scholarly journals The Anatomy of the Lateral Branches of the Sacral Dorsal Rami: Implications for Radiofrequency Ablation

2014 ◽  
Vol 5;17 (5;9) ◽  
pp. 459-464
Author(s):  
Joseph Fortin
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Radiofrequency Ablation ◽  
Sacroiliac Joint ◽  
Low Back ◽  
Sacral Foramina ◽  
Dorsal Rami ◽  
Lateral Branches ◽  
The Right ◽  
Segmental Innervation

Background: The sacroiliac joint (SIJ) is a major source of pain in patients with chronic low back pain. Radiofrequency ablation (RFA) of the lateral branches of the dorsal sacral rami that supply the joint is a treatment option gaining considerable attention. However, the position of the lateral branches (commonly targeted with RFA) is variable and the segmental innervation to the SIJ is not well understood. Objectives: Our objective was to clarify the lateral branches’ innervation of the SIJ and their specific locations in relation to the dorsal sacral foramina, which are the standard RFA landmark. Methods: Dissections and photography of the L5 to S4 sacral dorsal rami were performed on 12 hemipelves from 9 donated cadaveric specimens. Results: There was a broad range of exit points from the dorsal sacral foramina: ranging from 12:00 – 6:00 position on the right side and 6:00 – 12:00 on the left positions. Nine of 12 of the hemipelves showed anastomosing branches from L5 dorsal rami to the S1 lateral plexus. Limitations: The limitations of this study include the use of a posterior approach to the pelvic dissection only, thus discounting any possible nerve contribution to the anterior aspect of the SIJ, as well as the possible destruction of some L5 or sacral dorsal rami branches with the removal of the ligaments and muscles of the low back. Conclusion: Widespread variability of lateral branch exit points from the dorsal sacral foramen and possible contributions from L5 dorsal rami and superior gluteal nerve were disclosed by the current study. Hence, SIJ RFA treatment approaches need to incorporate techniques which address the diverse SIJ innervation. Key words: Sacroiliac joint pain, radiofrequency ablation, dorsal sacral rami, low back pain

scholarly journals Endoscopic Radiofrequency Treatment of the Sacroiliac Joint Complex for Low Back Pain: A Prospective Study with a 2-Year Follow-Up

2019 ◽  
Vol 2 (22.2) ◽  
pp. E111-E118
Author(s):  
Albert E. Telfeian
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Radiofrequency Ablation ◽  
Minimally Invasive ◽  
Sacroiliac Joint ◽  
Sensory Nerve ◽  
Case Series ◽  
Low Back ◽  
Radiofrequency Treatment ◽  
Si Joint

Background: The sacroiliac joint complex (SIJC) is considered a major sources of chronic low back pain. Interventional procedures for sacroiliac (SI) joint pain tend to be short-lived and surgical treatment usually involves a fusion procedure. Objectives: To determine the clinical efficacy of endoscopically visualized radiofrequency treatment of the SIJC in the treatment of low back pain. Study Design: Retrospective chart review. Setting: This study took place in a single-center, orthopedic specialty hospital. Methods: Patients received general anesthesia and under endoscopic visualization, radiofrequency ablation was performed on 1) the perforating branches that innervate the posterior capsule of the SI joint capsule, 2) along the course of the long posterior SI ligament, 3) the lateral edges of the S1, S2, and S3 foramen, and 4) the L4, L5, and S1 medial marginal nerve branches along the lateral facet margins. Results: From January 2015 to June 2016, a total of 30 patients who met the precise inclusion criteria were treated with the endoscopic SIJC radiofrequency treatment for low back pain. The average patient was aged 56 years (19 women and 11 men), the average preoperative visual analog scale (VAS) score was 7.23, and the average Oswestry disability index (ODI) score was 44.8. VAS and ODI were measured at 3, 6, 9, 12, 15, 21 and 24 months: VAS was reduced from 7.23 at baseline to 2.82 at 24 months (61% reduction), and ODI was improved from 44.8 at baseline to 22.2 at 24 months (50% reduction). Limitations: Small retrospective case series. Conclusions: Full-endoscopic radiofrequency ablation of the large sensory SI joint innervation complex, that includes the sensory nerve branches along the lateral S1-3 foramina and the L4-S1 medial branches, is perhaps a minimally invasive surgical procedure that could provide significant relief of lumbar back pain in the carefully selected patient. Key words: Endoscopic spine surgery, minimally invasive, low back pain, sacroiliac joint, radiofrequency treatment

scholarly journals A New Radiofrequency Ablation Procedure to Treat Sacroiliac Joint Pain

