• Paul Dreyfuss, Benjamin D Snyder, Kathryn Park, Frank Willard, Jane Carreiro, and Nikolai Bogduk.
• Washington Interventional Spine Associates, Bellevue, Washington, USA. pauldreyfuss@gmail.com
• Pain Med. 2008 Oct 1;9(7):844-50.

ObjectiveTo determine the physiologic effectiveness of single site, single depth sacral lateral branch injections.DesignRandomized, controlled, and double-blinded study.SettingOutpatient pain management center.PatientsFifteen asymptomatic volunteers.InterventionsThe dorsal sacroiliac ligament was probed and the sacroiliac joint was injected with contrast medium until capsular distension occurred. The presence or absence of pain with each maneuver was noted. Under double-blind conditions, subjects returned 1 week later for L5 dorsal ramus and S1-4 lateral branch injections; 10 subjects received 4% lidocaine (active) injections while five subjects received saline (control) injections. After 30 minutes, subjects had repeat ligamentous probing and capsular distension of the same sacroiliac joint that was previously tested. The presence or absence of pain with each maneuver was noted. In a parallel anatomic study, S1 and S2 lateral branch injections with green dye were performed on two nonembalmed cadavers. Dissection was undertaken to quantify the degree of staining of these target lateral branch nerves.Outcome MeasuresPresence or absence of pain for ligamentous probing and sacroiliac joint capsular distension.ResultsForty percent had no discomfort upon repeat ligamentous probing after active lateral branch injections while 100% retained pain upon repeat ligamentous probing with control lateral branch injections. Forty percent of the active group and 20% of the control group did not feel repeat capsular distension of the sacroiliac joint after the lateral branch injections. In the anatomic study, 11 lateral branch nerves were isolated while staining occurred in only four cases or 36%.ConclusionsAnatomic limitations exist with single site, single depth sacral lateral branch injections rendering them physiologically ineffective on a consistent basis.

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