A NEW RADIOFREQUENCY ABLATION PROCEDURE TO TREAT SACROILIAC JOINT PAIN

Authors: Cheng J, Chin S.L, Zimmerman N, Dalton J.E, La Salle G, Rosenquist R.W
Study type: Methodology development. Prospective non-randomized trial.
Publication: Pain Physician 2016; 19:603-615 (Link to PubMed)
Key Words: Chronic Low back pain – Sacroiliac Joint – bipolar RF vs cooled RF - Palisade™

Graphs created by Boston Scientific based on the published data.

STUDY GOAL

In this study, the authors developed a novel bipolar radiofrequency (bRFA) ablation technique to relieve pain secondary to SIJ disorders. This study also compared the effectiveness of bRFA ablation with cooled RF (cRFA).

STRATEGY

  • Devise a guide-block device that facilitates accurate placement of multiple electrodes to simultaneously ablate the L5 dorsal ramus and lateral branches of the S1, S2, and S3 dorsal rami. 
  • Use of bipolar RF ablation to create a strip-like lesion covering from the lateral border of the base of the sacral superior articular process (L5-S1 facet joint) to the lateral border of the S3 sacral foramen.

METHODOLOGY

  • Apply this novel technique in N=31 patients and compare the procedural and clinical outcomes with a group of N=62 patients who were treated with cRFA.
  • Study outcomes included: Pain relief at one-year follow-up, operating time, and radiation exposure and dose.
SIJ area image
The SIJ area is a difficult area to treat, due to size, accessibility, and varying patients‘ anatomy. The disposable Palisade™ guide-block simplifies the placement and alignment of cannulas, to create larger lesions and/or two bipolar lesions at once.

RESULTS

  • bRFA, aided by the new guide-block device (Palisade™), provided satisfactory pain relief (p<0,001. 1, 3, 6, and 12 months), and demonstrated to be clinically and statistically superior to cRFA.
  • Operating time and X-ray exposure were reduced by >50% and >80%, respectively. Procedural costs were reduced by > $1,000 per case.
Operating time image
X-ray exposure time image
Percent with more than 50% pain relief image
Operating time. (bRFA: 23.5 ± 3.27 vs cRFA: 49.5 ± 27.25). X-ray exposure time. (bRFA: 19.1 ± 4.7 vs cRFA: 96.3 ± 96.2). Wide standard deviation (cRFA) reflects procedure difficulties and operators’ experience. bRFA patients experienced a longer duration of >50% pain relief

AUTHOR’S CONCLUSION

This new method of RF ablation is safe, efficacious, and cost-effective.

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