2016 ◽  
Vol 8;19 (8;11) ◽  
pp. 603-615
Author(s):  
Jianguo Cheng
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Sacroiliac Joint ◽  
Operating Time ◽  
Low Back ◽  
Lateral Border ◽  
X Ray ◽  
Bipolar Radiofrequency

Background: Low back pain may arise from disorders of the sacroiliac joint in up to 30% of patients. Radiofrequency ablation (RFA) of the nerves innervating the sacroiliac joint has been shown to be a safe and efficacious strategy. Objectives: We aimed to develop a new RFA technique to relieve low back pain secondary to sacroiliac joint disorders. Study Design: Methodology development with validation through prospective observational non-randomized trial (PONRT). Setting: Academic multidisciplinary health care system, Ohio, USA. Methods: We devised a guide-block to facilitate accurate placement of multiple electrodes to simultaneously ablate the L5 dorsal ramus and lateral branches of the S1, S2, and S3 dorsal rami. This was achieved by bipolar radiofrequency ablation (b-RFA) to create a strip lesion from the lateral border of the base of the sacral superior articular process (L5-S1 facet joint) to the lateral border of the S3 sacral foramen. We applied this technique in 31 consecutive patients and compared the operating time, x-ray exposure time and dose, and clinical outcomes with patients (n = 62) who have been treated with the cooled radiofrequency technique. Patients’ level of pain relief was reported as < 50%, 50 – 80%, and > 80% pain relief at one, 3, 6, and 12 months after the procedure. The relationship between RFA technique and duration of pain relief was evaluated using interval-censored multivariable Cox regression. Results: The new technique allowed reduction of operating time by more than 50%, x-ray exposure time and dose by more than 80%, and cost by more than $1,000 per case. The percent of patients who achieved > 50% pain reduction was significantly higher in the b-RFA group at 3, 6, and 12 months follow-up, compared to the cooled radiofrequency group. No complications were observed in either group. Limitations: Although the major confounding factors were taken into account in the analysis, use of historical controls does not balance observed and unobserved potential confounding variables between groups so that the reported results are potentially confounded. Conclusion: Compared to the cooled radiofrequency ablation (c-RFA) technique, the new b-RFA technique reduced operating time by more than 50%, decreased x-ray exposure by more than 80%, and cut the cost by more than $1000 per case. The new method was associated with significantly improved clinical outcomes despite the limitations of the study design. Thus this new technique appeared to be safe, efficacious, and cost-effective. Key words: Sacroiliac joint pain, sacroiliac joint, low back pain, radiofrequency ablation (RFA), bipolar radiofrequency ablation (b-RFA), cooled radiofrequency ablation (c-RFA), cost-effectiveness

scholarly journals Chronic sacroiliac joint pain treated with pulsed radiofrequency ablation

2020 ◽  
Vol 3 (1) ◽  
pp. 9-11
Author(s):  
Farid Yudoyono ◽  
Dewi Pratiwi ◽  
Hendra Gunawan ◽  
Deasy Herminawaty
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Radiofrequency Ablation ◽  
Sacroiliac Joint ◽  
Joint Pain ◽  
Low Back ◽  
Pulsed Radiofrequency ◽  
Sacroiliac Joints ◽  
Aging Society ◽  
Si Joint

Chronic sacroiliac joint (SI) pain can cause disability in an aging society. Effective treatment of low back pain (LBP) originating from sacroiliac joints is difficult to achieve. We report the successful treatment of pulsed radiofrequency (PRF) ablation in a patient with chronic SI joint pain. There were no post-interventional complications. Clinical improvement reported after 12 months.

