Endoscopic Radiofrequency Ablation of the Sacroiliac Joint Complex in the Treatment of Chronic Low Back Pain: A Preliminary Study of Feasibility and Efficacy of a Novel Technique

Won-Suh Choi, Jin-Sung Kim, Kyeong-Sik Ryu, Jung-Woo Hur, Ji-Hoon Seong, Hyun-Jin Cho, Won-Suh Choi, Jin-Sung Kim, Kyeong-Sik Ryu, Jung-Woo Hur, Ji-Hoon Seong, Hyun-Jin Cho

Abstract

Background. Radiofrequency ablation (RFA) is a less invasive technique for treatment of sacroiliac joint (SIJ) pain. Objective. To evaluate the feasibility and efficacy of endoscope-guided RFA for the treatment of CLBP from the SIJ complex. Methods. In this retrospective study, the medical records of 17 patients who underwent endoscope-guided RFA of the SIJ complex were reviewed. A bipolar radiofrequency probe was used to lesion the posterior capsule of the SIJ as well as the lateral branches of S1, S2, S3, and the L5 dorsal ramus in multiple locations. We visualized the ablation area using endoscope. We assessed visual analogue scale (VAS) and the Oswestry disability index (ODI) preoperatively, immediately postop, and at 1-, 3-, and 6-month postop outpatient clinic visits. Patient satisfaction of the procedure was assessed in percentages. Results. The mean duration of operation was 20 to 50 minutes. The mean VAS and the ODI scores decreased significantly immediately after the procedure and were kept significantly lower than baseline levels during the follow-up periods. No complications occurred perioperatively and during the follow-up periods. 88.6% of patients were satisfied with the procedure. Conclusions. Our preliminary results suggest that endoscope-guided RFA may be alternative option to treat CLBP secondary to SIJ complex.

Conflict of interest statement

The authors declare that there is no conflict of interests regarding the publication of this paper.

Figures

Figure 1
Figure 1
((a) and (b)) Long posterior ligament (black arrowheads) overlying the posterior capsule of the SIJ. (c) Corresponding position of the cannula tip in the anteroposterior fluoroscopic image.
Figure 2
Figure 2
(a) Lateral sacral branches of S1 as they exit from the S1 foramen (black arrowheads). (b) Corresponding position of the endoscope cannula. (c) Small arteries or veins can often be seen coursing along the nerve branches (white arrowheads), which can help with identification of thin nerve branches.
Figure 3
Figure 3
Fluoroscopic view of the endoscopic cannula tip in various positions during the procedure. The cannula tip can be moved in the subcutaneous plane and can be repositioned without causing much discomfort. If patients did experience discomfort, an additional lidocaine injection was applied.
Figure 4
Figure 4
Under endoscopic view, it is possible to clearly discern areas that have already been ablated (surrounded by arrows) and which areas have not. It is also possible to gauge the depth of the ablation.

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