Innervation of the Anterior Sacroiliac Joint

Cox, Marcus; Ng, Garrett; Mashriqi, Faizullah; Iwanaga, Joe; Alonso, Fernando; Tubbs, Kevin; Loukas, Marios; Oskouian, Rod J.; Tubbs, R. Shane

doi:10.1016/j.wneu.2017.08.062

Cited by 18 publications

(16 citation statements)

References 6 publications

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“…69 The sacroiliac joint is thought to receive its innervation from the ventral rami of L4 and L5, the dorsal rami of L5, S1, S2, and S3, as well as the superior gluteal nerve. 70,71 There is an additional ventral innervation of the sacroiliac joint that is inaccessible for denervation.…”

Section: Lateral Sacral Branch Radiofrequency Neurotomymentioning

confidence: 99%

Latest Evidence-Based Application for Radiofrequency Neurotomy (LEARN): Best Practice Guidelines from the American Society of Pain and Neuroscience (ASPN)

Lee¹,

Pritzlaff²,

Jung³

et al. 2021

JPR

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Radiofrequency neurotomy (RFN), also known as radiofrequency ablation (RFA), is a common interventional procedure used to treat pain from an innervated structure. RFN has historically been used to treat chronic facet-joint mediated pain. The use of RFN has more recently expanded beyond facet-joint mediated pain to peripherally innervated targets. In addition, there has also been the emergence of different radiofrequency modalities, including pulsed and cooled RFN. The use of RFN has been particularly important where conservative and/or surgical measures have failed to provide pain relief. With the emergence of this therapeutic option and its novel applications, the American Society of Pain and Neuroscience (ASPN) identified the need for formal evidence-based guidance. The authors formed a multidisciplinary work group tasked to examine the latest evidence-based medicine for the various applications of RFN, including cervical, thoracic, lumbar spine; posterior sacroiliac joint pain; hip and knee joints; and occipital neuralgia. Best practice guidelines, evidence and consensus grading were provided for each anatomical target.

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Section: Lateral Sacral Branch Radiofrequency Neurotomymentioning

confidence: 99%

Latest Evidence-Based Application for Radiofrequency Neurotomy (LEARN): Best Practice Guidelines from the American Society of Pain and Neuroscience (ASPN)

Lee¹,

Pritzlaff²,

Jung³

et al. 2021

JPR

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“…The anterior aspect of the SIJ is innervated by segments L4-S2, sometimes L3, and the sacral plexus, and in one study, even the superior gluteal nerve (Table 4) (70,(146)(147)(148).…”

Section: Innervation Of the Sijmentioning

confidence: 97%

“…The posterior aspect of the SIJ is innervated by a nerve plexus formed by the lateral branches of posterior rami of L5 to S4 (Table 5) (23,70,(147)(148)(149)(150)(151)(152)(153)(154). The posterior innervation was noted to be asymmetrical between the left and right sides of the body, and interindividual differences were found (23,(146)(147)(148)(149)(150)(151)(152)(153)(154)(155)(156). Two groups stated the involvement of the sacral plexus in SIJ innervation, when other groups did not mention its contribution.…”

Section: Fig 24 Dorsal View Of the Blood Supply Of The Posterior Sacroiliac Joint And The Sacrotuberous Ligament (Stl) Based On Lai Et Almentioning

confidence: 99%

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A Systematic Review of the Normal Sacroiliac Joint Anatomy and Adjacent Tissues for Pain Physicians

Poillio

2019

Pain Phys

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Background: The sacroiliac joint (SIJ) forms a complex joint and has shown to be underappreciated in its involvement with lower back pain. Research efforts have intensified on SIJ anatomy and biomechanics because of its predisposing position to pain and dysfunction in individuals suffering from lower back discomfort. Previous work has focused on SIJ anatomy including bone and joint structure, innervation, as well as biomechanics and the treatment of SIJ pain. However, to date, no review exists describing the range of ‘normal’ anatomic features of the SIJ. Objectives: To describe the normal appearance of the SIJ and adjacent tissues, as opposed to ‘abnormal’ conditions involving SIJ morphology. It will also identify key areas that require further study because of lacking information or disagreement. Study Design: A systematic literature review. Setting: The research took place at the University of Otago, New Zealand. All published research on ‘normal SIJ anatomy’ available from MEDLINE, OVID, Scopus, Web of Science, PubMed, and Science Direct were included, available until December 2018, in English, French, and German. Subject areas included bony landmarks, joint type, bone morphology, ligamentous attachments, muscular and fascial relationships, blood supply, fatty infiltration, and morphologic variation. Methods: Articles met the selection criteria if they contained specific information on SIJ anatomy, including bone morphology and architecture, ligaments, muscle attachments, innervation, vasculature, and the presence of fat. Biomechanics and kinematics related keywords were used as the literature often couples these with the anatomy. Keywords of individual articles were named as ‘structures of interest.’ Results: A total of 88 primary and 101 secondary articles were identified in the time frame from 1851 to 2018. Primary articles provided quantitative data and detailed anatomic descriptions. Secondary articles did not focus specifically on the anatomy of the SIJ. Although research appeared to be in general agreement on bony landmarks, joint type, myofascial attachments, vasculature, and innervation of the SIJ, there was only part consensus on ligament attachments and cartilage structure. Information regarding bone density of the articulating surfaces of the SIJ is lacking. Despite its potential clinical significance, fatty infiltration within the joint lacks research to date. Limitations: Only the given databases were used for the initial search. Keyword combinations used for this review may not have been inclusive of all articles relevant to the SIJ. Work in languages other than the ones listed or work that is not available via the internet may be missing. Conclusions: This study provides an overview of normal SIJ structures, including all neuromusculoskeletal elements related to the joint. There is a lack of knowledge on the SIJ ligaments warranting further investigation. Furthermore, there are discrepancies in relation to the nomenclature, layers, attachment sites, and on the topographical relationships between ligamentous tissues and nerves. Subsequent studies on the quantification of fat and bone density in the SIJ have been suggested. These could be useful radiologic parameters to assess the condition of the joint clinically. This review may provide insight into the clinical signs and abnormal biomechanical features of the joint for the purposes of treating SIJ pain. Key words: Bone density, bony landmarks, fat infiltration, innervation, ligaments morphology, muscles, sacroiliac joint, vasculature

