radiofrequency neurotomy for sacroiliac joint pain; … · 1. cohen sp, salahadina. lateral branch...
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1. Cohen SP, Salahadin A. Lateral Branch Blocks as a treatment for sacroiliac joint pain: A pilot study. RAPM 28;2 (113-119) 2. Wright, RE et al. In and Ex Vivo Validation of a Novel Technique for Radiofrequency Denervation of the Dorsal Sacroiliac Joint Including a Case Study. Regional Anesthesia and Pain Medicine, vol. 38, no. 5, supplement, E161-E162. 3. Burnham R, et al An Assessment of a Short Composite Questionnaire Designed for Use in an Interventional Spine Pain Practice. AAPMR Vol 4 (413-418)
Robert E. Wright, MD, DABPM, FIPP [email protected]
Robert E. Wright, MD, DABPM, FIPP Metro Pain Group Melbourne Australia
Method: Retrospective chart review n=182.
Background: The Sacroiliac Joint (SIJ) is an acknowledged paingenerator; various descriptions of variable joint innervationinform Radiofrequency ablation (RFA) practices. Manypractitioners target S1-S3 lateral branches (LBs) with a “striplesion” RFA technique while others include the L4 medial branch(MB) and L5 dorsal ramus (DR) in their tactic (1).
Objectives: Ascertain whether RFA of the SIJ results in adurable (twelve month) benefit and determine if including RFA ofthe L4 MB and L5 DR improved outcomes.
Methods: One hundred and eighty-two (n=182) patient chartswere reviewed. 103 female 79 male average age 52 years. Allpatients presented with > three months pain, >5/10 on pain VAS,index pain below the belt-line and positive Fortin’s finger test.Fluoroscopically guided contrast-confirmed intra-articularinjection with > 70% relief of index pain and confirmatory multi-site multi-depth lateral branch blocks with > 70% relief of indexpain was required for RFA. Ninety-three (93) patients underwentbipolar ablation of S1-S3 lateral branches using a multi-tinedexpandable electrode (Nimbus®) based on the techniquedescribed by Wright et al (2). The author modified his techniqueand subsequently eighty-nine (89) patients underwentmonopolar RFA of the L4 MB and L5 DR in addition to S1-S3 LBbipolar RFA. Patient’s pain VAS and global PDQQ-S (3) scoreswere obtained at baseline, one, six, and twelve months. Onlytwelve-month data was used to assess ‘durable’ benefit.
RADIOFREQUENCY NEUROTOMY FOR SACROILIAC JOINT PAIN; TWELVE MONTH OUTCOMES AND
COMPARISON BETWEEN TWO TECHNIQUES
Results: Global baseline pain VAS was 7.2 +/- 1.1 and globalPDQQ-S score was 48.4 +/- 6.8. At twelve months pain VASdecreased to 2.8 +/- 1.2 and PDQQ-S to 20 +/- 8.9. (P values<0.001). Subset analysis of the S1-S3 RFA only group showedbaseline pain VAS of 7.2 +/- 1.0 and global PDQQ-S of 48.7 +/-5.8. At twelve months VAS decreased to 3.3 +/- 1.3 and globalPDQQ-S of 21.2 +/- 8.7. The group Including RFA of L4 MB andL5 DR had baseline pain VAS of 7.1 +/- 1.2 and PDQQ-S of 48.1+/- 9.0 At twelve months pain decreased to VAS of 2.4 +/- 1 andglobal PDQQ-S of 18.5 +/- 7.8.Conclusions: RFA of the S1-S3 sacral lateral branches in a wellselected population using an anatomically accurate bipolar striplesion technique producing the necessary and sufficient lesiontopography provides highly significant pain reduction andimprovement in PDQQ-S at twelve months follow up. IncludingL4 MB and L5 DR may provide additional benefit and furtherstudy is encouraged.
Technique example: post lumbar fusion; AP and sacral contralateral oblique
Post-procedure MRI validation of lesion size and shape (2)
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Total S123 L45 S123
PDQQ-S
Baseline Final
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Total S123 L45 S123
VAS
Baseline Final