As individuals age, arthritis ensues and weight bearing mobile joints may experience significant pain. There are sacroiliac joints on both sides of the body. They are joints with cartilage and some movement does occur in the joints. It is not nearly as much movement as a ball and socket joint like the hip, but enough to cause daily pain for individuals. Radiofrequency ablation may help for an extended duration in the SI joints and be an excellent nonoperative treatment.
The unfortunate things about sacroiliac joint pain are that
1) it is a very common problem to have
2) It can be tough to diagnose the SI joint as a pain generator
3) It is a tough problem to treat either non-operatively or operatively
Similar to the facet joints in the lumbar spine, it can be difficult for a pain doctor to accurately place a needle into the joint. A significant angle may be necessary to achieve placement, and it should always be performed under x-ray guidance. Having a sacroiliac joint injection performed without it entails a high miss rate, upwards of 50%.
The objective with a radiofrequency ablation, also called a radiofrequency neurotomy, is to heat up and "deaden" the small nerve endings supplying the sacroiliac joint causing a patient's pain. These are not nerves that supply vital motor or sensory functions, but tiny little nerve endings that bring sensation to the joint itself. If those can be negated, pain can be decreased.
Prior to it being performed, the pain doctor will perform a diagnostic injection containing numbing medicine around these nerve endings to make sure the patient will obtain pain relief and the joint is the source of the pain.
If it works, then the radiofrequency procedure is indicated and the patient's insurance company usually approves the procedure. The procedure has been shown on average to alleviate pain from six to 18 months, which is more than double the average of a standard cortisone injection.
A radiofrequency ablation is an outpatient procedure. Patients who are on blood thinning medications like Coumadin will need to stop this for at least 5 days or so prior - the physician can give specific time frames.
The procedure usually lasts 30 to 45 minutes and the patient will be sore for days afterwards. In fact, the patient may get worse for a few weeks as the initial trauma from the procedure wears off and the benefits "kick in".
At a certain point after the procedure, the nerve endings will grow back and regenerate. This may bring back the pain from before, it may not. If this happens, the procedure may be repeated.
Potential complications of a radiofrequency neurotomy include pain around the injection site, numbness of the skin over the injection site, initially worsened pain due to muscle spasms, infections (rare), or in a small amount of cases worsened pain from the procedure (unusual).
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