scholarly journals Double Needle Technique: An Alternative Method for Performing Difficult Sacroiliac Joint Injections

2011 ◽  
Vol 3;14 (3;5) ◽  
pp. 281-284
Author(s):  
Sanjeeva Gupta
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Sacroiliac Joint ◽  
Joint Line ◽  
Complex Nature ◽  
Common Source ◽  
Low Back ◽  
Needle Technique ◽  
Large Joint ◽  
The Right

The sacroiliac joint (SIJ) is a common source of low back pain. The most appropriate method of confirming SIJ pain is to inject local anesthesia into the joint to find out if the pain decreases. Unfortunately, although the SIJ is a large joint, it can be difficult to enter due to the complex nature of the joint and variations in anatomy. In my experience a double needle technique for sacroiliac joint injection can increase the chances of accurate injection into the SIJ in difficult cases. After obtaining appropriate fluoroscopic images, the tip of the needle is advanced into the SIJ. Once the tip of the needle is correctly placed, its position is checked under continuous fluoroscopy while moving the C-arm in the right and left oblique directions (dynamic fluoroscopy). On dynamic fluoroscopy the tip of the needle should remain within the joint line and not appear to be on the bone. If the tip of the needle appears to be on the bone a new joint line will need to be identified (the most translucent area through the joint) by dynamic fluoroscopy and another needle advanced into the newly identified joint line. Dynamic fluoroscopy is repeated again to confirm that the tip of the second needle remains within the joint line. Once both needles are in place contrast dye is injected through the needle that is most likely to be in the SIJ. If the contrast dye spread is not satisfactory then it is injected through the other needle. I have used this technique in 10 patients and found it very helpful in accurately performing SIJ injection which can at times be challenging. Key words: double needle techique, sacroiliac joint, low back pain, contrast dye, fluoroscopy

Poster 306: Intra-Articular Sacroiliac Joint Pulsed Radiofrequency Ablation for the Management of Chronic Low Back Pain: A Case Series

PM&R ◽  
2018 ◽  
Vol 10 ◽  
pp. S102-S102
Author(s):  
Lisa M. Koplik-Nieves ◽  
Eduardo J. Otero-Loperena ◽  
Marimie Rodriguez-Campos ◽  
Carlos Calvo-Silva
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Radiofrequency Ablation ◽  
Chronic Low Back Pain ◽  
Sacroiliac Joint ◽  
Case Series ◽  
Low Back ◽  
Pulsed Radiofrequency

scholarly journals Low Back Pain in Hidradenitis Suppurativa: A Diagnosis Not to Miss!

2018 ◽  
Vol 10 (2) ◽  
pp. 187-189
Author(s):  
Benjamin Schnebert ◽  
Véronique del Marmol ◽  
Farida Benhadou
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Hidradenitis Suppurativa ◽  
Combined Therapy ◽  
Skin Lesions ◽  
Skin Area ◽  
Low Back ◽  
Inflammatory Drugs ◽  
The Right ◽  
Altered Sensitivity

We report the case of a patient suffering from hidradenitis suppurativa since puberty and complaining of chronic low back pain associated to altered sensitivity and muscular weakness in the right leg. A diagnosis of lumbosciatica was confirmed. Symptoms were not relieved after the use of nonsteroidal anti-inflammatory drugs and analgesics. A surgical decompression was then indicated but heavily debated. Indeed, extended inflammatory and fibrotic hidradenitis suppurativa lesions were located regarding the skin area eligible for the proposed surgery. A combined therapy with clindamycine/rifampicin was started and the surgery was postponed. A complete remission of the articular symptoms was observed 1 month after the start of the antibiotherapy and the inflammatory skin lesions were greatly improved. With the presentation of this clinical case, we would like to discuss the spectrum of rheumatic disorders associated to hidradenitis suppurativa that needs to be correctly diagnosed and taken into consideration in the therapeutic management of the patient.

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