Minimally Invasive and Conservative Interventions for the Treatment of Sacroiliac Joint Pain: A Review of Recent Literature

Abstract

Sacroiliac joint (SIJ) pain is responsible for approximately 15-25% of reported back pain. Patients with SIJ pain report some of the lowest quality of life scores of any chronic disease. Understanding of the physiology and pathology of the SI joint has changed dramatically over the years, and SI joint pain and injury can now be thought of in two broad categories: traumatic and atraumatic. Both categories of SI joint injury are thought to be caused by inflammation or injury of the joint capsule, ligaments, or subchondral bone in the SI joint. Treatment of SI joint pain usually involves a multi-pronged approach, utilizing both, multi-modal medical pain control and interventional pain/surgical techniques such as steroid injections, radiofrequency nerve ablation, and minimally invasive sacroiliac arthrodesis. Though conservative management through multi-modal pain control and physical therapy have their role as first line therapies, an increasing body of evidence supports the use of minimally invasive procedures, both as adjuvant treatments to conservative management and as second line therapies for patient’s that fail first line treatment.

Radiological Insights into Sacroiliitis: A Narrative Review

“…In addition, potential therapies for sacroiliitis regenerative medicine, including platelet-rich plasma (PRP) injections, and stem cell therapy are being explored as potential treatments for sacroiliitis. They are supposed to stimulate tissue repair and lessen inflammation [ 78 ].…”

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

“…Targeted RFN of specific SIJ innervation segments has been shown to produce clinically significant and durable improvements in pain severity, physical functioning, and a reduction in the need for opioid analgesics. [4][5][6][7][8][9] In the recently published best practice guidelines issued by the American Society of Pain and Neuroscience (ASPN), lateral sacral branch RFN for the treatment of posterior sacral ligament and joint pain received a grade of II-1 B based on the compilation of published clinical findings reflecting moderate to substantial clinical benefit as demonstrated in well-designed clinical trials. 10 The SIJ is innervated from several sources including the ventral rami of L4 and L5, the dorsal rami of L5, S1, S2, and S3, as well as the superior gluteal nerve.…”

Treatment of chronic sacroiliac joint pain using Conventional Radiofrequency (CRF) and Pulsed Radiofrequency (PRF): A randomized control study.

“…Intra-articular joint injections 10 , radiofrequency ablation (RFA) 11 , and surgical treatment are all interventional treatments for the management of SIJ pain. 12 RFA is an old technique and was first discussed in the literature in 1975 13 for treating chronic back pain and is now the most commonly used treatment method. For many years, X-ray fluoroscopy-guided percutaneous conventional radiofrequency (CRF) has been used to treat spinal pain.…”