Anatomical Comparison of Radiofrequency Ablation Techniques for Sacroiliac Joint Pain

Roberts, Shannon L.; Stout, Alison; Loh, Eldon; Swain, Nathan; Dreyfuss, Paul; Agur, Anne

doi:10.1093/pm/pnx329

Cited by 26 publications

(24 citation statements)

References 54 publications

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“…The posterior portion of the SIJ is innervated by a posterior sacral network (PSN), which is the convergence of the lateral branches of the dorsal ramus of the spinal nerves from S1 to S3, with possible contributions from L4 and L5 branches. 4,5 As demonstrated by Roberts et al, 4 the PSN is formed in the lateral sacral crest between the levels of S1-S3 (Figure 1). Therefore, it was hypothesized that injecting neurolytic agents in the lateral sacral crest at the levels of S2 and S3 would be sufficient to denervate the SIJ due to dispersion of the phenol.…”

Section: Chemical Neurolysis Of the Lateral Branches Of The Sacral Do...mentioning

confidence: 78%

Chemical neurolysis of the lateral branches of the sacral dorsal rami for the treatment of chronic pain in the sacroiliac joint: Case report and description of the technique

et al. 2021

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Section: Chemical Neurolysis Of the Lateral Branches Of The Sacral Do...mentioning

confidence: 78%

Chemical neurolysis of the lateral branches of the sacral dorsal rami for the treatment of chronic pain in the sacroiliac joint: Case report and description of the technique

et al. 2021

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“…44 Another cadaveric study compared 3 monopolar versus 4 bipolar lesions and capture rates of the sacral branches. 45 The authors found that bipolar lesions more reliably captured the lateral branches with the potential of a 100% capture rate. These findings do help direct future studies toward more anatomically valid techniques that can appropriately lesion the targeted nerves.…”

Section: Discussionmentioning

confidence: 98%

“…One recent cadaveric study looked at the percentage of lateral branches that would be captured by cooled RFA and found that adjustments in needle placement did affect capture rates of the lateral branches . Another cadaveric study compared 3 monopolar versus 4 bipolar lesions and capture rates of the sacral branches . The authors found that bipolar lesions more reliably captured the lateral branches with the potential of a 100% capture rate.…”

Section: Discussionmentioning

confidence: 99%

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

Yang

McCormick

Zheng

et al. 2019

PM&R

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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.

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“…Historically, literature suggested the lateral branches of S1-S3 dorsal rami and L5 dorsal ramus supply the posterior aspect of the SIJ (1,5). 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).…”

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confidence: 98%

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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Anatomical Comparison of Radiofrequency Ablation Techniques for Sacroiliac Joint Pain

Cited by 26 publications

References 54 publications

Chemical neurolysis of the lateral branches of the sacral dorsal rami for the treatment of chronic pain in the sacroiliac joint: Case report and description of the technique

Chemical neurolysis of the lateral branches of the sacral dorsal rami for the treatment of chronic pain in the sacroiliac joint: Case report and description of the technique

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

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

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