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A sacroiliac (SI) joint nerve ablation, also called radiofrequency lesioning, can be used to alleviate SI joint pain. In addition, the SI joint can be injected with a steroidal agent and anesthetic, which also offers longer pain relief. The procedure takes around 20 minutes to perform.

What conditions are treated with SI joint injections and radiofrequency lesioning?

SI therapies are used to relieve low back pain. In American, around 30 million Americans suffer some type of back discomfort, and around 25% of back pain comes from the SI joint. Humans have one SI joint per each side of the low back, and each joint can be afflicted with arthritis. SI joint arthritis involves loss of normal cartilage, which leads to stiffness, pain, and limited range of motion.

How can I prepare for the SI injection procedure?

Before the SI joint injection procedure, you will meet with the doctor to discuss the pros and cons of the technique. After taking a medical history, the pain management specialist will perform a physical examination. In addition, the doctor has you sign a consent form.

Before the procedure, you should discuss your medications with the doctor. Certain agents that thin the blood must be held for several days before the procedure. Because a mild sedative may be given, you should arrange to have someone drive you home. Also, plan to be off from work for a few days, and delay any activities requiring strenuous exercise for a week or so.

How is the SI injection done?

The sacroiliac joint injection involves instilling an anesthetic medication (Marcaine or Lidocaine), with or without a corticosteroid, into the SI joint to block activity of the targeted nerves. The doctor will clean the lower back skin with an antiseptic, and numb the skin and deeper tissues using a small gauge needle. Once numb, the procedure needle is inserted into the joint under x-ray guidance. After the medication is instilled, the needle is removed, and a bandage is applied. Usually, when a patient achieves more than 50% pain relief with the block, an ablation is scheduled.

Why is radiofrequency done?

The nerves can be partially destroyed with radiofrequency energy. This procedure is done when the block works, and for patients who desire longer pain-free intervals. While the nerves do regenerate, the ablation offers 6-18 months of pain relief. The procedure is done much like the block. However, a special probe is used to treat the nerves with radiofrequency energy.

What can I expect after the radiofrequency lesioning procedure?

After the nerve block or ablation, expect to have some soreness at the needle insertion site. Once you are awake and alert from sedation, you are discharged home. Avoid heavy strenuous activities for 1-2 days, and gradually return to usual duties. Because a sedative was given, you should have someone drive you home, and avoid driving for 24 hours.

Does radiofrequency SI neurotomy work?

Many studies have shown that radiofrequency lesioning works well for treating nerve-related pain. The SI radiofrequency ablation procedure is used for facet joint pain, low back pain, and SI joint arthritis. In a recent study, the procedure was 90% effective. In a recent study, 65% of patients reported complete symptom relief following the SI radiofrequency lesioning. In addition, many other patients reported partial symptom relief.

The Pain and Spine Clinics providers offer both sacroiliac injections and radiofrequency neurotomy. The procedures typically offer long term relief, and may be repeated when relief wears off. Most insurance is accepted at the practice. Call today!

Resources

Dreyfuss P, et al. Sacroiliac joint pain. J Am Acad Orthop Surg. 2004;12:255–265.

Forst SL, Wheeler MT, Fortin JD, et al. The sacroiliac joint: anatomy, physiology and clinical significance. Pain Physician. 2006;9:61–68.

Hansen HC, McKenzie-Brown AM, Cohen SP. Sacroiliac joint interventions: a systematic review. Pain Physician. 2007;10:165–184.

Yin W, et al. Sensory stimulation-guided sacroiliac joint radiofrequency neurotomy: technique based on neuroanatomy of the dorsal sacral plexus. Spine. 2003;28:2419–2425. doi: 10.1097/01.BRS.0000085360.03758.C3