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 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 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 Fluoroscopic-guided sacroiliac joint injections for treatment of chronic axial low back pain in a tertiary Hospital in Nigeria: a preliminary study

2018 ◽  
Vol 52 (3) ◽  
pp. 153-157
Author(s):  
Zakari A. Suleiman ◽  
Israel K. Kolawole ◽  
Ajibade Okeyemi
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Relief ◽  
Chronic Low Back Pain ◽  
Sacroiliac Joint ◽  
Joint Pain ◽  
Steroid Injection ◽  
Tertiary Hospital ◽  
Low Back ◽  
Si Joint

Background: The injection of mixture of plain bupivacaine and triamcinolone acetonide into the sacroiliac joint (SIJ) to relieve chronic low back pain is uncommon in the West African sub-region. The objective of this study was to demonstrate the efficacy or otherwise of fluoroscopic-guided SI joint injection in the management of chronic axial low back pain in Nigeria.Design: This was a prospective observational interventional studySetting: The study was carried out at a tertiary hospital in NigeriaParticipants: Twenty-six patients with SI joint pain, based on IASP diagnostic criteria, who presented to our unit over 36 months from March 2012 to March 2015 and.Interventions: Fluoroscopic-guided injections of 5mls mixture of bupivacaine and triamcinolone acetonide into the sacro-iliac (SI) joints of 26 patients with SI joint pain out of 116 patients who were offered different interventions for chronic low back pain. The patients were followed up for year and pain intensity and functional status were assessed at 3-, 6- and 12 months post-intervention.Main outcome measures: Pain relief and functional improvement were the main outcome measures.Results: The mean numeric rating score (NRS) and Oswestry Disability index (ODI) score in 14 (53.9%) patients at 12 months post-interventions were significantly lower compared with baseline values; 3.19 ± 1.10 vs 8.54 ±1.14 p=0.000 and 25.35 ± 5.40 vs 37.54 ±8.41, p=0.000 respectively.Conclusion: Fluoroscopic-guided steroid injection into the SI joint resulted into reduction in pain intensity and improved physical function in the majority of patients with SI joint pain. Funding: Not declaredKeywords: Axial low back pain, sacroiliac joint, steroid injection, fluoroscopy, pain relief

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 Retrospective Study of the Analgesic Effect of Sacroiliac Joint Radiofrequency Denervation

2021 ◽  
pp. E625-E629
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Retrospective Study ◽  
Pain Relief ◽  
Pain Intensity ◽  
Sacroiliac Joint ◽  
Analgesic Effect ◽  
Low Back ◽  
Pulsed Rf

BACKGROUND: Interventional radiofrequency (RF) ablation techniques are indicated when an adequate effect is not obtained with conservative measures. OBJECTIVES: The primary objective of this study was to evaluate pain relief after RF denervation of the sacroiliac joint. The secondary objective was to evaluate pain intensity and relief duration. STUDY DESIGN: The study was retrospective. SETTING: The study was conducted at Vera Cruz Hospital, Campinas, Brazil. METHODS: Data were collected from the medical records of patients undergoing RF denervation for low back pain originating in the sacroiliac joint, from January 2015 to December 2017. There were 78 patients studied, between 18 and 65 years old, of both genders, ASA I or II, who underwent knee arthroscopic meniscectomy. The patients were submitted to denervation of sacroiliac joint by 3 types of RF (conventional, pulsed, and cooled). The following parameters were evaluated, number of patients who obtained ? 50% pain relief; pain intensity, measured using the visual analog scale (before the procedure and 15, 30, 90 and 180 days after, performed by the same evaluator); and the use of complementary analgesic for 2 weeks. RESULTS: Of the 78 included patients, 56 (71.8%) underwent conventional RF, 9 (11.5%) underwent pulsed RF, and 13 (16.7%) underwent cooled RF. There were losses to follow-up including 40 patients who underwent conventional RF, 5 who underwent pulsed RF, and 12 who underwent cooled RF, who were retained for 6 months. There was significant pain relief with the three types of RF for up to 6 months of follow-up, with no difference among the types. After 6 months, 90.2% of patients who underwent conventional RF, 100% who underwent pulsed RF, and 91.7% who underwent cooled RF maintained ? 50% pain relief. Complementary analgesics were used by 95% of the patients who underwent conventional RF, 80% who underwent pulsed RF, and 91% who underwent cooled RF 2 weeks after the procedure. There were mild adverse effects, such as edema, hematoma, and local pain, without complications. LIMITATIONS: As for limitations, the number of pulsed and cooled RF is low and in a retrospective study some data may be missing, especially from follow-up. CONCLUSIONS: RF denervation of the sacroiliac joint is effective and promotes a long-lasting analgesic effect. KEY WORDS: Analgesia, denervation, low back pain, radiofrequency, sacroiliac joint

