Iliolumbar Ligament Injection

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Best done under fluoroscopic-guidance so the crest can be visualized and you can ensure an even distribution of injection sites (red X's).

By Chris Faubel, M.D. —

Best done under fluoroscopic-guidance so the crest can be visualized and you can ensure an even distribution of injection sites (red X’s).

To learn about Iliolumbar Syndrome, follow this link.

ICD 10 code:  M46.06 (lumbar spine enthesopathy)

CPT codes: 

  • 20550 “Injection(s); single tendon sheath, or ligament, aponeurosis”
  • 77002 “Fluoroscopic guidance for all types of needle placement, i.e., biopsy, aspiration, injection, or localization device”

PROCEDURE TECHNIQUE:

Solution:  Varies depending on the number of sites that you plan to inject.  Typically, I inject four sites and use a 4-ml solution consisting of 3-ml of 0.5% bupivicaine and 1-ml of Depo-Medrol 40mg/ml.  You can also use just local anesthetic if the patient has an elevated blood sugar.

Position:  Prone

Fluoroscopy:  An 18-gauge 1.5″ needle tip is placed on the cleaned skin over the patient’s point of maximal tenderness along the iliac crest.  An A-P fluoroscopic view is used to visualize the iliac crest under this needle.

Technique:  First, create a skin wheal and anesthetize the deeper subcutaneous skin with 1% lidocaine and a 25-gauge 1.5-inch needle.  Next, a 22- or 25-gauge Quincke needle is used to advance down to the area of the posterior edge of the iliac crest at the point of maximal tenderness.  Inject 1-ml of the solution here.  Then, pick three or four other sites on either side of the initial injection site (see the picture to the right).

Expectations:  Patient should have significant reduction in pain within a few minutes if this is the real source of his/her pain; this injection is then both diagnostic and therapeutic.

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