Radiofrequency Ablation for Posterior Sacroiliac Joint Complex Pain: A Narrative Review

Abstract

Radiofrequency ablation (RFA) of the sacral lateral branches targets the innervation of the posterior sacroiliac ligaments and posterior portion of the sacroiliac joint, also referred to as the posterior sacroiliac joint complex. This review assesses the published evidence on local anesthetic blocks for the diagnosis of posterior sacroiliac joint complex pain and the efficacy of RFA of the sacral lateral branches as a treatment. The current evidence suggests that RFA can provide relief of pain that originates from the posterior sacroiliac joint complex, but interpretation of this literature is limited by variability in patient selection criteria, the specific nerves targeted for ablation, and the types of RFA technology and technique utilized.

Minimally Invasive Sacroiliac Joint Fusion with Triangular Titanium Implants: Cost-Utility Analysis from NHS Perspective

“…This is likely to have bolstered outcomes for these patients. The current evidence suggests RFA can provide temporary pain relief, but there remains variability in patient selection, nerves targeted, and types of RFA technology and techniques utilized [ 11 , 12 ]. Effectiveness data for RFA were sourced from an RCT that assessed the efficacy of lateral branch neurotomy for chronic SIJ pain against placebo [ 30 ].…”

“…Nonsurgical management (NSM) for chronic SIJ pain include medical management, physical therapy, intra-articular or peri-articular steroid injections, and radiofrequency ablation (RFA) of sacral nerve root branches. However, the evidence base supporting the efficacy of these interventions is limited [8][9][10][11][12].…”

Platelet-Rich Plasma Versus Corticosteroid Injection for Lumbar Spondylosis and Sacroiliac Arthropathy: A Systematic Review of Comparative Studies

“…Pharmacological agents like opioids and muscle relaxants have also been used in short-term treatments but the neurologic, psychosocial, and gastrointestinal side effects limit their benefit [ 13 - 14 ]. When assessing sacroiliac arthropathy, facet and joint steroid injection is often a preferred treatment modality, however, there is a limited duration of relief provided by steroid injections [ 11 , 48 ]. In the setting of sacroiliac pain resistant to steroid injection, radiofrequency ablation (RFA) is another option, with relief being reported to up to a year, but there is high heterogeneity in the delivery of RFA and what nerves to specifically target [ 11 , 48 ].…”

“…When assessing sacroiliac arthropathy, facet and joint steroid injection is often a preferred treatment modality, however, there is a limited duration of relief provided by steroid injections [ 11 , 48 ]. In the setting of sacroiliac pain resistant to steroid injection, radiofrequency ablation (RFA) is another option, with relief being reported to up to a year, but there is high heterogeneity in the delivery of RFA and what nerves to specifically target [ 11 , 48 ]. Regarding surgical treatment for lumbar spondylosis and sacroiliac arthropathy, the literature is inconclusive as to which patients may be best served by surgical intervention as well as the heterogeneity of different procedures involved in treating numerous pathologies that could lead to pain manifestation [ 11 , 48 ].…”

Disfunción de articulación sacroiliaca

“…Uno de los principales problemas con la rizotomía de ablación es la variabilidad anatómica por lo que se ha demostrado que el uso de radiofrecuencia bipolar, por su forma de acción, puede detectar hasta el 100% de todo el ramo lateral sacro. 22 La radiofrecuencia fría fue comparada con placebo en un estudio por Patel y colaboradores y demuestran resultados favorables a los tres y seis meses en más de la mitad de los pacientes que fueron intervenidos. 23 Peebles y su equipo determinan mejores resultados con radiofrecuencia fría en pacientes obsesos y con alto nivel de actividad.…”