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SacroiliitisNCT02420041

Comparing the Effects of Ultrasound Versus Fluoroscopy for Sacroiliac Joint Injections

A study testing Active comparator: Fluoroscopic Guided SIJ injection, Ultrasound Guided Sacroiliac Joint Injection and Havel's Inc. EchoStim (facet tip) 21 Gauge 4" needle in people with Sacroiliitis, run by United States Naval Medical Center, San Diego at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this research project is to compare two different techniques for performing an injection of the sacroiliac joint. Although both techniques are safe and accurate, the goal of the study is to determine if one technique is better than the other with respect to improvement in a patient's pain, function, and… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Sacroiliitis
What is being tested?
Active comparator: Fluoroscopic Guided SIJ injection, Ultrasound Guided Sacroiliac Joint Injection and Havel's Inc. EchoStim (facet tip) 21 Gauge 4" needle
Could I receive a placebo?
No, everyone receives an active treatment
How many people
28 participants
Where
1 siteUnited States
Study dates
Oct 2012to Mar 2014
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Diagnosis of SIJ dysfunction by history and physical exam
  • History: Either low back pain or buttock pain
  • Exam: Either tenderness to palpation over the SIJ or a positive provocative maneuver (i.e., Patrick's, Gaenslen's, and/or Yeoman's test)
  • Failed a trial of conservative therapy which may included medications, physical therapy, or both
  • Age > 18
  • Patient agrees to participate in study

Who cannot join

  • Coagulopathy
  • Renal or Hepatic Failure
  • Current Pregnancy or actively pursuing pregnancy
  • Known allergy to local anesthetic or steroids
  • Infection at site of needle placement or SIJ infection
  • Patient unable to consent himself or herself
Show all 9Show fewer
  • Patient refusal
  • Prior surgical procedures involving the SIJ
  • Body Mass Index > 35 kg/m2

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Pain Medicine Center, Department of Anesthesiology, Naval Medical Center, San Diego

    San Diego, California, 92134

Other trials in United States

About this study

Official title: Comparison of the Efficacy of Two Techniques for Sacroiliac Joint Injection: Ultrasound Guidance Versus Fluoroscopic Guidance

The purpose of this research project is to compare two different techniques for performing an injection of the sacroiliac joint. Although both techniques are safe and accurate, the goal of the study is to determine if one technique is better than the other with respect to improvement in a patient's pain, function, and his or her satisfaction. Additionally, the investigators want to determine if one technique is quicker and more efficient than the other.

Read the detailed description

Sacroiliac joint dysfunction is a source of low back pain that causes significant pain and disability. Injection of the sacroiliac joint with a local anesthetic/corticosteroid mixture has shown efficacy in treating this condition, when conservative therapy fails. The use of fluoroscopic guidance and anatomic landmarks are traditional methods for performing this injection; however, ultrasound imaging has recently been utilized for performing this procedure. Although studies exist that describe and validate the ultrasound technique, no studies exist that compare the techniques with respect to short-term and long-term outcomes. In this study, the primary objective is to determine if a difference exists between a fluoroscopic-guided technique and ultrasound-guided technique with respect to pain and function. A secondary objective is to compare the two techniques with respect to procedural characteristics.

Conditions
Sacroiliitis
Being tested
Active comparator: Fluoroscopic Guided SIJ injection, Ultrasound Guided Sacroiliac Joint Injection, Havel's Inc. EchoStim (facet tip) 21 Gauge 4" needle, SonoSite S-nerve, iohexol
Keywords
Sacroiliac Joint Injection, Fluoroscopy, Ultrasound
Medical subject headings
Sacroiliitis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Active comparator: Fluoroscopic Guided SIJ injectionProcedure or surgery

