gms | German Medical Science

Objective: Sacroiliac joint (SIJ) dysfunction is an underestimated and frequent cause of low back pain triggered by pelvic obliquity, arthritis, trauma, pregnancy, and lastly and importantly by spine surgeries. The treatment of SIJ pain is difficult, if physiotherapy does not result in a permanent pain relief. An infiltration with local anaesthetics and corticosteroids frequently reduces low back pain only for a short period. Therefore there are multiple approaches to treat the SIJ pain with denervation techniques. The evidence of the effectiveness of radiofrequency denervation (RFD) is very low and a main point of therapy failure might be caused by an incomplete denervation. This study investigates the clinical results of a multi-lesion probe, which was created to enable a simple and fast gapless denervation of the SIJ.

Method: We retrospectively investigated 2 groups, who received a RFD of the SIJ. 35 patients were treated with a standard percutaneous denervation via a single-lesion probe (SL group) placed at several points medial to the SIJ and 42 patients were treated with a with a multi-lesion probe (ML group) placed along the sacrum medial to the SIJ. VAS, ODI, Roland and Morris Disability Questionnaire, Odom's criteria, SF-36, employment status and pain medication were collected from our outpatient department. Both groups were compared concerning their results after 1, 3 and 6 months of follow-up.

Results: In both groups patients benefitted from SIJ RFD after 1 and 3 months. After 6 months we detected a recurrence of low back pain in many patients. Nevertheless there was still a statistical significant pain release in the ML group, whereas in the SL group the pain was nearly on the same level as before the denervation. Accordingly we observed a decrease of the pain associated disability and an improved quality of life in the first months after denervation. In the SL group about 25% were able to reduce their pain medication, in the MLG 30%. The SIJ denervation did not influence the employment status of pain associated unemployed patients. There was no perioperative complication determined in both groups.

Conclusions: Percutaneous RFD of the SIJ is a secure treatment, which reduces SIJ pain significantly. Nevertheless already after 6 months we find a high recurrency rate. The RFD of the SIJ with a multi-lesion probe seems to be slightly advanced compared to a single-lesion probe. This might be due to a gapless denervation of nerves arising from medio-dorsal.