Open AccessEndoscopic Radiofrequency Treatment of the Sacroiliac Joint Complex for Low Back Pain: A Prospective Study with a 2-Year Follow-Up
Author(s) -
Richard Ibrahim,
Albert E. Telfeian,
Karl Gohlke,
Oleg Decker
Publication year - 2019
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj/2019.22.e11
Subject(s) - medicine , sacroiliac joint , low back pain , prospective cohort study , interventional pain management , physical therapy , surgery , pain management , alternative medicine , pathology
Background: The sacroiliac joint complex (SIJC) is considered a major sources of chronic lowback pain. Interventional procedures for sacroiliac (SI) joint pain tend to be short-lived and surgicaltreatment usually involves a fusion procedure.Objectives: To determine the clinical efficacy of endoscopically visualized radiofrequencytreatment of the SIJC in the treatment of low back pain.Study Design: Retrospective chart review.Setting: This study took place in a single-center, orthopedic specialty hospital.Methods: Patients received general anesthesia and under endoscopic visualization, radiofrequencyablation was performed on 1) the perforating branches that innervate the posterior capsule of theSI joint capsule, 2) along the course of the long posterior SI ligament, 3) the lateral edges of theS1, S2, and S3 foramen, and 4) the L4, L5, and S1 medial marginal nerve branches along the lateralfacet margins.Results: From January 2015 to June 2016, a total of 30 patients who met the precise inclusioncriteria were treated with the endoscopic SIJC radiofrequency treatment for low back pain. Theaverage patient was aged 56 years (19 women and 11 men), the average preoperative visualanalog scale (VAS) score was 7.23, and the average Oswestry disability index (ODI) score was 44.8.VAS and ODI were measured at 3, 6, 9, 12, 15, 21 and 24 months: VAS was reduced from 7.23 atbaseline to 2.82 at 24 months (61% reduction), and ODI was improved from 44.8 at baseline to22.2 at 24 months (50% reduction).Limitations: Small retrospective case series.Conclusions: Full-endoscopic radiofrequency ablation of the large sensory SI joint innervationcomplex, that includes the sensory nerve branches along the lateral S1-3 foramina and the L4-S1medial branches, is perhaps a minimally invasive surgical procedure that could provide significantrelief of lumbar back pain in the carefully selected patient.Key words: Endoscopic spine surgery, minimally invasive, low back pain, sacroiliac joint,radiofrequency treatment