Chapter 4 - Sacral lateral branch nerve block

Abstract

Eight-four percent of adults have low back pain at some time in their lives; most cases are self-limited. Patients who continue to have back pain beyond the acute period (4 weeks) have subacute back pain (lasting between 4 and 12 weeks) and may go on to develop chronic back pain s(persists for ≥12 weeks). Sacroiliac joint (SIJ) pain and dysfunction is “a term to describe pain in the region of the SIJ believed to be due to malalignment or abnormal joint movement.” It is a challenging condition estimated to account for between 13% and 30% of chronic axial low back pain cases. Diagnosing this condition is difficult because of the absence of an agreed upon “gold standard.” Physical examination is the most important tool in diagnosing SIJ as the source of low back pain. By far, the thigh thrust test, the compression test, and three or more positive provocative tests have discriminative power for diagnosing SIJ pain. Periarticular and intraarticular SIJ steroid injections resulted mostly in poor outcome or short-term pain relief. In the past several years, radiofrequency denervation has emerged as a promising treatment alternative for refractory cases of SIJ pain.