    • Needle entry point is in the lower one-third of the SIJ
    • Sterile preparation (with chlorhexidine) and draping and 3 mL of 1% lidocaine injected subcutaneously at site of needle entry
    • Under fluoroscopy guidance, Havel's Inc. EchoStim (facet tip) 21 Gauge 4" needle is inserted in a coaxial fashion into the SIJ
    • 1 mL of contrast (iohexol 300 mg/mL) is injected to outline the SIJ and to ensure no vascular uptake
    • Injection of 20 mg of triamcinolone diluted in 4 mL of 1% lidocaine
    • Patient observed in recovery bay for 20 minutes and then discharged home
  • Ultrasound Guided Sacroiliac Joint InjectionProcedure or surgery

    • Sterile preparation (with chlorhexidine) and drape
    • Using ultrasound guidance (SonoSite S-nerve) with a low frequency (2-5 Hz) curvilinear transducer in a sterile cover, the transducer is placed in a transverse plane over the SIJ and needle entry point is chosen at the medial end of the ultrasound transducer
    • 3 mL of 1% lidocaine is injected subcutaneously at site of needle entry
    • Under ultrasound guidance, a Havel's Inc. EchoStim (facet tip) 21 Gauge 4" needle is inserted in a medial to lateral direction and guided into the SIJ. (0.5-2 mL of normal saline may be injected during needle insertion to locate tip of needle and to ensure solution does not "spill out" onto sacrum).
    • After using the Doppler function to identify any surrounding vessels (to avoid intravascular injection), 20 mg of triamcinolone diluted in 4 mL of 1% lidocaine is injected.
    • Patient observed in recovery bay for 20 minutes and then discharged home
  • Havel's Inc. EchoStim (facet tip) 21 Gauge 4" needleDevice

  • SonoSite S-nerveDevice

  • iohexolDevice

  • triamcinolone/lidocaineDrug

Study groups in NCT02420041
Study groupRoleWhat they receive
Fluoroscopic GuidanceActive comparatorPatients referred to the Naval Medical Center-San Diego Pain Medicine Clinic. Need a history and physical showing objective findings of sacroiliac joint (SIJ) dysfunction. If the patient meets inclusion / exclusion criteria, they will be presented with the study. After accepting and being consented, they will then be scheduled. The day of the appointment they will be randomised to Group A or B. In Group A : Fluoroscopy will be used to Guide Needle Placement to inject Steroid into joint. Then complete the multidimensional pain inventory (MPI) and rate their pain on the NRS from 0-11. After procedure, they will rate their pain from 0-10 in the recovery area and then be discharged to home. They will complete an MPI, Patient Global Impression of Change (PGIC), numerical rating scale (NRS), and adverse events questionnaire 1-2 weeks post-procedure and 3 months post-procedure.
Receives: Procedure: Active comparator: Fluoroscopic Guided SIJ injection; Device: Havel's Inc. EchoStim (facet tip) 21 Gauge 4" needle; Device: iohexol; Drug: triamcinolone/lidocaine
Ultrasound GuidanceExperimentalPatients referred to the Naval Medical Center-San Diego Pain Medicine Clinic. Need a history and physical showing objective findings of SIJ dysfunction. If the patient meets inclusion / exclusion criteria, they will be presented with the study. After accepting and being consented, they will then be scheduled. The day of the appointment they will be randomised to Group A or B. In Group B Ultrasound will be used to Guide Needle Placement to inject steroid into joint. Then complete the MPI and rate their pain on the NRS from 0-11. After procedure, they will rate their pain from 0-10 in the recovery area and then be discharged to home. They will complete an MPI, Patient Global Impression of Change (PIGC), NRS, and adverse events questionnaire 1-2 weeks post-procedure and 3 months post-procedure.
Receives: Procedure: Ultrasound Guided Sacroiliac Joint Injection; Device: Havel's Inc. EchoStim (facet tip) 21 Gauge 4" needle; Device: SonoSite S-nerve; Drug: triamcinolone/lidocaine

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Difference in Minutes Between a Sacroiliac Joint Injection Done With Ultrasound vs Fluoroscopy

    during procedure from the time monitors are placed on patient to the time of withdrawal of needle from skin

    Measured: difference in minutes between a sacroiliac joint injection, an expected average of 9 minutes

  2. Change in Pain Score From Baseline to 30 Minutes Pre-procedure Using the Defense and Veterans Pain Rating Scale (DoD/VA PRS) 0-10

    Study subjects rate their pain on a scale of 0-10 (0=no pain, 10= the highest level of pain experienced), hence the lower the score the better the outcome.

