Randomized Placebo-controlled Study Evaluating Lateral Branch Radiofrequency Denervation for Sacroiliac Joint Pain

Abstract

Background Sacroiliac joint pain is a challenging condition accounting for approximately 20% of cases of chronic low back pain. Currently, there are no effective long-term treatment options for sacroiliac joint pain. Methods A randomized, placebo-controlled study was conducted in 28 patients with injection-diagnosed sacroiliac joint pain. Fourteen patients received L4-5 primary dorsal rami and S1-3 lateral branch radiofrequency denervation using cooling-probe technology following a local anesthetic block, and 14 patients received the local anesthetic block followed by placebo denervation. Patients who failed to respond to placebo injections crossed over and were treated with radiofrequency denervation using conventional technology. Results One, 3 and 6-months post-procedure, 11 (79%), 9 (64%) and 8 (57%) of radiofrequency treated patients experienced ≥ 50% pain relief and significant functional improvement. In contrast, only 2 (14%) patients in the placebo group experienced significant improvement at their 1-month follow-up, and none experienced benefit 3-months post-procedure. In the crossover group (n=11), 7 (64%), 6 (55%) and 4 (36%) patients experienced improvement 1, 3 and 6-months post-procedure. One year after treatment, only 2 (14%) patients in the treatment group continued to demonstrate persistent pain relief. Conclusions These results provide preliminary evidence that L4 and L5 primary dorsal rami and S1-3 lateral branch radiofrequency denervation may provide intermediate-term pain relief and functional benefit in selected patients with suspected sacroiliac joint pain. Larger studies are needed to confirm our results, and determine the optimal candidates and treatment parameters for this poorly understood disorder.

Sacroiliac Joint Pain: Burden of Disease

“…6,7 Treatment options for SIJ pain include physical therapy, 8 SIJ steroid injections, 9,10 radiofrequency ablation of the SIJ, 11,12 and open 13 or minimally invasive [14][15][16][17][18] SIJ fusion. The impact of pain from the SIJ has not been well described.…”

Long-term follow-up in sacroiliac joint pain patients treated with radiofrequency ablative therapy

“…Histological analysis of the sacroiliac joint has verified the presence of nerve fibers within the joint capsule and adjoining ligaments. It has been variously described that the sacroiliac joint receives its innervation from the ventral rami of L4 and L5, the superior gluteal nerve, and the dorsal rami of L5, S1, and S2, or that it is almost exclusively derived from the sacral dorsal rami 5,7,12,13,14,15,16,17 .…”

Application of Radiofrequency in Low Back Pain Treatment

“…Inclusion criteria includes axial low back or buttock pain ≥ 6 months in duration with tenderness overlying the SIJ(s); failure to respond to conservative therapy (e.g. physical therapy and pharmacotherapy), including long-term (>2 months) pain relief with SIJ corticosteroid injections; and ≥ 75% pain relief as calculated from a 6-hour post-block pain diary following a single diagnostic SIJ injection (Cohen & Abdi 2003;Cohen et al, 2008). At each level, placement of the electrode in close proximity to the nerve was confirmed using electrostimulation at 50 Hz, with concordant sensation achieved at ≤ 0.5 V. Prior to lesioning, the absence of leg contractions was verified with stimulation at 2 Hz up to 2 V. After satisfactory electrode placement, 0.5 ml of lidocaine 2% was injected through each cannula to reduce thermal pain and ensure blinding.…”