Radiofrequency Ablation Of the Sacroiliac Joint (SI Joint)

Pain in the sacroiliac joint causes low back pain in 10 to 25% of those with chronic low back pain. Unfortunately, there are 2 SI joints which can both cause pain at any one point in time due to degenerative arthritis. The SI joints have cartilage just like any other joint and can be afflicted with painful arthritis. Ahh, the beauty of getting older!

Typical treatments for pain coming from the SI joint include over-the-counter medications such as Tylenol and anti-inflammatory's, physical therapy, chiropractic treatment, along with potentially a TENS unit.

If these treatments are not satisfactory, a pain management doctor can provide excellent relief of SI joint pain with various alternatives. One may be a short-term use of narcotic medications. Long term narcotics for sacroiliac joint dysfunction is not recommended.

Injections into the sacroiliac joint can serve two purposes. The first is diagnostic, which can tell the pain doctor if the pain really is coming from the SI joint. The diagnostic injection consists of numbing medicine with or without cortisone. This injection may provide a few weeks to quite a few months of pain relief.

At times, sacroiliac joint injections are performed for therapeutic benefit specifically and this would include cortisone being placed into the joint. If the injection was either performed for a diagnostic reason or therapeutic only, one important factor is to understand how much pain relief the patient achieved. If over 50% pain relief was achieved and then wears off, the injection may be either repeated or the patient may go on to have a radiofrequency ablation. Insurance companies will often require this much pain relief for subsequent approval of the radiofrequency neurotomy.

A radiofrequency ablation procedure of the sacroiliac joint consists of burning the small nerve endings that supply the joint with sensation. This can provide pain relief for a few months upwards of 2 years. Numerous small studies have looked at sacroiliac joint radiofrequency ablation and found that the pain relief worked well 30 to 90% of the time. There are no large-scale studies looking at the radiofrequency neurotomy procedure for SI joint pain.

Usually, insurance companies require greater than a 50% pain relief with a diagnostic injection prior to approving a radiofrequency neurotomy. This is the same as what it is with the facet joints of the lumbar and cervical spine. Newly search is coming out showing that even if patients did not get excellent pain relief with a sacroiliac joint diagnostic injection, the patient may still obtain excellent results with a radiofrequency procedure.

Additional research will hopefully tell us whether or not this is actually the case. If the radiofrequency ablation provides excellent relief and then after 6 to 18 months the nerve endings grow back, the pain may come back as well. It is at this point that the radiofrequency ablation procedure can simply be repeated.