Lateral branch blocks

Mapping Intimacies ◽

10.1093/med/9780197607947.003.0007 ◽

2021 ◽

pp. 75-82

Author(s):

Benjamin K. Homra ◽

Yashar Eshraghi ◽

Maged Guirguis

Keyword(s):

Radiofrequency Ablation ◽

Local Anesthetic ◽

Sacroiliac Joint ◽

Joint Pain ◽

Lateral Branch ◽

Ultrasound Technique ◽

Posterior Aspect ◽

Sacroiliac Joint Pain ◽

Lateral Branches

The posterior sacral network is a complex meshwork of lateral branches of the dorsal sacral rami that innervate the posterior aspect of the sacroiliac joint. Pain arising from this joint can be diagnostically targeted using either a fluoroscopic or ultrasound technique to determine if the patient would benefit from radiofrequency ablation of the lateral branches. Injecting local anesthetic near the dorsal foramina using these techniques will temporarily block the transmission of pain by the lateral branches from the sacroiliac joint. This chapter covers the anatomy of the posterior sacral network, discusses the details of the two techniques for lateral branch blocks and evidence for their utility, provides information about the risks and contraindications associated with the techniques, and concludes by discussing the implications of the procedure.

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Radiofrequency ablation of the sacroiliac joint

10.1093/med/9780197607947.003.0008 ◽

2021 ◽

pp. 83-92

Author(s):

Haider M. Ali ◽

Yashar Eshraghi ◽

Maged Guirguis

Keyword(s):

Radiofrequency Ablation ◽

Pain Management ◽

Pain Relief ◽

Sacroiliac Joint ◽

Joint Pain ◽

Positive Response ◽

Lateral Branch ◽

Tissue Destruction ◽

Sacroiliac Joint Pain ◽

Pain Syndromes

Radiofrequency ablation (RFA) is a revolutionary procedure in the practice of pain management that can be used in the treatment of sacroiliac joint pain syndromes. It is a technology that uses radiofrequency needle probes to create lesions by way of localized tissue destruction. It is indicated for patients with chronic sacroiliac joint pain who have had a positive response to a lateral branch block. This procedure typically provides at least 6 and up to 12 months of significant pain relief and can be repeated. Practitioners should be well versed in the different evolving methods for RFA as well as its evidence, relevant anatomy, the technology used in RFA, and the complications that may occur with this procedure and how to prevent them. This chapter explores these principles and presents the relevant findings from the literature for this innovative procedure for sacroiliac joint pain.

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Randomized Placebo-controlled Study Evaluating Lateral Branch Radiofrequency Denervation for Sacroiliac Joint Pain

Anesthesiology ◽

10.1097/aln.0b013e31817f4c7c ◽

2008 ◽

Vol 109 (2) ◽

pp. 279-288 ◽

Cited By ~ 169

Author(s):

Steven P. Cohen ◽

Robert W. Hurley ◽

Chester C. Buckenmaier ◽

Connie Kurihara ◽

Benny Morlando ◽

...

Keyword(s):

Pain Relief ◽

Local Anesthetic ◽

Sacroiliac Joint ◽

Joint Pain ◽

Lateral Branch ◽

Controlled Study ◽

Sacroiliac Joint Pain ◽

Long Term Treatment ◽

Radiofrequency Denervation ◽

Dorsal Rami

Background Sacroiliac joint pain is a challenging condition accounting for approximately 20% of cases of chronic low back pain. Currently, there are no effective long-term treatment options for sacroiliac joint pain. Methods A randomized placebo-controlled study was conducted in 28 patients with injection-diagnosed sacroiliac joint pain. Fourteen patients received L4-L5 primary dorsal rami and S1-S3 lateral branch radiofrequency denervation using cooling-probe technology after a local anesthetic block, and 14 patients received the local anesthetic block followed by placebo denervation. Patients who did not respond to placebo injections crossed over and were treated with radiofrequency denervation using conventional technology. Results One, 3, and 6 months after the procedure, 11 (79%), 9 (64%), and 8 (57%) radiofrequency-treated patients experienced pain relief of 50% or greater and significant functional improvement. In contrast, only 2 patients (14%) in the placebo group experienced significant improvement at their 1-month follow-up, and none experienced benefit 3 months after the procedure. In the crossover group (n = 11), 7 (64%), 6 (55%), and 4 (36%) experienced improvement 1, 3, and 6 months after the procedure. One year after treatment, only 2 patients (14%) in the treatment group continued to demonstrate persistent pain relief. Conclusions These results provide preliminary evidence that L4 and L5 primary dorsal rami and S1-S3 lateral branch radiofrequency denervation may provide intermediate-term pain relief and functional benefit in selected patients with suspected sacroiliac joint pain. Larger studies are needed to confirm these results and to determine the optimal candidates and treatment parameters for this poorly understood disorder.

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