120 Efficacy of Radiofrequency Neurotomy for Lumbar Facet Syndrome and Sacroiliac Joint Pain

Background: The sacroiliac joint has been implicated as a source of low back and lower extremity pain. There are no definite historical, physical, or radiological features that can definitively establish a diagnosis of sacroiliac joint pain. Based on the present knowledge, an accurate diagnosis is made only by controlled sacroiliac joint diagnostic blocks. The sacroiliac joint has been shown to be a source of pain in 10% to 27% of suspected patients with chronic low back pain utilizing controlled comparative local anesthetic blocks. Study Design: A systematic review of diagnostic and therapeutic sacroiliac joint interventions. Objective: To evaluate the accuracy of diagnostic sacroiliac joint interventions and the utility of therapeutic sacroiliac joint interventions. Methods: The literature search was carried out by searching the databases of PubMed, EMBASE, and Cochrane reviews. Methodologic quality assessment of included studies was performed using the Agency for Healthcare Research and Quality (AHRQ) methodologic quality criteria for diagnostic accuracy and observational studies, whereas randomized trials were evaluated utilizing the Cochrane review criteria. Only studies with scores of 50 or higher were included for assessment. Level of evidence was based on the U.S. Preventive Services Task Force (USPSTF) criteria. Outcome Measures: For diagnostic interventions, the outcome criteria included at least 50% pain relief coupled with a patient’s ability to perform previously painful maneuvers with sustained relief using placebo-controlled or comparative local anesthetic blocks. For therapeutic purposes, outcomes included significant pain relief and improvement in function and other parameters. Short-term relief for therapeutic interventions was defined as 6 months or less, whereas long-term effectiveness was defined as greater than 6 months. Results: The indicated level of evidence is II-2 for the diagnosis of sacroiliac joint pain utilizing comparative, controlled local anesthetic blocks. The prevalence of sacroiliac joint pain is estimated to range between 10% and 38% using a double block paradigm in the study population. The false-positive rate of single, uncontrolled, sacroiliac joint injections is 20% to 54%. The evidence for provocative testing to diagnose sacroiliac joint pain is Level II-3 or limited. For radiofrequency neurotomy the indicated evidence is limited (Level II-3) for short- and longterm relief. Limitations: The limitations of this systematic review include the paucity of literature evaluating the role of both diagnostic and therapeutic interventions and widespread methodological flaws. Conclusions: The indicated evidence for the validity of diagnostic sacroiliac joint injections is Level II-2. The evidence for the accuracy of provocative maneuvers in the diagnosing of sacroiliac joint pain is limited (Level II-3). The evidence for radiofrequency neurotomy is also limited (Level II-3). Key words: Chronic low back pain, sacroiliac joint pain, sacroiliitis, sacroiliac joint injection, sacroiliac joint dysfunction, thermal radiofrequency, pulsed radiofrequency

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A comparison of efficacy among different radiofrequency ablation techniques for the treatment of lumbar facet joint and sacroiliac joint pain: A systematic review and meta-analysis

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2020.105854 ◽

2020 ◽

Vol 195 ◽

pp. 105854 ◽

Cited By ~ 1

Author(s):

Chia-Lung Shih ◽

Po-Chih Shen ◽

Cheng-Chang Lu ◽

Zi-Miao Liu ◽

Yin-Chun Tien ◽

...

Keyword(s):

Systematic Review ◽

Radiofrequency Ablation ◽

Sacroiliac Joint ◽

Joint Pain ◽

Facet Joint ◽

Meta Analysis ◽

Ablation Techniques ◽

Lumbar Facet Joint ◽

Sacroiliac Joint Pain ◽

Lumbar Facet

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Sacroiliac Joint Interventions: A Systematic Review

January 2018 - Pain Physician ◽

10.36076/ppj.2007/10/165 ◽

2007 ◽

Vol 1;10 (1;1) ◽

pp. 165-184

Author(s):

