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Janapala RN, Knezevic E, Knezevic NN, Pasupuleti R, Sanapati MR, Kaye AD, Pampati V, Shekoohi S, Manchikanti L. Systematic Review and Meta-Analysis of the Effectiveness of Radiofrequency Ablation of the Sacroiliac Joint. Curr Pain Headache Rep 2024; 28:335-372. [PMID: 38472618 DOI: 10.1007/s11916-024-01226-6] [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: 02/04/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE OF REVIEW To evaluate the effectiveness of radiofrequency neurotomy in managing sacroiliac joint pain utilizing a systematic review with meta-analysis of randomized controlled trials (RCTs) and observational studies. RECENT FINDINGS The prevalence of sacroiliac joint pain is estimated at around 25% of low back pain cases, and its diagnosis lacks a gold standard. Treatments include exercise therapy, injections, ablation, and fusion, with variable effectiveness. COVID-19 altered utilization patterns of interventions, including sacroiliac joint procedures, and the evidence for these interventions remains inconclusive. Recently, Medicare has issued its local coverage determinations (LCDs) in the United States, which provides noncoverage of sacroiliac joint radiofrequency neurotomy. Additionally, a recent systematic review of sacroiliac joint injections showed Level III or fair evidence. The sacroiliac joint, a critical axial joint linking the spine and pelvis, contributes to low back pain. Its complex innervation pattern varies among individuals. Sacroiliac joint dysfunction, causing pain and stiffness, arises from diverse factors.The present systematic review and meta-analysis aimed to evaluate radiofrequency neurotomy's effectiveness for sacroiliac joint pain management by applying rigorous methodology, considering both RCTs and observational studies. Despite methodological disparities, the evidence from this review, supported by changes in pain scores and functional improvement, suggests Level III evidence with fair recommendation for radiofrequency neurotomy as a treatment option. The review's strengths include its comprehensive approach and quality assessment. However, limitations persist, including variations in criteria and technical factors, underscoring the need for further high-quality studies in real-world scenarios.
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Affiliation(s)
| | - Emilija Knezevic
- College of Liberal Arts and Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center and College of Medicine, University of Illinois, Chicago, IL, USA
- College of Medicine, University of Illinois, Chicago, IL, USA
| | | | - Mahendra R Sanapati
- Pain Management Centers of America, Paducah, KY, USA
- Pain Management Centers of America, Evansville, IN, USA
| | - Alan D Kaye
- LSU School of Medicine, New Orleans, LA, USA
- Tulane School of Medicine, New Orleans, LA, USA
- LSU Health Sciences Center, Ochsner Shreveport Hospital and Interventional Pain Clinic Feist-Wieller Cancer Center, ShreveportShreveport, LA, USA
- LSU School of Medicine, Shreveport, LA, USA
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport LA, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Vidyasagar Pampati
- Pain Management Centers of America, Paducah, KY, USA
- Pain Management Centers of America, Evansville, IN, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport LA, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Laxmaiah Manchikanti
- Pain Management Centers of America, Paducah, KY, USA
- Pain Management Centers of America, Evansville, IN, USA
- University of Louisville, Louisville, KY, USA
- Department of Anesthesiology, School of Medicine, LSU Health Sciences Center, Shreveport, LA, USA
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Klessinger S, Casser HR, Gillner S, Koepp H, Kopf A, Legat M, Meiler K, Norda H, Schneider M, Scholz M, Slotty PJ, Tronnier V, Vazan M, Wiechert K. Radiofrequency Denervation of the Spine and the Sacroiliac Joint: A Systematic Review based on the Grades of Recommendations, Assesment, Development, and Evaluation Approach Resulting in a German National Guideline. Global Spine J 2024:21925682241230922. [PMID: 38321700 DOI: 10.1177/21925682241230922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
STUDY DESIGN Systematic review of the literature and subsequent meta-analysis for the development of a new guideline. OBJECTIVES This manuscript summarizes the recommendations from a new clinical guideline published by the German Spine Society. It covers the current evidence on recommendations regarding the indication, test blocks and use of radiofrequency denervation. The guidelines aim is to improve patient care and efficiency of the procedure. METHODS A multidisciplinary working group formulated recommendations based on the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) approach and the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. RESULTS 20 clinical questions were defined for guideline development, with 87.5% consensus achieved by committee members for one recommendation and 100% consensus for all other topics. Specific questions that were addressed included clinical history, examination and imaging, conservative treatment before injections, diagnostic blocks, the injected medications, the cut-off value in pain-reduction for a diagnostic block as well as the number of blocks, image guidance, the cannula trajectories, the lesion size, stimulation, repeat radiofrequency denervation, sedation, cessation or continuation of anticoagulants, the influence of metal hardware, and ways to mitigate complications. CONCLUSION Radiofrequency (RF) denervation of the spine and the SI joint may provide benefit to well-selected individuals. The recommendations of this guideline are based on very low to moderate quality of evidence as well as professional consensus. The guideline working groups recommend that research efforts in relation to all aspects of management of facet joint pain and SI joint pain should be intensified.
