Abstract
Introduction Ischial bursitis is a challenging chronic pain condition often resistant to conservative treatments. Ischial bursa injections, including fluoroscopically guided and landmark-based approaches, are commonly used when first-line interventions fail. This study aims to compare the efficacy of these two techniques in providing pain relief and improving function in patients with refractory ischial bursitis. Methods A retrospective analysis was conducted using electronic medical records of nine patients with refractory ischial bursitis treated between April 1, 2023, and November 30, 2024. Patients were categorized based on the injection technique: fluoroscopically guided (n=4) or landmark-based (n=5). Pain relief was assessed at follow-up appointments using patient-reported outcomes. Statistical analyses were performed to compare the mean pain relief between groups. Results The fluoroscopically guided group demonstrated significantly greater pain relief, with a mean improvement of 86.25% ± 11.09%, compared to 55.00% ± 13.23% in the landmark-based group (p < 0.05). Patients receiving fluoroscopic injections consistently reported ≥75% relief, while the landmark-based group experienced more variable outcomes, ranging from 40% to 75%. These findings highlight the superior efficacy and consistency of image-guided injections. Conclusion Fluoroscopically guided ischial bursa injections provide greater pain relief compared to landmark-based injections in patients with refractory ischial bursitis. The precise delivery of medication under image guidance appears to enhance therapeutic outcomes. Future studies with larger sample sizes and randomized designs are warranted to validate these findings and refine treatment protocols for this patient population.