Objective Using stringent inclusion criteria, a double-blinded study protocol, and fluoroscopic guided injections, we compare intraarticular sacroiliac joint platelet rich plasma injections to intraarticular steroids Design Double-blind, randomized controlled trial. Setting Two large university-based interdisciplinary spine centers. Subjects 26 patients after positive diagnostic block (>80% relief) Methods Subjects who a positive diagnostic block were randomized to either undergo a fluoroscopically-guided intra-articular injection of steroid or platelet rich plasma injection. Follow-up was at 1-month, 3 months, and 6-months. Outcomes included level of pain as indicated on a 0- to 100-mm Numeric Pain Rating Scale and functional disability score using the Oswestry Disability Index (ODI). Results At one, three, and six months, both groups improved, however subjects who received steroid injections reported lower pain scores than subjects who received platelet rich plasma. Using categorical data, we observed significantly more responders (defined as pain scores which improved by 50% or more from baseline) at one and three months in the group that received steroids compared to the group that received platelet rich plasma. Conclusion While both groups showed improvements in pain and function, the steroid group had significantly greater response and significantly more responders than the PRP group.

IV.

BackgroundPercutaneous diagnostic and therapeutic procedures are commonly used in the treatment of spinal pain. The success of these procedures depends on the accuracy of needle placement, which is influenced by needle size and shape.ObjectivesThe purpose of this study is to examine and quantify the deviation of commonly used spinal needles based on needle tip design and gauge, using a ballistic gel tissue simulant.Materials and MethodsSix needles commonly used in spinal procedures (Quincke, Short Bevel, Chiba, Tuohy, Hustead, Whitacre) were selected for use in this study. Ballistic gel samples were made in molds of two depths, 40mm and 80 mm. Each needle was mounted in a drill press to ensure an accurate needle trajectory. Distance of deflection was recorded for each needle.ResultsIn comparing the mean deflection of 22 gauge needles of all types at 80 mm of depth, deflection was greatest among beveled needles [Short Bevel (9.96 ± 0.77 mm), Quincke (8.89 ± 0.17 mm), Chiba (7.71 ± 1.16 mm)], moderate among epidural needles [Tuohy (7.64 ± 0.16 mm) and least among the pencil-point needles [Whitacre (0.73 ± 0.34 mm)]. Increased gauge (25 g) led to a significant increase in deflection among beveled needles. The direction of deflection was away from the bevel with Quincke, Chiba and Short Beveled needles and toward the bevel of the Tuohy and Hustead needles. Deflection of the Whitacre pencil-point needle was minimal.ConclusionsThere is clinical utility in knowing the relative deflection of various needle tips. When a procedure requires a needle to be steered around obstacles, or along non-collinear targets, the predictable and large amount of deflection obtained through use of a beveled spinal needle may prove beneficial.

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