Hans C. Hansen

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Local Anesthetic ◽

Sacroiliac Joint ◽

Joint Pain ◽

Low Back ◽

Sacroiliac Joint Pain ◽

Radiofrequency Neurotomy ◽

Joint Injections

Background: The sacroiliac joint is a diarthrodial synovial joint with abundant innervation and capability of being a source of low back pain and referred pain in the lower extremity. There are no definite historical, physical, or radiological features to provide definite diagnosis of sacroiliac joint pain, although many authors have advocated provocational maneuvers to suggest sacroiliac joint as a pain generator. An accurate diagnosis is made by controlled sacroiliac joint diagnostic blocks. The sacroiliac joint has been shown to be a source of pain in 10% to 27% of suspected cases with chronic low back pain utilizing controlled comparative local anesthetic blocks. Intraarticular injections, and radiofrequency neurotomy have been described as therapeutic measures. This systematic review was performed to assess diagnostic testing (non-invasive versus interventional diagnostic techniques) and to evaluate the clinical usefulness of interventional techniques in the management of chronic sacroiliac joint pain. Objective: To evaluate and update the available evidence regarding diagnostic and therapeutic sacroiliac joint interventions in the management of sacroiliac joint pain. Study Design: A systematic review using the criteria as outlined by the Agency for Healthcare Research and Quality (AHRQ), Cochrane Review Group Criteria for therapeutic interventions and AHRQ, and Quality Assessment for Diagnostic Accuracy Studies (QUADAS) for diagnostic studies. Methods: The databases of EMBASE and MEDLINE (1966 to December 2006), and Cochrane Reviews were searched. The searches included systematic reviews, narrative reviews, prospective and retrospective studies, and cross-references from articles reviewed. The search strategy included sacroiliac joint pain and dysfunction, sacroiliac joint injections, interventions, and radiofrequency. Results: The results of this systematic evaluation revealed that for diagnostic purposes, there is moderate evidence showing the accuracy of comparative, controlled local anesthetic blocks. Prevalence of sacroiliac joint pain is estimated to range between 10% and 27% using a double block paradigm. The false-positive rate of single, uncontrolled, sacroiliac joint injections is around 20%. The evidence for provocative testing to diagnose sacroiliac joint pain is limited. For therapeutic purposes, intraarticular sacroiliac joint injections with steroid and radiofrequency neurotomy were evaluated. Based on this review, there is limited evidence for short-term and longterm relief with intraarticular sacroiliac joint injections and radiofrequency thermoneurolysis. Conclusions: The evidence for the specificity and validity of diagnostic sacroiliac joint injections is moderate. The evidence for accuracy of provocative maneuvers in diagnosis of sacroiliac joint pain is limited. The evidence for therapeutic intraarticular sacroiliac joint injections is limited. The evidence for radiofrequency neurotomy in managing chronic sacroiliac joint pain is limited. Keywords: Low back pain, sacroiliac joint pain, axial pain, spinal pain, diagnostic block, sacroiliac joint injection, thermal radiofrequency, and pulsed radiofrequency

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The Effects of Radiofrequency Neurotomy Using a Strip-Lesioning Device on Patients with Sacroiliac Joint Pain: Results from a Single-Center, Randomized, Sham-Controlled Trial

January 2018 - Pain Physician ◽

10.36076/ppj.2018.6.607 ◽

2018 ◽

Vol 1 (21;1) ◽

pp. 607-618 ◽

Cited By ~ 3

Author(s):

Vivek Mehta

Keyword(s):

Back Pain ◽

Sacroiliac Joint ◽

Joint Pain ◽

Controlled Trial ◽

Active Group ◽

Sham Treatment ◽

Randomized Controlled ◽

Sacroiliac Joint Pain ◽

Radiofrequency Neurotomy

Background: Radiofrequency neurotomy (RFN) is a therapy aimed at providing lasting back pain relief for sacroiliac joint (SIJ) pain. A recent advancement in RFN is a strip lesioning technique that involves placement of a single curved electrode and a 3-pole design that facilitates the creation of 5 overlapping lesions. These lesions form one long strip lesion accessible through a single entry point, without the need for multiple punctures. Although the early case series data looks promising, there is lack of long-term, randomized, controlled study evaluating the strip-lesioning system for SIJ pain. Objectives: The purpose of this study was to examine the safety and effectiveness of RFN using a strip lesioning device for reduction of SIJ pain. Study Design: Prospective, double-blind, randomized, sham-controlled trial with 6-month follow-up Setting: A tertiary care interventional pain management center in the UK Methods: Patients with SIJ pain with positive diagnostic local anesthetic blocks were randomly assigned (2:1) to either the sham (no RF lesions performed) or the active group (RF lesions performed). The primary endpoint was improvement of pain using the Numeric Rating Scale (NRS-11) at 3 months. Results were analyzed using nonparametric tests. Safety, secondary, and long-term outcome data were also collected. Results: Seventeen of 30 enrolled patients were randomly assigned to active treatment (n = 11) or sham treatment (n = 6). At 3 months, the mean NRS-11 score for the active group had decreased significantly, from 8.1 (± 0.8) at baseline to 3.4 (± 2.0) (P < 0.001). The sham group did not experience a statistically or clinically meaningful decrease in mean NRS-11 score from baseline (7.3 ± 0.8) to 3 months (7.0 ± 1.7). On average, patients in the active group moved from borderline anxiety at baseline (9.4 ± 5.9) to no anxiety (6.6 ± 6.3) at 3 months. Results were similar at 6 months. Limitations: Recruitment was stopped at 30 enrolled patients, only 17 of whom were randomly assigned to active or sham treatment, after the interim analysis indicated a statistically significant (P < 0.001) difference in the pain outcome between the treatment and the sham groups. Conclusions: This study demonstrated that radiofrequency neurotomy using a strip lesioning device is an appropriate therapy to treat SIJ pain. Key words: Radiofrequency, sacroiliac joint pain, low back pain, neurotomy, randomized controlled trial, simplicity

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