Discriminatory Aspects of Pre-employment Screening: Low-Back X-ray Examinations in the Railroad Industry

1979 ◽  
Vol 5 (3) ◽  
pp. 197-214
Author(s):  
Paul H. Rockey ◽  
Jane Fantel ◽  
Gilbert S. Omenn
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Screening Program ◽  
Job Applicants ◽  
Radiation Hazard ◽  
Low Back ◽  
Negative Consequences ◽  
X Ray ◽  
Work Related ◽  
Increased Risk

AbstractIn screening the majority of job applicants, most of this nation's railroads administer a low-back X-ray examination in an attempt to ascertain the likelihood that the applicant will sustain future work-related low-back pain or injury. Many applicants are rejected for employment on the basis of the X-ray findings. The railroads apparently perceive this screening program as a cost-effective means (1) of decreasing the incidence of compensation claims for work-related injuries, brought against the rail-roads under the Federal Employers' Liability Act (FELA), (2) of reducing the number of lost workdays resulting from low-back pain or injury, and (3) of protecting particularly susceptible workers from job-related hazards.The authors of this Article submit that low-back X-ray examinations are poor predictors of future low-back pain or injury. They assert that the railroads' use of such examinations misclassifies a substantial number of job applicants as being at increased risk for such pain or injury, and, in consequence, unfairly denies them employment. Furthermore, the authors claim, the screening program has other negative consequences. For example, applicants rejected for railroad employment on the basis of X-ray findings may as a result have difficulty finding jobs in other industries. In addition, they state, there is a potential radiation hazard to examinees. Moreover, both the railroads and those applicants accepted for employment may inappropriately be reassured by normal findings.On balance, the authors conclude, the screening program has a negative social value. The authors suggest that the program, in effect, erroneously labels many applicants as handicapped, and then denies them employment. Such persons might have legal recourse under federal and state statutes prohibiting employment discrimination against the handicapped.

Efficacy of Transverse Tripolar Spinal Cord Stimulator for the Relief of Chronic Low Back Pain from Failed Back Surgery

2008 ◽  
Vol 3;11 (5;3) ◽  
pp. 333-338
Author(s):  
Asokumar Buvanendran
Keyword(s):  
Spinal Cord ◽  
Low Back Pain ◽  
Back Pain ◽  
Case Report ◽  
Pain Relief ◽  
Failed Back Surgery Syndrome ◽  
Low Back ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Stimulation Of

Background: Failed back surgery syndrome is a common clinical entity for which spinal cord stimulation has been found to be an effective mode of analgesia, but with variable success rates. Objective: To determine if focal stimulation of the dorsal columns with a transverse tripolar lead might achieve deeper penetration of the electrical stimulus into the spinal cord and therefore provide greater analgesia to the back. Design: Case report. Methods: We describe a 42-year-old female with failed back surgery syndrome that had greater back pain than leg pain. The tripolar lead configuration was achieved by placing percutaneously an octapolar lead in the spinal midline followed by 2 adjacent quadripolar leads, advanced to the T7-T10 vertebral bodies. Results: Tripolar stimulation pattern resulted in more than 70% pain relief in this patient during the screening trial, while stimulation of one or 2 electrodes only provided 20% pain relief. After implantation of a permanent tripolar electrode system with a single rechargeable battery, the pain relief was maintained for one year. Conclusion: This is case report describing a case of a patient with chronic low back pain with a diagnosis of failed back surgery syndrome in which transverse tripolar stimulation using an octapolar and 2 quadripolar leads appeared to be beneficial. The transverse tripolar system consists of a central cathode surrounded by anodes, using 3 leads. This arrangement may contribute to maximum dorsal column stimulation with minimal dorsal root stimulation and provide analgesia to the lower back. Key words: Epidural, low back pain, spinal cord stimulation, failed back surgery syndrome, tripolar stimulation

scholarly journals P.087 RETRACTION - Low back pain relief with a new 32-contact surgical lead and neural targeting algorithm

2017 ◽  
Vol 44 (6) ◽  
pp. 763-763
Author(s):  
J. Pilitisis ◽  
G. Barolat ◽  
J. Rosenow ◽  
J. Brennan ◽  
A. Bailey ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Relief ◽  
Low Back
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