Radiofrequency sacroiliac joint denervation for sacroiliac syndrome

Background and Objectives: Radiofrequency (RF) denervation of the sacroilia c (SI) joint has been advocated for the treatment of sacroiliac syndrome, y et no clinical studies or case series support its use. Methods: We report the results of a consecutive series of 50 SI joint RF de nervations performed in 33 patients with sacroiliac syndrome. All patients underwent diagnostic SI joint injections with local anesthetic before dener vation. Changes in visual analog pain scores (VAS), pain diagrams, physical examination (palpation tenderness over the joint, myofascial trigger point s overlying the joint, SI joint pain provocation tests, and range of motion of the lumbar spine), and opioid use were assessed pre- and postdenervatio n. Results: The criteria for successful RF denervation were at least a 50% dec rease in VAS for a period of at least 6 months; 36.4% of patients (12 of 33 ) met these criteria. Failure of denervation correlated with the presence o f disability determination and pain on lateral flexion to the affected side . The average duration of pain relief was 12.0 +/- 1.2 months in responders versus 0.9 +/- 0.2 months in nonresponders (P less than or equal to .0001) . A positive response was associated with an atraumatic inciting event. Suc cessful denervation was associated with a change in the pain diagram and a reduction in the pattern of referred pain, a normalization of SI joint pain provocation tests, and a reduction in the use of opioids. Conclusions: This study suggests that RF denervation of the SI joint can si gnificantly reduce pain in selected patients with sacroiliac syndrome for a protracted time period. Moreover, certain abnormal physical findings (i.e. , SI joint pain provocation tests) revert to normal for the duration of the analgesia.