Complications of Sacral Injections

Common Minor Complications

Sacral injections are generally safe procedures with minimal risk of serious complications, though common minor side effects occur in approximately 40% of patients, including injection-site soreness, pain exacerbations, vasovagal reactions, and transient sciatic nerve block 1, 2
Injection-site soreness occurs in 12.9-17.1% of patients and represents the most frequent delayed adverse event 2, 3
Pain exacerbations affect 5.3-8.8% of patients immediately following injection 2
Vasovagal reactions occur in 2.5% of patients, manifesting as lightheadedness, nausea, or syncope 2, 3
Facial flushing and/or sweating affects approximately 2.3% of patients and is specific to corticosteroid use 1, 2

Transient sciatic nerve block can occur from anterior capsular disruption when local anesthetic is included in the injectate, with rates ranging from 6.3% (8 of 127 patients) in some technique-dependent studies to lower rates in others 1, 2, 3
This complication carries fall risk and patients should be counseled accordingly 1, 2

Joint infection of the sacroiliac joint following intra-articular injection has been reported in case reports 1, 2, 3
Spinal epidural abscess, meningitis, and endocarditis have been documented in immunosuppressed patients 1, 2, 3
These serious infections remain exceedingly rare in clinical practice 4

Hyperglycemia is a well-described effect of systemic steroid absorption 1, 2, 3
Hypothalamic-pituitary axis suppression can occur with repeated injections 1, 2, 3
Cushing Syndrome has been reported with chronic steroid exposure 1, 2, 3
Decreased bone mineral density with possible increased fracture risk occurs with repeated corticosteroid injections 1, 2, 3
Immunosuppression with increased risk of infection is a recognized systemic effect 1, 2, 3

Fluoroscopic guidance is preferred as it allows confirmation of intra-articular needle placement and rules out intravascular needle tip position through contrast injection observation 1, 2, 3, 4
Radiation exposure from fluoroscopy is low, though long-term effects on operators have not been fully studied 1, 2, 3
Bleeding risks are low and most guidelines recommend continuing anticoagulation during sacroiliac joint injections 1, 2

Counsel patients about fall risk when local anesthetic is used due to potential transient sciatic nerve block 1, 2
Screen for immunosuppression as these patients face elevated risk of serious infectious complications 1, 2, 3
Monitor diabetic patients closely for hyperglycemia following corticosteroid injection 1, 2, 3