
==== Front
Interv Pain Med
Interv Pain Med
Interventional Pain Medicine
2772-5944
Elsevier

S2772-5944(22)00130-3
10.1016/j.inpm.2022.100132
100132
Commentary
Commentary to "Using radiology images to characterize an angle of insertion for S1/S2 and SI joint injections: A retrospective observational study"
Aner Musa M. Musa.M.Aner@hitchcock.org

Center for Pain and Spine, Dartmouth-Hitchcock Medical Center Department of Anesthesiology, The Geisel School of Medicine at Dartmouth, NH, Lebanon
06 9 2022
9 2022
06 9 2022
1 3 1001329 8 2022
10 8 2022
© 2022 The Author(s)
2022
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
==== Body
pmc“One accurate measurement is worth a thousand expert opinions.”

Grace Hopper – American computer scientist 1906-1992

The pursuit to achieve precision, accuracy and reliable reproducibility is at the core of any scientific research. Along with increasing the understanding and knowledge of the topic, the quest is to get to the accuracy of the results and establish a standard to obtain consistently similar results, under similar circumstances.

One of the challenges of Interventional Pain Medicine, along with correct diagnosis of the problem, is the compounding complexity of injection accuracy. In recent years, there has been an increased effort to define technical details to standardize and unify the way injections are performed. In the inaugural issue of IPM, Gill et al. proposed a systemic nomenclature that not only would simplify the understanding, but also would bring multiple disciplines in the field to a common language [1].

Historically, prior descriptions of spine interventions have been based on clinical acumen and traditional use of techniques described by numerous authors [2]. Multiple disciplines including interventional radiology, interventional pain medicine and physiatry have proposed innovative injection techniques that have set the stage to different approaches that have been successful in treatment [3]. Although applied effectively by multiple interventionalists, these techniques lack the specificity and the detail necessary to translate a uniform understanding of the injection technique across the field.

The literature contains multiple studies discussing the diagnosis and treatment of the sacroiliac joint pain, but there is a paucity of data in the technical aspects of the injection [4,5]. In the same context, multiple studies have reported technical difficulties and novelties in administering an S1 transforaminal epidural injection [6,7]; however, very few describe the technical details of the injection. Moreover, there are no specific entries to describe the anatomical aspects of the S2 transforaminal epidural injection.

In this retrospective observational study, Chang et al. provide the field with an introduction to the anatomical landmarks and the specific measurements of the angulations of the sacroiliac joint and the S1 and S2 nerve roots, using a CT-guided computation [8].

Despite a small sample size, this is an innovative first step for the technical development of these frequently challenging injections. By defining the angles of access, they open the doors to understanding the challenges, the accuracy, and the reproducibility of these injections across patients of different ages, genders, and body habiti.

These preliminary findings set the stage for further investigation to establish the correlation of these findings with fluoroscopy, as the standard of care in most interventional pain practices, as well as the correlation of the technique to patient outcomes.

As a result of their preliminary work, and future studies based on these results, we can look forward to a more accurate and precise set of interventions that will provide standardized and efficient treatment of sacroiliac joint, and S1 and S2 nerve root pathology and related pain.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
==== Refs
References

1 Gill Jatinder S. Cohen Steven P. Simopoulos Thomas T. Furman Michael B. Hayek Salim M. Van Boxem Koen Kennedy David J. Michael Hooten W. Shah Vinil Stojanovic Milan P. A proposed nomenclature for spinal imaging and interventional procedural reporting Inter Pain Med 1 1 March 2022 100082
2 Furman M.B. Berkwits L. Atlas of image-guided spinal procedures second ed. 2018 Elsevier, Inc Philadelphia, PA
3 Dussault Robert G. Kaplan Phoebe A. Anderson Mark W. Fluoroscopy-guided sacroiliac joint injections Radiology 214 2000 273 277 (1)
4 Falowski S. Sayed D. Pope J. Patterson D. Fishman M. Gupta M. Mehta P. A review and algorithm in the diagnosis and treatment of sacroiliac joint pain J Pain Res 13 2020 Dec 8 3337 3348 10.2147/JPR.S279390 PMID: 33335420; PMCID: PMC7737553 33335420
5 Gartenberg A. Nessim A. Cho W. Sacroiliac joint dysfunction: pathophysiology, diagnosis, and treatment Eur Spine J 30 10 2021 Oct 2936 2943 10.1007/s00586-021-06927-9 Epub 2021 Jul 16. PMID: 34272605 34272605
6 Gupta S. Gupta H. Baranidharan G. Sharma M. Technical challenges of performing S1 root block: role for double needle and multilevel needle technique Br J Pain 15 2 2021 May 129 133 10.1177/2049463720960497 Epub 2020 Sep 24. PMID: 34055334; PMCID: PMC8138611 34055334
7 Park Y.J. Lee S.H. Ryu K.H. Kim Y.K. Shim J. Lee H.W. Kim Y.H. Novel method for S1 transforaminal epidural steroid injection World Neurosurg 133 2020 Jan e443 e447 10.1016/j.wneu.2019.09.051 Epub 2019 Sep 14. PMID: 31526885 31526885
8 Chang Jason L. Patel Ajay K. Modi Devas J. Johnson Peyton Mukhdomi Taif Gulati Amitabh Using Radiology images to characterize an angle of insertion for S1/S2 and SI joint injections: a retrospective observational study Inter Pain Med 2022 100068 10.1016/j.inpm.2022.100068 https://www.sciencedirect.com/science/article/pii/S2772594422000590 S2772-5944(22)00059-0
