Radiofrequency Neurotomy for Sacroiliac Joint Pain: Twelve Month Outcomes and Comparison Between Two Techniques

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Published Dec 26, 2023
DOI: https://doi.org/10.18103/mra.v11i12.4978

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Main Article Content

Robert E. Wright, M.D
Northern Pain Centre, St. Leonards NSW, Australia
Jon E. Block, Ph.D.
Consultant, San Francisco, CA, USA

Abstract

Background: Radiofrequency neurotomy (RFN) is an effective treatment option for patients with severe sacroiliac joint (SIJ) pain.


Aims: We evaluated the 12-month clinical outcomes between patients (n=93) having RFN of the lateral branches of S1-S3 compared to patients (n=89) undergoing the same procedure augmented with RFN of the L4 medial branch and L5 dorsal ramus.


Methods: This was a retrospective chart review. Following diagnostic intra-articular anesthetic injections and multi-site multi-depth lateral branch nerve blocks to establish SIJ pain, patients underwent bipolar ablation of the S1-S3 lateral branches using the Nimbus multitined electrode. The second group of patients underwent supplementary monopolar RFN of the L4 medial branch and the L5 dorsal ramus. Pain severity and global Pain Disability Quality of Life Questionnaire-Spine (PDQQ-S) scores were obtained prior to RFN and at 12 months.


Results: There were 61% and 59% average 12-month improvements in SIJ-related pain severity and global PDQQ-S scores, respectively, in the overall study group (P<0.001 for both comparisons). Efficacy was moderately better for patients with augmented ablation that captured the L4 medial branch/L5 dorsal ramus. For example, 12-month average pain reduction was 54% and 66%, and PDQQ-S improvement was 56% and 62% for patients treated with S1-S3 lateral branch RFN and the augmented RFN procedure, respectively. The percentage of patients exhibiting ≥ 50% improvement in pain severity at 12-months was 73% (68 of 93) and 88% (78 of 89) (P=0.016) for the same study groups.


Conclusion: RFN of the S1-S3 sacral lateral branches using an anatomically accurate bipolar strip lesion technique produced a sufficient lesion topography to provide highly significant pain reduction and improvement in PDQQ-S at 12-months follow-up. Including the L4 medial branch and L5 dorsal ramus in the RFN treatment protocol may offer more complete denervation of all afferent pain pathways and provide additional clinical benefit.

Keywords: radiofrequency, sacroiliac, pain, neurotomy, Nimbus, bipolar

Article Details

How to Cite
WRIGHT, Robert E.; BLOCK, Jon E.. Radiofrequency Neurotomy for Sacroiliac Joint Pain: Twelve Month Outcomes and Comparison Between Two Techniques. Medical Research Archives, [S.l.], v. 11, n. 12, dec. 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/4978>. Date accessed: 15 may 2024. doi: https://doi.org/10.18103/mra.v11i12.4978.
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Issue
Vol 11 No 12 (2023): December Issue, Vol.11, Issue 12
Section
Review Articles

