gauge, 88-mm spinal needle.

Medication/Volume: 0.5% bupivacaine 2 mL plus 40 mg methylprednisolone.

Anatomic Landmarks: Posterior superior iliac spine and sacrum.

Approach and Technique: After sterile preparation of the region, the sacroiliac joint is identified under fluoroscopy in the anteroposterior view (Fig. 70-1A). To gain access to this joint space, the fluoroscopic beam must be rotated approximately 15° to 30° to the opposite side of the joint to locate the posterior face of the sacroiliac joint, and then 20° to 30° cephalad and caudad (Ferguson view; Fig. 70-1B). Two separate injections can be performed. The first injection is aimed at the inferior one-third of the joint. Accordingly, the 22-gauge spinal needle is aimed in the same direction as the fluoroscopic beam to gain access to the joint. A loss of resistance is often felt as the joint space is entered. Next, the superior one-third of the joint space is entered in a similar fashion. To help confirm the joint space location, 0.5 to 1.0 mL of contrast dye can be injected prior to the injection of the local anesthetic mixture.