OBJECTIVE: Current therapies for sacroiliac joint (SIJ) dysfunction offer discouraging results in alleviating low back pain. The innervation and target nerves for radiofrequency denervation (RFD) of the SIJ remain unclear. We present a prospective case series on the treatment of intractable SIJ dysfunction with pulsed radiofrequency denervation (PRFD) of lateral branches from L4-S3. INTERVENTIONS: A total of 126 patients with presumptive SIJ dysfunction based on history and physical examination underwent arthrographically confirmed steroid/local anesthetic SIJ injection. Fifty-two patients (41.3%) had >75% pain relief after two consecutive injections, physical therapy, repeated SIJ injections, and/or analgesics. Twenty-two patients failed to respond. These patients underwent PRFD of the medial branch of L4, posterior primary rami of L5, and lateral branches S1 and S2. OUTCOME MEASURES: Visual analog score (VAS) and quality of life (QOL) assessments were performed prior to and after treatment. RESULTS: Sixteen patients (72.7%) experienced "Good" (>50% reduction in VAS), or "Excellent" (>80% reduction in VAS) pain relief following PRFD. Duration of pain relief range was 6-9 weeks in four patients, 10-16 weeks in five patients, and 17-32 weeks in seven patients. In addition, QOL scores improved significantly in all measured categories. Six patients (26.1%) did not respond to PRFD and had less than 50% reduction in VAS and were considered failures. CONCLUSIONS: PRFD of the lateral branch of the medial branch of L4, posterior primary rami of L5, and lateral branches S1 and S2 is an effective treatment for some patients with SIJ pain unresponsive to other forms of therapy.
OBJECTIVE: Current therapies for sacroiliac joint (SIJ) dysfunction offer discouraging results in alleviating low back pain. The innervation and target nerves for radiofrequency denervation (RFD) of the SIJ remain unclear. We present a prospective case series on the treatment of intractable SIJ dysfunction with pulsed radiofrequency denervation (PRFD) of lateral branches from L4-S3. INTERVENTIONS: A total of 126 patients with presumptive SIJ dysfunction based on history and physical examination underwent arthrographically confirmed steroid/local anesthetic SIJ injection. Fifty-two patients (41.3%) had >75% pain relief after two consecutive injections, physical therapy, repeated SIJ injections, and/or analgesics. Twenty-two patients failed to respond. These patients underwent PRFD of the medial branch of L4, posterior primary rami of L5, and lateral branches S1 and S2. OUTCOME MEASURES: Visual analog score (VAS) and quality of life (QOL) assessments were performed prior to and after treatment. RESULTS: Sixteen patients (72.7%) experienced "Good" (>50% reduction in VAS), or "Excellent" (>80% reduction in VAS) pain relief following PRFD. Duration of pain relief range was 6-9 weeks in four patients, 10-16 weeks in five patients, and 17-32 weeks in seven patients. In addition, QOL scores improved significantly in all measured categories. Six patients (26.1%) did not respond to PRFD and had less than 50% reduction in VAS and were considered failures. CONCLUSIONS: PRFD of the lateral branch of the medial branch of L4, posterior primary rami of L5, and lateral branches S1 and S2 is an effective treatment for some patients with SIJ pain unresponsive to other forms of therapy.
Authors: Mila Pastrak; Nikola Vladicic; Jordan Sam; Bruce Vrooman; Frederick Ma; Ammar Mahmoud; James S Khan; Alaa Abd-Elsayed; Farhan Khandwalla; Scott McGilvray; Ognjen Visnjevac Journal: Curr Pain Headache Rep Date: 2022-09-30