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References

1. Le Huec JC, Bourret S, Thompson W, Daulouede C, Cloche T. A painful unknown: sacroiliac joint diagnosis and treatment. EFORT Open Rev. 2020;5(10):691-698.
2. Ou-Yang DC, York PJ, Kleck CJ, Patel VV. Diagnosis and Management of Sacroiliac Joint Dysfunction. J Bone Joint Surg Am. 2017;99(23):2027-2036.
3. Cher D, Polly D, Berven S. Sacroiliac joint pain: burden of disease. Med Devices (Auckl). 2014;7:73-81.
4. Aranke M, McCrudy G, Rooney K, et al. Minimally Invasive and Conservative Interventions for the Treatment of Sacroiliac Joint Pain: A Review of Recent Literature. Orthop Rev (Pavia). 2022;14(3):31915.
5. Chen CH, Weng PW, Wu LC, Chiang YF, Chiang CJ. Radiofrequency neurotomy in chronic lumbar and sacroiliac joint pain: A meta-analysis. Medicine (Baltimore). 2019;98(26):e16230.
6. Lowe M, Okunlola O, Raza S, et al. Radiofrequency Ablation as an Effective Long-Term Treatment for Chronic Sacroiliac Joint Pain: A Systematic Review of Randomized Controlled Trials. Cureus. 2022;14(6):e26327.
7. Shih CL, Shen PC, Lu CC, et al. A comparison of efficacy among different radiofrequency ablation techniques for the treatment of lumbar facet joint and sacroiliac joint pain: A systematic review and meta-analysis. Clin Neurol Neurosurg. 2020;195:105854.
8. Tinnirello A. Reduction of opioid intake after cooled radiofrequency denervation for sacroiliac joint pain: a retrospective evaluation up to 1 year. Korean J Pain. 2020;33(2):183-191.
9. Yang AJ, Wagner G, Burnham T, McCormick ZL, Schneider BJ. Radiofrequency Ablation for Chronic Posterior Sacroiliac Joint Complex Pain: A Comprehensive Review. Pain Med. 2021;22(Suppl 1):S9-S13.
10. Lee DW, Pritzlaff S, Jung MJ, et al. Latest Evidence-Based Application for Radiofrequency Neurotomy (LEARN): Best Practice Guidelines from the American Society of Pain and Neuroscience (ASPN). J Pain Res. 2021;14:2807-2831.
11. Cox M, Ng G, Mashriqi F, et al. Innervation of the Anterior Sacroiliac Joint. World Neurosurg. 2017;107:750-752.
12. Ikeda R. [Innervation of the sacroiliac joint. Macroscopical and histological studies]. Nihon Ika Daigaku Zasshi. 1991;58(5):587-596.
13. Dutta K, Dey S, Bhattacharyya P, Agarwal S, Dev P. Comparison of Efficacy of Lateral Branch Pulsed Radiofrequency Denervation and Intraarticular Depot Methylprednisolone Injection for Sacroiliac Joint Pain. Pain Physician. 2018;21(5):489-496.
14. Roberts SL, Burnham RS, Ravichandiran K, Agur AM, Loh EY. Cadaveric study of sacroiliac joint innervation: implications for diagnostic blocks and radiofrequency ablation. Reg Anesth Pain Med. 2014;39(6):456-464.
15. Cohen SP, Abdi S. Lateral branch blocks as a treatment for sacroiliac joint pain: A pilot study. Reg Anesth Pain Med. 2003;28(2):113-119.
16. Cohen SP, Hurley RW, Buckenmaier CC, 3rd, Kurihara C, Morlando B, Dragovich A. Randomized placebo-controlled study evaluating lateral branch radiofrequency denervation for sacroiliac joint pain. Anesthesiology. 2008;109(2):279-288.
17. Des Jarlais DC, Lyles C, Crepaz N, Group T. Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health. 2004;94(3):361-366.
18. Mitchell B, MacPhail T, Vivian D, Verrills P, Barnard A. Diagnostic sacroliliac joint injections: is a control block necessary? Surg Sci. 2015;6(7):273-281.
19. Dreyfuss P, Henning T, Malladi N, Goldstein B, Bogduk N. The ability of multi-site, multi-depth sacral lateral branch blocks to anesthetize the sacroiliac joint complex. Pain Med. 2009;10(4):679-688.
20. Derby R, Melnik I, Lee JE, Lee SH. Correlation of lumbar medial branch neurotomy results with diagnostic medial branch block cutoff values to optimize therapeutic outcome. Pain Med. 2012;13(12):1533-1546.
21. Wright RE, Allan KJ, Bainbridge JS. In and Ex Vivo Validation of a Novel Technique for Radiofrequency Denervation of the Dorsal Sacroiliac Joint Including a Case Study. Reg Anesth Pain Med. 2013;38(5):E161-E162.
22. Burnham R, Stanford G, Gray L. An assessment of a short composite questionnaire designed for use in an interventional spine pain management setting. PM R. 2012;4(6):413-418; quiz 418.
23. Rossi MJ, Brand JC, Lubowitz JH. Minimally Clinically Important Difference (MCID) Is a Low Bar. Arthroscopy. 2023;39(2):139-141.
24. Ostelo RW, Deyo RA, Stratford P, et al. Interpreting change scores for pain and functional status in low back pain. Towards international consensus regarding minimal important change. Spine. 2008;33(1):90-94.
25. Glassman SD, Copay AG, Berven SH, Polly DW, Subach BR, Carreon LY. Defining substantial clinical benefit following lumbar spine arthrodesis. J Bone Joint Surg Am. 2008;90(9):1839-1847.
26. Power JD, Perruccio AV, Canizares M, et al. Determining minimal clinically important difference estimates following surgery for degenerative conditions of the lumbar spine: analysis of the Canadian Spine Outcomes and Research Network (CSORN) registry. Spine J. 2023.
27. Pham T, Tubach F. Patient acceptable symptomatic state (PASS). Joint Bone Spine. 2009;76(4):321-323.
28. Amatto A, Smith A, Pan B, Al Hamarneh Y, Burnham T. An assessment of the minimal clinically important difference for the pain disability quality-of-life questionaire. Intervent Pain Med. 2022;1:100116.
29. Tubach F, Dougados M, Falissard B, Baron G, Logeart I, Ravaud P. Feeling good rather than feeling better matters more to patients. Arthritis Rheum. 2006;55(4):526-530.
30. Martin CT, Haase L, Lender PA, Polly DW. Minimally Invasive Sacroiliac Joint Fusion: The Current Evidence. Int J Spine Surg. 2020;14(Suppl 1):20-29.
31. Loh E, Agur AM, Burnham RS. Ultrasound-guided radiofrequency Ablation for SI joint pain:An observational study. Intervent Pain Med. 2022;1(100118).
32. Cedeno DL, Vallejo A, Kelley CA, Tilley DM, Kumar N. Comparisons of Lesion Volumes and Shapes Produced by a Radiofrequency System with a Cooled, a Protruding, or a Monopolar Probe. Pain Physician. 2017;20(6):E915-E922.
33. Finlayson RJ, Thonnagith A, Elgueta MF, Perez J, Etheridge JB, Tran DQ. Ultrasound-Guided Cervical Medial Branch Radiofrequency Neurotomy: Can Multitined Deployment Cannulae Be the Solution? Reg Anesth Pain Med. 2017;42(1):45-51.
34. Cox RC, Fortin JD. The anatomy of the lateral branches of the sacral dorsal rami: implications for radiofrequency ablation. Pain Physician. 2014;17(5):459-464.
35. Vallejo R, Benyamin R, Tilley DM, Kelley CA, Cedeno DL. An ex vivo comparison of cooled-radiofrequency and bipolar-radiofrequency lesion size and the effect of injected fluids. Reg Anesth Pain Med. 2014;39(4):312-321.