    Measured: 30 minutes pre-procedure minus baseline

  3. Change in Pain Score From Baseline to 2 Weeks Post-procedure Using the DoD/VA PRS

    Study subjects rate their pain on a scale of 0-10 (0=no pain, 10= the highest level of pain experienced), hence the lower the score the better the outcome.

    Measured: 2 weeks post-procedure minus baseline

  4. Change in Pain Score From Baseline to 3 Months Post-procedure Using the DoD/VA PRS

    Study subjects rate their pain on a scale of 0-10 (0=no pain, 10= the highest level of pain experienced), hence the lower the score the better the outcome.

    Measured: 3 months post-procedure minus baseline

Secondary outcomes (6)
  1. Impression of Change of Condition at 2 Weeks Post-procedure Using the Patient Global Impression of Change (PGIC) Scale

    Study subjects rate their change in overall condition on a scale of 0-6 (0=no change, 6=better and a definite improvement that has made a real worthwhile difference). The range of the change in pain for both groups observed was in fact 0-5.

    Measured: 2 weeks post-procedure

  2. Impression of Change of Condition at 3 Months Post-procedure Using the PGIC Scale

    Study subjects rate their change in overall condition on a scale of 0-6 (0=no change, 6=better and a definite improvement that has made a real worthwhile difference). The range of the change in pain for both groups observed was in fact 0-5.

    Measured: 3 months post-procedure

  3. Change in Pain Score Since Sacroiliac (SI) Injection at 2 Weeks Post-procedure Using the DoD/VA PRS

    Study subjects rate their pain on a scale of 0-10 (0=no pain, 10= the highest level of pain experienced), hence the lower the score the better the outcome. Score reported is reporting a difference/change between two time points.

    Measured: during/just before sacroiliac (SI) injection and 2 weeks post-procedure

  4. Change in Pain Score Since SI Injection at 3 Months Post-procedure Using the DoD/VA PRS

    Study subjects rate their pain on a scale of 0-10 (0=no pain, 10= the highest level of pain experienced), hence the lower the score the better the outcome.Score reported is reporting a difference/change between two time points.

    Measured: during/just before sacroiliac (SI) injection and 3 months post-procedure

  5. Satisfaction of Procedure as a Measure of Safety and Tolerability Using a Numerical Scale 1-5

    "1= very dissatisfied" to "5=very satisfied".

    Measured: 2 weeks post-procedure

  6. Satisfaction of Procedure as a Measure of Safety and Tolerability Using a Numerical Scale 1-5

    "1= very dissatisfied" to "5=very satisfied".

    Measured: 3 months post-procedure

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 Apr 2015 (estimated)
  2. Study startOct 2012
  3. Primary completionMar 2014
  4. Study completionMar 2014

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
28 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02420041
Sponsor's protocol ID
NMCSD.2012.0112
Status last verified
Oct 2015
First submitted
30 Sep 2014
Last updated
13 Nov 2015
Data monitoring committee
Yes

Questions about this trial

What is this clinical trial studying?

A study testing Active comparator: Fluoroscopic Guided SIJ injection, Ultrasound Guided Sacroiliac Joint Injection and Havel's Inc. EchoStim (facet tip) 21 Gauge 4" needle in people with Sacroiliitis, run by United States Naval Medical Center, San Diego at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 13 Nov 2015. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 13 Nov 2015). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Difference in Minutes Between a Sacroiliac Joint Injection Done With Ultrasound vs Fluoroscopy (time frame: difference in minutes between a sacroiliac joint injection, an expected average of 9 minutes). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Nov 2015.

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