CT-guided percutaneous radiofrequency denervation of the sacroiliac joint

Abstract

Defining the origin of low back pain is a challenging task. Among a variety of factors the sacroiliac joint (SIJ) is a possible pain generator, although precise diagnosis is difficult. Joint blocks may reduce pain, but are, in cases, of only temporary effect. This study was conducted to evaluate CT-guided percutaneous radiofrequency denervation of the sacroiliac joint in patients with low back pain. The procedure was performed on 38 patients who only temporarily responded to CT-guided SIJ blocks. The denervation was carried out in the posterior interosseous sacroiliac ligaments and on the dorsal rami of the fifth spinal nerve. All interventions were carried out under CT guidance as out-patient therapies. Three months after the therapy, 13 patients (34.2%) were completely free of pain. Twelve patients (31.6%) reported on a substantial pain reduction, 7 patients (18.4%) had obtained a slight and 3 patients (7.9%) no pain reduction. The data of 3 patients (7.9%) was missing. There were no intra- or postoperative complications. Computed tomography-guided percutaneous radiofrequency denervation of the sacroiliac joint appears safe and effective. The procedure may be a useful therapeutic modality, especially in patients with chronic low back pain, who only temporarily respond to therapeutic blocks.

An Intraarticular Sacroiliac Steroid Injection Under the Guidance of Computed Tomography for Relieving Sacroiliac Joint Pain: A Clinical Outcome Study with Two Years of Follow-Up

“…This is comparable to our previous experience and the data determined from the present study. In another study by Gevargez et al, [23] only three out of 38 patients did not respond to injection treatment of SIJ pain. In our study, we had comparable results.…”

“…Various studies have analyzed the effectiveness of SIJ injection in heterogeneous study groups. [11,22,23] The indication for injection and inclusion criteria in these studies was not very clear, preventing any comparative analysis. To clarify indication and define the study group, some provocative tests have been described in the literature.…”

“…This is essential not only for the therapy outcome, but also for the protection of nearby vessels and other neural structures. [23,35] In the literature, it has been reported that CT guidance is essential for the effectiveness and safety of interventional procedures, especially in complicated structures such as the SIJ. [23,35,36] As a result, in our study, we preferred CT for injection guidance.…”

“…[23,35] In the literature, it has been reported that CT guidance is essential for the effectiveness and safety of interventional procedures, especially in complicated structures such as the SIJ. [23,35,36] As a result, in our study, we preferred CT for injection guidance. Using this method, we had no injection-related complications, no neurovascular iatrogenic injuries, and no missed injections.…”

Sacroiliac joint arthropathy and low back pain

“…The techniques used have ranged from denervating the nerves supplying the SI joint 31 to creating lesions in the joint itself 32 , with one study using a combination of the two 33 . The success rates of studies targeting the nerve supply are higher than those focusing on the joint itself, with approximately two thirds of patients reporting significant pain relief.…”