Radiofrequency neurotomy of the sacroiliac joints in the treatment of chronic lumbosacral pain

The study objective is to compare the effectiveness of different methods of radiofrequency denervation of the sacroiliac joint (SJ): standard neurotomy (SN) of the posterior medial branch L 5 and lateral branches S 1 –S 3 , ligamentous neurotomy (LN) and a combination of ligamentous and standard methods – a combined neurotomy (CN). Materials and methods. The results of the treatment of 311 patients with SJ dysfunction were analyzed. LN was perfomed in 117 patients, SN – in 102, CN – in 92. The effectiveness of SJ neurotomy was assess using the visual-analog scale (WAS) and the Oswestry Disability Index (ODI) 3 days, 3, 6 and 12 months or more after denervation. Results. The most significant improving the patient’s condition occurred after CN, the average ODI decreased from 35.14 ± 7.49 before the intervention to 22.64 ± 10.26 a year after it (p = 0.006). After SN and LN, a decrease in the degree of maladaptation occurred, respectively, from 36.00 ± 7.32 to 28.08 ± 7.03 (p = 0.021) and from 34.50 ± 6.75 to 26.45 ± 7.18 (p = 0.018). The intensity of the pain syndrome according to WAS after CN decreased from 7.2 ± 2.0 to 3.6 ± 2.5 a year after denervation (p = 0,00024). After SN and LN, a decrease in pain intensity according to WAS occurred respectively from 7.2 ± 2.0 to 4.8 ± 2.3 (p = 0.0025) and from 7.1 ± 2.3 to 5.7 ± 2.5 (p = 0.00016) a year after denervation. Conclusion. All methods of denervation in case of defeat of SJ lead to a statistically significant decrease in pain syndrome and an improvement in the quality of life. A positive result of denervation persists for a year after the intervention. CN leads to a more significant improvement and its results exceed the results of SN and LN for most of the period of postoperative observation.