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“…More recent literature supports that L5 dorsal ramus contribution is variable and inconsistent (6,7). L4 and L5 ventral rami are proposed to innervate the ventral aspect of the SIJ (8). In addition, the nerves providing innervation can vary in depth, number, and location.…”

mentioning

confidence: 99%

Simplicity Radiofrequency Ablation Demonstrates Greater Functional Improvement Than Analgesia: A Prospective Case Series

Brennick¹,

Bickelhaupt

Boies

et al. 2021

Pain Phys

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BACKGROUND: Pain originating from the posterior sacroiliac complex is notoriously difficult to effectively treat due to its complex anatomy and variable innervation. Data on radiofrequency ablation (RFA) is limited. The Abbott Simplicity probe creates 3 monopolar lesions along the medial aspect of the sacroiliac joint and 2 bipolar lesions between the active portions of the probe. This device has been studied previously with improvement of pain-associated disability and pain reduction, but insufficient data is present to determine its utility at this time. Using the most recent literature for the potential innervation of the posterior sacroiliac joint, it is reasonable to explore this novel device and its ability to treat sacroiliac joint pain. OBJECTIVES: Identify the percentage of improved posterior sacroiliac complex pain and improved function in patients who completed posterior sacroiliac complex radiofrequency ablation using the Simplicity probe. STUDY DESIGN: Prospective case series. SETTING: A single outpatient pain clinic. METHODS: This prospective case-series occurred at an outpatient pain clinic. Data were analyzed after completion of follow-up appointments. Inclusion criteria included 2 successful lateral branch blocks. Fourteen patients with posterior sacroiliac complex pain were examined and completed sacroiliac ablation with the Simplicity probe. The numeric rating scale and the Modified Oswestry Disability Index were used as outcome measures for pain and function, respectively. The primary outcome measures were improvement in the numeric rating scale score by a reduction of 2.5 points and an improvement in Modified Oswestry Disability Index by 15% based upon previous studies demonstrating these values as the minimal clinical important difference . Patients were followed at a 3 to 6 month interval and 12 month interval (an average of 88 and 352 days, respectively). RESULTS: In total, 14 patients were examined. At the first follow-up, 29% of patients had analgesia and 38% functionally improved. At the second follow-up, 15% of patients had analgesia and 31% functionally improved. LIMITATIONS: Considering data were collected retrospectively, this study relied on completed charts. Therefore, data points of interest were limited to what was previously documented, which included multiple answers or the absence of numerical data points. In addition, patients were disproportionately female (71.4%). Data were also affected by patients lost to follow-up. Also, this study examined a relatively small number of patients, therefore the results should be carefully considered. CONCLUSIONS: Radiofrequency ablation of the posterior sacroiliac complex with the Simplicity probe resulted in more functional improvement than analgesia. This study provides more data for clinicians to utilize in managing posterior sacroiliac complex pain. IRB: Protocol number 20170342HU. Not registered in clinical trials. KEY WORDS: Posterior sacroiliac complex, sacroiliac pain, chronic low back pain, radiofrequency denervation, functional improvement, strip lesion, multi-lesion, Simplicity probe

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Innervation of the Anterior Sacroiliac Joint

Cited by 18 publications

References 6 publications

Latest Evidence-Based Application for Radiofrequency Neurotomy (LEARN): Best Practice Guidelines from the American Society of Pain and Neuroscience (ASPN)

Latest Evidence-Based Application for Radiofrequency Neurotomy (LEARN): Best Practice Guidelines from the American Society of Pain and Neuroscience (ASPN)

A Systematic Review of the Normal Sacroiliac Joint Anatomy and Adjacent Tissues for Pain Physicians

Simplicity Radiofrequency Ablation Demonstrates Greater Functional Improvement Than Analgesia: A Prospective Case Series

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