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Affiliation(s)
- Stephan Klessinger
- Neurochirurgie Biberach, Biberach, Germany
- Universitätsklinikum Ulm, Ulm, Germany
| | | | | | - Holger Koepp
- Wirbelsäulenzentrum, St Josefs-Hospital, Wiesbaden, Germany
| | - Andreas Kopf
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | - Matti Scholz
- ATOS Orthopädische Klinik Braunfels GmbH & Co KG, Braunfels, Germany
| | | | | | - Martin Vazan
- Wirbelsäulen- und Rückenzentrum Dresden, Praxis für Neurochirurgie, Dresden, Germany
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Yang AJ, Schneider BJ, Miller S. Sacroiliac Joint Interventions. Phys Med Rehabil Clin N Am 2022; 33:251-265. [DOI: 10.1016/j.pmr.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hamdy O, Salem AE. Three-in-one procedure for failed spinal surgery improved pain, disability scores and serum inflammatory milieu: Three-years follow-up. EGYPTIAN JOURNAL OF ANAESTHESIA 2021. [DOI: 10.1080/11101849.2021.1972259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Ossama Hamdy
- Department of Anesthesia, Icu and Pain Management, School of Medicine, South Valley University, Qena, Egypt
| | - Ahmed E. Salem
- Department of Anesthesiology & Icu, Faculty of Medicine, Tanta University, Tanta, Egypt
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Yang AJ, Wagner G, Burnham T, McCormick ZL, Schneider BJ. Radiofrequency Ablation for Chronic Posterior Sacroiliac Joint Complex Pain: A Comprehensive Review. PAIN MEDICINE 2021; 22:S9-S13. [PMID: 34308953 DOI: 10.1093/pm/pnab021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Radiofrequency ablation of the sacral lateral branches targets the innervation of the posterior sacroiliac ligaments and posterior portion of the sacroiliac joint. These structures are also collectively referred to as the posterior sacroiliac joint complex. This review will discuss current diagnostic block paradigms and selection criteria for sacral lateral branch radiofrequency ablation, varying techniques and technologies utilized for sacral lateral branch radiofrequency ablation, and updates on the clinical outcome literature. The current evidence suggests that sacral lateral branch radiofrequency ablation can provide relief for posterior sacroiliac joint complex pain, but the literature is limited by variability in selection criteria, the specific nerves targeted by radiofrequency ablation, and the types of radiofrequency ablation technology and techniques utilized in clinical outcome studies.
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Affiliation(s)
- Aaron J Yang
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Graham Wagner
- Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Taylor Burnham
- Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Zachary L McCormick
- Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Byron J Schneider
- Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Zhu W, Zhao Q, Ma R, Liu Z, Zhao J, Liu Z, Chen J, Zhang R, Zheng Z, Xu Y, Deng S, Cheng L, Li Q. Anatomical study of the innervation of different parts of the posterior ligamentous region of the sacroiliac joint. Reg Anesth Pain Med 2021; 46:410-415. [PMID: 33619182 DOI: 10.1136/rapm-2020-102366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/03/2021] [Accepted: 02/06/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES The periarticular sacroiliac joint (SIJ) technique has become an important area of focus, and the quartering of the SIJ posterior ligamentous region has been proposed as a way to refine this technique. However, detailed nerve distribution combined with the division of the SIJ posterior ligamentous region is lacking. We aimed to explore the innervation of the SIJ posteriorly based on the quartering of the SIJ posterior ligamentous region. METHODS Sixteen SIJs from eight embalmed cadavers were studied. Each SIJ posterior ligamentous region was equally divided into areas 0-3 from top to bottom. The origin, distribution, quantity, transverse diameter, spatial orientation, relation with bony structures, and the number of identifiable terminal nerve branches in each area were examined. RESULTS Areas 0-1 were innervated by the lateral branches of the dorsal rami of L4-L5 directly in all specimens. Areas 2-3 were innervated by that of both lumbar and sacral nerves via the posterior sacral network (PSN), with L5 contributing to the PSN in all specimens and L4 in 68.75%. The number of identifiable terminal nerve branches were significantly higher in areas 2-3 than in areas 0-1. CONCLUSIONS The inferior part of the SIJ posterior ligamentous region seems to be the main source of SIJ-related pain and is innervated by lumbar and sacral nerves via the PSN. However, the superior part directly innervated by lumbar nerves should not be neglected, and further clinical verification is needed.
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Affiliation(s)
- Weijia Zhu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qinghao Zhao
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Runxun Ma
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Zezheng Liu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Jianjun Zhao
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Zexian Liu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Junjie Chen
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Rusen Zhang
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Zhiyang Zheng
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yejie Xu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Shangxi Deng
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Liang Cheng
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qingchu Li
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
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