Successful Thermal Neurotomy of the Painful Sacroiliac Ligament/Joint Complex-A Comparison of Two Techniques.

Background: There are many physical, pharmacological, and interventional therapies aimed at alleviating sacroiliac ligament/joint complex pain, including thermal neurotomy. Sacroiliac joint (SIJ) innervation, as opposed to posterior sacroiliac ligament complex innervation, remains uncertain; thus lateral branch thermal neurotomy to alleviate sacroiliac joint pain remains controversial.

Objective: This study aimed to compare the success rates of two lateral branch neurotomy techniques, large continuous-lesion multi-electrode radiofrequency neurotomy (RFN; Simplicity, Neurotherm Inc.) and small-lesion monopolar periforaminal, to relieve pain from sacroiliac joints, as well as whether these would alter physical and psychological health.

Design: Retrospective clinical audit of prospectively gathered consecutive data.

Setting: A private community-based multidisciplinary pain clinic.

Subjects: Referred from primary care environments.

Methods: Of 96 consecutive thermal neurotomies with baseline data completed, follow-up data were found in 73 patients during the period 2011-2017. After diagnosis by dual-positive fluoroscopic intra-articular injections, 41 patients underwent 47 monopolar periforaminal neurotomies, and 32 underwent 49 large continuous-lesion multi-electrode RFNs, with >12-month follow-up. The primary outcome was 50-100% relief of pain for more than six months. Results are presented as success rates. Secondary outcomes were Functional Rating Index Depression Anxiety and Stress Scale and Patient Specific Functional Scale.

Results: Follow-up data were available for 80 (83%) of the 96 procedures. Success occurred in 69% of all procedures (39% complete >75% relief and 30% good 50-75% relief). Success was 57% with worst-case analysis. Success rates were 71% in the large continuous-lesion multi-electrode RFN group and 65% in the periforaminal group, with overlapping confidence intervals. Significant improvements also occurred in the secondary measures.

Conclusions: Thermal neurotomy demonstrated a 69% success rate in reduction of sacroiliac ligament/joint complex pain for more than six months equally by large continuous-lesion multi-electrode RFN and periforaminal monopolar techniques, with attendant improvement in physical and psychological function.