Complications following diagnostic and therapeutic sacroiliac joint region injections in horses: A study describing clinicians' experiences.
Authors: Nagy Annamaria, Dyson Sue
Journal: Equine veterinary journal
Summary
# Sacroiliac Joint Injections: Understanding Complication Rates and Clinical Variability Nagy and Dyson surveyed 212 specialist equine veterinarians across North America and Europe to characterise complications following sacroiliac joint region injections and document how clinicians perform these procedures in practice. Diagnostic injections proved more problematic than therapeutic or combined approaches, with 48% of clinicians (53/110) experiencing complications after diagnostic procedures compared to 18% (33/187) after therapeutic injections and 12% (6/49) after combined injections. Hindlimb weakness or ataxia emerged as the most frequent complication across all injection types—occurring in 40% of diagnostic cases, 8% of therapeutic cases, and 4% of combined cases—though rare but serious outcomes including death or euthanasia were reported in 6 horses following therapeutic injections and 1 following diagnostic injection. Although the data reveal considerable variation in injection technique, volume and substance selection among clinicians and suggest diagnostic local anaesthesia carries higher complication risk, the findings should be interpreted cautiously given the acknowledged limitations around recall bias and the lack of precise prevalence estimates. For practitioners, these results highlight the importance of careful case selection, meticulous injection technique, and appropriate client counselling regarding neurological complications—particularly when performing diagnostic procedures.
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Practical Takeaways
- •Diagnostic SI joint injections carry substantially higher complication rates than therapeutic injections; clinicians should weigh diagnostic benefit against risk of hindlimb ataxia (40% complication rate)
- •Hindlimb weakness/ataxia is the expected complication pattern across all injection types; owners should be counselled on this risk and appropriate monitoring protocols established
- •Although rare, serious complications including death have been reported; ensure informed consent, appropriate facilities for observation/emergency management, and consider whether diagnostic information could be obtained through alternative methods
Key Findings
- •53/110 clinicians (48%) experienced complications after diagnostic SI joint injections compared to 33/187 (18%) after therapeutic and 6/49 (12%) after combined injections (p<0.01)
- •Hindlimb weakness/ataxia was the most common complication: 40% after diagnostic injections, 8% after therapeutic, and 4.1% after combined injections
- •Six deaths or euthanasia cases were reported (5 after therapeutic injections, 1 after diagnostic injections out of 297 total injection cases)
- •No prevalence of complications could be established due to selection and recall biases, and lack of detailed complication descriptions