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Pastrak M, Vladicic N, Sam J, Vrooman B, Ma F, Mahmoud A, Khan JS, Abd-Elsayed A, Khandwalla F, McGilvray S, Visnjevac O. Review of Opioid Sparing Interventional Pain Management Options and Techniques for Radiofrequency Ablations for Sacroiliac Joint Pain. Curr Pain Headache Rep 2022; 26:855-862. [PMID: 36178572 DOI: 10.1007/s11916-022-01088-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The goal of this clinical review was to provide an update about the existing treatment options and associated evidence for various radiofrequency ablation techniques for sacroiliac joint pain. An electronic literature search on radiofrequency for the treatment of sacroiliac joint pain was conducted using PubMed, NCBI and Google Scholar. The following search keywords were used: radiofrequency ablation (cooled, pulsed, conventional, bipolar, intra-articular), sacroiliac joint and sacroiliac pain. The search was limited to human subjects, English language and articles with available full text. The bibliographic sections of all manuscripts were further searched for additional relevant citations. The full text of the relevant articles was reviewed by all the authors. RECENT FINDINGS Our study showed that radiofrequency ablation is a safe and effective treatment option that can be utilized to manage sacroiliac joint pain. It offers accessibility to the primary care physician, reduces office visits with "pain" as the primary complaint and provides the added benefit of acting as a non-opioid sparing means of analgesia.
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Affiliation(s)
| | - Nikola Vladicic
- St. George's University School of Medicine, St. George's, Grenada
| | - Jordan Sam
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Bruce Vrooman
- Dartmouth Hitchcock Medical Centre, Lebanon, NH, USA
| | | | | | | | - Alaa Abd-Elsayed
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
| | | | | | - Ognjen Visnjevac
- McMaster University, Hamilton, ON, Canada
- Bloor Pain Specialists, Toronto, ON, Canada
- Cleveland Clinic Canada, Toronto, ON, Canada
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Lowe M, Okunlola O, Raza S, Osasan SA, Sethia S, Batool T, Bambhroliya Z, Sandrugu J, Hamid P. Radiofrequency Ablation as an Effective Long-Term Treatment for Chronic Sacroiliac Joint Pain: A Systematic Review of Randomized Controlled Trials. Cureus 2022; 14:e26327. [PMID: 35911275 PMCID: PMC9311336 DOI: 10.7759/cureus.26327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/25/2022] [Indexed: 12/03/2022] Open
Abstract
Radiofrequency ablation (RFA) has emerged as a popular intervention for chronic pain management, including pain originating in the sacroiliac joint. It offers a less invasive option than surgery but with better results than the previous standard treatment with steroid and anesthetic injections. Procedure volumes have enjoyed significant growth in the market in recent years. The evidence supporting this intervention, in the form of randomized controlled trials, however, is both thin and mixed. The purpose of this systematic review is to evaluate the body of randomized controlled trials (RCTs) to determine the quality of support for and against the use of radiofrequency ablation to treat sacroiliac joint (SIJ) pain. Several important new papers have emerged since previous systematic reviews with similar objectives were published. The review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and three databases were used: PubMed, Google Scholar, and Scopus. Only RCTs were sought, and no other filters, such as a historical timeline cut-off, were used. Among 95 publications that returned in response to the query, 16 were ultimately accepted as meeting the inclusion/exclusion criteria. The Cochrane risk-of-bias tool was utilized as a quality assessment measure, and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework was used to assess the certainty of the evidence. Among the included publications, 15 out of 16 publications featured positive results and conclusions that supported the use of RFA in treating chronic sacroiliac joint pain. The single negative study was also the largest trial (n=681), but it was identified as “High Risk” using the Cochrane risk-of-bias tool. It included several design flaws including neither operator nor patient blinding, missing information, use of inconsistent treatment modalities across groups, and disproportionate drop-out rates. Despite its flaws, we have included this study in the present review because of its sheer size. Taken in aggregate, the total body of research included in this review supports this intervention. Questions continue to exist around whether there are clinically significant benefits associated with different RFA modalities (for example, unipolar vs. bipolar), with convincing evidence supporting each of them. Finally, it can be concluded that while the benefits are reasonably and justifiably supported in this patient population for up to one year, there is a dearth of evidence beyond a 12-month post-intervention follow-up.
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Burnham TR, Smith A, McCormick ZL, Teramoto M, Burnham R. Evaluation of an Ultrasound-Assisted Longitudinal Axis Lateral Crest Approach to Radiofrequency Ablation of the Sacroiliac Joint. Am J Phys Med Rehabil 2022; 101:26-31. [PMID: 34915543 DOI: 10.1097/phm.0000000000001733] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the effectiveness and procedural characteristics of a novel, ultrasound/fluoroscopically guided technique (longitudinal axis sacroiliac joint radiofrequency ablation) for sacroiliac joint denervation. DESIGN A single-arm cohort with historical cohort comparison was used in this study. METHODS Thirty-seven participants underwent longitudinal axis sacroiliac joint radiofrequency ablation after 50% or more pain reduction after diagnostic dual-block criterion. Outcomes were the proportion of participants with 50% or more pain reduction and mean Pain Disability Quality of Life Questionnaire change. Subanalysis included longitudinal axis sacroiliac joint radiofrequency ablation procedural and fluoroscopy times compared with participants previously treated with palisade radiofrequency ablation technique. RESULTS Primary outcome worst case analysis demonstrated a responder rate of 64.9% (95% confidence interval = 48.8%-78.2%) and 59.5% (95% confidence interval = 43.5%-73.7%) at 3 and 6 mos. There was significant decrease in mean Pain Disability Quality of Life Questionnaire at 3 (45.6 ± 9.5 to 21.4 ± 16.0, P < 0.001) and 6 mos (45.6 ± 9.5 to 23.0 ± 16.5, P < 0.001). Longitudinal axis sacroiliac joint radiofrequency ablation required more procedure time than the palisade technique (38.2 ± 7.9 vs. 32.1 ± 6.9 mins, P = 0.031) but less fluoroscopy time (35.0 ± 11.8 vs. 57.6 ± 16.8 secs, P < 0.001). CONCLUSIONS Longitudinal axis sacroiliac joint radiofrequency ablation resulted in improvement in pain, disability, and quality of life at 3 and 6 mos. Compared with the palisade technique, longitudinal axis sacroiliac joint radiofrequency ablation required greater procedure time but less fluoroscopy time.
