NEUROAUGMENTATION IN THE MANAGEMENT OF SACROILIAC JOINT PAIN REPORT OF 2 CASES

Study Design. A report of two cases of severe sacroiliac pain that wer e resistant to conventional management techniques. Both patients had u ndergone lumbar fusion. This appeared to be a predisposing factor. Obj ective. To define the source of pain in these patients by performing a series of diagnostic blocks under fluoroscopic guidance to determine if these patients were candidates for neuroaugmentation. Summary of Ba ckground Data. Mild to moderate sacroiliac joint pain can be managed c onservatively with analgesics, anti-inflammatory drugs, and physical t herapy. Severe sacroiliac joint pain can be incapacitating and more ch allenging to manage. Fluoroscopically guided intra-articular local ane sthetic-steroid injections, followed by joint manipulation, can be eff ective. Intracapsular injections of glycerin, glucose, and phenol also may be beneficial in some patients. The use of neuroaugmentation to m anage pain of synovial origin has not been reported previously. Sacral nerve root stimulation in particular has been used to manage urinary bladder dysfunction and pain, but not sacroiliac joint pain. Methods. Two patients with severe sacroiliac joint pain were treated by implant ing a neuroprosthesis at the third sacral nerve roots, The patients ha d undergone lumbar fusion for back pain that developed as a result of work-related injuries. Stimulation was tried for 1 week with bilateral , percutaneously implanted, cardiac pacing wires at the third sacral n erve roots. Results. Both patients experienced relief of approximately 60% of their pain during the trial period. Therefore, a neuroprosthes is (Medtronics, MN) was implanted permanently bilaterally at the third sacral nerve root in both patients. The use of analgesics was reporte dly the same after implantation, but significantly more effective, and the patients' daily living activities were more tolerable. Conclusion s. Two cases of refractory sacroiliac joint pain are reported that wer e managed with permanently Implanted neuroprostheses at the third sacr al nerve roots. The authors suggest that neuroaugmentation can be a re asonable option in selected patients with refractory sacroiliac pain.