The sacroiliac joint (SIJ) syndrome is defined as a mechanical pain originated in the SIJ, generally localized in the gluteal region. Nevertheless, referred SIJ pain might be also perceived in the lower lumbar region, groin, upper lumbar region, and rarely, in the abdomen. Consequently, SIJ pain can be difficult to distinguish from other forms of low back pain1.
Depending on the diagnostic criteria employed (SIJ provocation maneuvers, intra-articular block test, or medical imaging), the reported prevalence of SIJ pain varies between 16% and 30%; among patients with chronic low back pain complaints. Risk factors for SIJ pain include leg-length discrepancy, abnormal gait pattern, and trauma; among others1.
Conventionally, the SIJ syndrome has been managed with intra- and extra-articular steroid injections that offer rather mild and limited pain management. Thermal Radiofrequency Ablation (RFA) is an accepted, effective, and long-lasting alternative for the treatment of SIJ pain that relies on RF-generated thermal energy (80-90°C) to coagulate the sensory nerve fibers of the SIJ, thereby interrupting nociceptive neurotransmission1.
EFFECTIVENESS OF RFA
Clinical evidence corroborating the effectiveness of thermal RFA for the management of SIJ pain has been consolidated in two meta-analyses and two recent literature review studies1-4 that encompass not only the main clinical findings reported in more than 10 publications (including various observational, retrospective and randomized clinical studies) but also the outcomes of more than 300 patients. These studies indicate that patients treated with RF for SIJ pain achieve significant pain relief (more than 50%) for at least 6 months, compared with other conservative nonsurgical treatments. Moreover, this cumulative evidence also points toward a significant improvement in functional outcomes; i.e., disability and quality of life improvement scores1-3
The palisade RFA procedure using the PalisadeTM block (Cosman) is included as a standardized approach for the denervation of the SIJ in the interventional pain guidebook for the FIPP exam (World Institute of Pain’s (WIP) -Fellow of Interventional Pain (FIPP) examination)5.