Sacroiliac Joint Radiofrequency

Abstract

The sacroiliac joint is the largest axial joint in the body. It is diarthrodial joint and has both anterior and posterior innervation. It is a significant source of nonradicular low back pain along with discogenic and facet joint-mediated pain. Sacroiliac (SI) joint pain is the source of nonradicular low back pain in approximately 15–30% of patients with chronic axial lumbosacral pain. Diagnosis of SI joint pain often proves difficult due to the lack of definitive medical history, physical exam, or imaging findings. Most clinicians use a positive response to SI joint injections to make a diagnosis. Conservative treatment consists of physical therapy and anti-inflammatory medications. If this treatment fails, SI joint injections, radiofrequency ablation, and surgery are interventional options. Radiofrequency ablation (RFA), including conventional, cooled, pulsed, and bipolar, is shown to provide intermediate duration pain relief. No gold standard exists for treatment of chronic SI joint pain or for the type of RFA that should be used. Prospective randomized controlled trials are needed to determine clinical outcomes and treatment standards for RFA of the SI joint.