Preliminary Results of Endoscopic Radiofrequency Treatment of the Sacroiliac Joint Syndrome
Background and Study The sacroiliac joint (SIJ) may be the primary source of pain in 15 to 25% of patients with axial low back pain. Furthermore, 75% of patients who have had fusion surgery develop SIJ pain within 10 years. Treatment options include SIJ blocks, radiofrequency (RF) denervation, and fusion. The RF techniques range from ablation of the nerves supplying the joint, creating lesions to the joint itself, or a combination of both techniques. However, different clinical studies could only identify a limited or, in some cases, no effect in decreasing of pain intensity and duration of the effect.
Methods In this retrospective study, we selected 23 patients with SIJ pain, with a duration of more than 12 months and a 50% pain reduction on the Numeric Rating Scale (NRS) after diagnostic block. All patients received endoscopic ablation of the medial branch L5/S1 and the lateral branches, exiting the sacral foramina on S1/S2 and S2/S3 on both sides while using only one incision on each side. Telephone interviews were conducted with all patients. The outcome was determined with Odom's criteria, percent reduction NRS, subjective assessment of the patient, and duration of the effect.
Results According to Odom's criteria, 79% of the patients showed acceptable to excellent results and confirmed that denervation helped them to manage their daily lives better. The average pain reduction in the responder group was 57% with an average duration of 13.4 months.
Conclusion In this retrospective study, we could demonstrate the practicability and effectiveness of endoscopic SIJ denervation in the treatment of SIJ pain using only one incision for three levels on each side. Further studies should investigate if this procedure is more effective than percutaneous RF.
Eingereicht: 20. Oktober 2019
Angenommen: 19. März 2020
Artikel online veröffentlicht:
17. November 2021
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- 1 Tender G, Waguespack A, Crutcher C, Digiorgio A, Nader R. Sacro-iliac joint fusion. In: Tender G. ed. Minim Invasive Spine Surgery Technique. Cham: Springer; 2018: 147-154
- 2 Tinnirello A, Barbieri S, Todeschini M, Marchesini M. Conventional (simplicity III) and cooled (SInergy) radiofrequency for sacroiliac joint denervation: one-year retrospective study comparing two devices. Pain Med 2017; 18 (09) 1731-1744
- 3 Cohen SP, Strassels SA, Kurihara C. et al. Outcome predictors for sacroiliac joint (lateral branch) radiofrequency denervation. Reg Anesth Pain Med 2009; 34 (03) 206-214
- 4 Hansen HC, McKenzie-Brown AM, Cohen SP, Swicegood JR, Colson JD, Manchikanti L. Sacroiliac joint interventions: a systematic review. Pain Physician 2007; 10 (01) 165-184
- 5 Rupert MP, Lee M, Manchikanti L, Datta S, Cohen SP. Evaluation of sacroiliac joint interventions: a systematic appraisal of the literature. Pain Physician 2009; 12 (02) 399-418
- 6 Bayerl SH, Finger T, Heiden P. et al. Radiofrequency denervation for treatment of sacroiliac joint pain-comparison of two different ablation techniques. Neurosurg Rev 2020; 43 (01) 101-107
- 7 Juch JNS, Maas ET, Ostelo RWJG. et al. Effect of radiofrequency denervation on pain intensity among patients with chronic lowback pain the mint randomized clinical trials. JAMA 2017; 318 (01) 68-81
- 8 Gupta A. Radiofrequency ablation techniques for chronic sacroiliac joint pain. Pain Med News. 2010; 8: 1-8
- 9 Walter SG, Schildberg FA, Rommelspacher Y. Endoscopic sacrolumbar facet joint denervation in osteoarthritic and degenerated zygapophyseal joints. Arthrosc Tech 2018; 7 (12) e1275-e1279
- 10 Choi WS, Kim JS, Ryu KS, Hur JW, Seong JH, Cho HJ. Endoscopic radiofrequency ablation of the sacroiliac joint complex in the treatment of chronic low back pain: a preliminary study of feasibility and efficacy of a novel technique. BioMed Res Int 2016; 2016: 2834259
- 11 Yoshihara H. Sacroiliac joint pain after lumbar/lumbosacral fusion: current knowledge. Eur Spine J 2012; 21 (09) 1788-1796
- 12 Rashbaum RF. Diagnosis and treatment of sacroiliac joint pain: sacrogenic pain. In: Whitaker C, Hochschuler S. eds. The Pocket Spine. 2nd ed.. Boca Raton, FL: CRC Press; 2014: 245-257
- 13 Salman OH, Gad GS, Mohamed AA, Rafae HH, Abdelfatah AM. Randomized, controlled blind study comparing sacroiliac intra-articular steroid injection to radiofrequency denervation for sacroiliac joint pain. Egypt J Anaesth 2016; 32 (02) 219-225
- 14 Zaidi HA, Montoure AJ, Dickman CA. Surgical and clinical efficacy of sacroiliac joint fusion: a systematic review of the literature. J Neurosurg Spine 2015; 23 (01) 59-66
- 15 Maas ET, Ostelo RW, Niemisto L. et al. Radiofrequency denervation for chronic low back pain. Cochrane Database Syst Rev 2015; (10) CD008572