Abstract
Background: The sacroiliac joint (SIJ) is an important cause of chronic low back pain, implicated in 15% - 30% of all cases. While radiofrequency neurotomy (RFN) is the interventional treatment of choice for spinal pain originating from the facet joints, fewer studies have investigated its potential for treating SIJ pain, and its long-term efficacy is unknown. Objectives: To obtain a real-world view of RFN treatment outcomes for SIJ pain by conducting an observational study within a community pain practice, among a heterogeneous patient group receiving standard-of-care diagnostic workup and treatment. Study Design: A prospective, observational study, with data collection over five years, was conducted at the authors' private practice. Patients & Methods: A cohort of 215 patients underwent fluoroscopically guided SIJ RFN of the dorsal and lateral branches of S1-S3 and the descending branch of L5. All patients had previously had their diagnosis of SIJ pain confirmed by controlled comparative analgesic blocks of relevant nerves, and recorded pre-procedure pain levels on the 11-point Numerical Rating Scale (NRS). Outcome measures included pain, and a Likert scale to measure alterations to analgesic use, changes to paid employment status and patient satisfaction. Results: We demonstrate an average pain reduction of 2.3 ± 2.1 NRS points following RFN (baseline pain score of 6.9 ± 1.7 to a follow-up average of 4.6 ± 2.7 NRS points; p ≤ 0.01). At a mean follow-up period of 14.9 ± 10.9 months (range 6 - 49 months), an overall 42.2% of patients reduced their analgesic use. Of the patients for whom employment capacity was applicable (82 patients), 21 patients reported an improvement. Overall, 67% of patients were satisfied with their outcome of post-RFN treatment. No complications occurred. Limitations: This observational study had no independent control group and only included a single study site. Conclusions: RFN is a safe and effective treatment for pain confirmed to originate from the sacroiliac joint.
Highlights
The sacroiliac joint (SIJ) is a diarthrodial joint adapted for pelvic stability [1]
One study has investigated the nociceptive innervation of the sacroiliac joint, by measuring calcitonin gene-related peptide (CGRP) immunoreactivity as a marker of nociceptive innervation in rat models
This study confirms the presence of nociceptive innervation in the rat sacroiliac joint, with the highest density of nociceptive fibers found in the dorsal aspect of the cranial portion of the joint, indicating that this part of the sacroiliac joint may be the most significant source of pain [15]
Summary
The sacroiliac joint (SIJ) is a diarthrodial joint adapted for pelvic stability [1]. It has matching articular surfaces separated by a joint space containing synovial fluid and enveloped by a fibrous capsule, but it is characterized by the discontinuity of the posterior capsule and an irregular articular surface that prevents excessive movement and enhances stability. This study confirms the presence of nociceptive innervation in the rat sacroiliac joint, with the highest density of nociceptive fibers found in the dorsal aspect of the cranial portion of the joint, indicating that this part of the sacroiliac joint may be the most significant source of pain [15]. While radiofrequency neurotomy (RFN) is the interventional treatment of choice for spinal pain originating from the facet joints, fewer studies have investigated its potential for treating SIJ pain, and its long-term efficacy is unknown. Objectives: To obtain a real-world view of RFN treatment outcomes for SIJ pain by conducting an observational study within a community pain practice, among a heterogeneous patient group receiving standard-of-care diagnostic workup and treatment. Conclusions: RFN is a safe and effective treatment for pain confirmed to originate from the sacroiliac joint
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