Andrew Michael Pagano MS, BA, Abstract Co-Author: Nothing to Disclose

A. Orlando Ortiz MD, MBA, Presenter: Nothing to Disclose

Stanley Golovac MD, Abstract Co-Author: Nothing to Disclose

To compare the utility, efficacy, and safety of 3 different sacral denervation techniques in the management of sacroiliac joint (SIJ) pain that is refractory to conservative medical management.

94 patients underwent radiofrequency (RF) neurolysis for the treatment of SIJ pain over a 56-month period. 8 patients were treated with cooled RF. 20 patients underwent bipolar RF. And 70 patients underwent multi-lesion RF (47 were treated at a second institution). Eligible patients suffered at least 7/10 SIJ pain, were on analgesic therapy, and had a favorable, but temporary response to SIJ injections. Clinical presentation, procedure time, fluoroscopy time, anesthesia, complications, pre- and post- pain scores, and analgesic requirements were recorded. Patients were followed up at 3 week, 3 month, and 1 year intervals.

In cooled RF patients, the mean pre-procedure pain score was 8.9, and all experienced complete long-term resolution of SIJ pain. The average procedure time was 2.5 hours and the average fluoroscopy time was 10 minutes. For patients who had received bipolar RF, The mean pre-procedure pain score was 9.1. Post-procedure, all but 1 patient  experienced complete resolution of SIJ pain. The average procedure time was 1.5 hours and average fluoroscopy time was 6 minutes. In multi-lesion RF patients, the mean pre-procedure pain score was 8.9 at the primary institution. All patients experienced complete resolution of their SIJ pain. Patients at the second institution experienced similar, dramatic outcomes. The average procedure time was 30 minutes and the average fluoroscopy time was 1.5 minutes.

All sacral RF procedures were effective in providing pain relief with a reasonable safety profile in properly selected patients. The sacral multi-RF procedure, however, was more efficient with the shortest average procedure time and the shortest average fluoroscopy time.

Among all causes of lower back pain for patients of any age, SIJ pain represents a major contributor. The goals of treatment for SIJ pain include long-term efficacy, safety, reproducibility, and efficiency. Radiofrequency neurolysis provides a procedure that is minimally invasive with excellent patient outcomes. The three RF techniques examined in this study represent different levels of technical complexity and analogous differences in procedure time and fluoroscopy time.

Pagano, A, Ortiz, A, Golovac, S, Sacral Radiofrequency Neurolysis (RF) for the Management of Sacroiliac Joint-related Pain: A Comparison of 3 Techniques.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14009565.html