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Affiliation(s)
- Taylor Robert Burnham
- From the Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah (TRB, ZLM, MT); Vivo Cura Health, Calgary, Alberta, Canada (AS, RB); Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (AS); Central Alberta Pain and Rehabilitation Institute, Lacombe, Alberta, Canada (RB); and Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Alberta, Canada (RB)
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Abstract
Radiofrequency ablation (RFA) is a potential treatment for those with sacroiliac joint (SIJ) pain. There is no consensus on the optimal procedural techniques for SIJ diagnostic blocks, or RFA. This article describes different techniques for SIJ diagnostic blocks and RFA, including the relevant innervation that underlies these techniques. SIJ RFA techniques differ in important ways, including lesioning techniques, needle placements, and type of RFA cannula used. Clinicians utilize a variety of image guidance modalities for SIJ RFA; fluoroscopic guidance is standard, although endoscopic and ultrasound-guided techniques are described. Additional studies are necessary to delineate potential differences between SIJ RFA techniques.
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Shih CL, Shen PC, Lu CC, Liu ZM, Tien YC, Huang PJ, Chou SH. A comparison of efficacy among different radiofrequency ablation techniques for the treatment of lumbar facet joint and sacroiliac joint pain: A systematic review and meta-analysis. Clin Neurol Neurosurg 2020; 195:105854. [PMID: 32353665 DOI: 10.1016/j.clineuro.2020.105854] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/09/2020] [Accepted: 04/14/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare the efficacy of different radiofrequency techniques (thermal, pulsed, and cooled radiofrequency) for treating lumbar facet joint (LFJ) or sacroiliac joint (SIJ) pain. PATIENTS AND METHODS The inclusion criteria were as follows: (1) age > 18 years; (2) patients suffering from LFJ or SIJ pain; and (3) patients receiving radiofrequency treatments. Four electronic databases, including Pubmed, Embase, Cochrane Library, and ISI Web of Knowledge were systematically searched from inception until December 2019 for relevant articles. The search was conducted on 2 January 2020. When the outcomes among articles showed heterogeneity, then a random-effects model was adopted to calculate the effect size; otherwise, a fixed-effects model was adopted. RESULTS All the three techniques showed significant improvements in LFJ or SIJ pain for up to 12 months compared with the baseline level. However, no significant differences among the three techniques were observed at any follow-up visits except for possibly a trend for variance in efficacy. For treating LFJ pain, cooled radiofrequency was the most effective, followed by thermal radiofrequency and then pulsed radiofrequency as the least respectively for the follow-up visit at 6 months. No serious complications were reported after receiving treatment using the three techniques. CONCLUSION Sequentially, cooled radiofrequency followed by thermal radiofrequency and then pulsed radiofrequency for treating LFJ pain were identified as most to least effective at the 6-month follow-up.
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Affiliation(s)
- Chia-Lung Shih
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Chih Shen
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Chang Lu
- Department of Orthopedics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan; College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Zi-Miao Liu
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yin-Chun Tien
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peng-Ju Huang
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Hsiang Chou
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Yang AJ, McCormick ZL, Zheng PZ, Schneider BJ. Radiofrequency Ablation for Posterior Sacroiliac Joint Complex Pain: A Narrative Review. PM R 2019; 11 Suppl 1:S105-S113. [DOI: 10.1002/pmrj.12200] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Aaron J. Yang
- Department of Physical Medicine and RehabilitationVanderbilt University Medical Center Nashville TN 37212
| | - Zachary L. McCormick
- Division of Physical Medicine and RehabilitationUniversity of Utah School of Medicine Salt Lake City UT
| | - Patricia Z. Zheng
- Department of Orthopaedic SurgeryUniversity of California – San Francisco San Francisco CA
| | - Byron J. Schneider
- Department of Physical Medicine and RehabilitationVanderbilt University Medical Center Nashville TN 37212
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Roberts SL, Stout A, Loh EY, Swain N, Dreyfuss P, Agur AM. Anatomical Comparison of Radiofrequency Ablation Techniques for Sacroiliac Joint Pain. PAIN MEDICINE 2018; 19:1924-1943. [DOI: 10.1093/pm/pnx329] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Shannon L Roberts
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Eldon Y Loh
- Department of Physical Medicine and Rehabilitation, Western University, London, Ontario, Canada
| | | | - Paul Dreyfuss
- EvergreenHealth, Kirkland, Washington, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Anne M Agur
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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