Sacroiliac Joint Neurotomy

Sacroiliac Joint Syndrome is pain that originates from the sacroiliac joint (SIJ) and is often characterized by the acute onset of pain during torsional strain, and/or tenderness over the affected joint. This pain can produce a severe aching discomfort across the lower back and buttock region that is usually worse in the early morning and after extended periods of sitting. However, SIJ pain may mimic many other common lower back disorders (disc herniation, degenerative disc disease, facet joint pain).

Chronic sacroiliac joint pain can be a frustrating and debilitating condition that can be hard to diagnose and treat. A diagnosis is usually suspected by the physical examination and then confirmed with an injection under fluoroscopic (live x-ray) guidance. See sacroiliac joint injection.

It may take months of intense therapy to restore normal function to your pelvis. For more resistant cases for intractable pain, patients may benefit from a Sacroiliac Joint Neurotomy.

SIJ Neurotomy Procedures

These neurotomy procedures are minimally invasive and takes approximately 1 hour. They are performed as an outpatient procedure, and do not involve general anesthesia. Light sedation may be given, but is often not necessary.

Pain Management SInergy™ System

During the procedure, a Pain Management SInergy™ probe is inserted into the region of the sacroiliac (SI) joint through an introducer needle. Radiofrequency energy is then passed through the probe, which heats the tissue surrounding the probe. An internal water-cooling system in the probe allows for temperature control, which ensures the creation of an ideal balance of heating and safety. The sensory nerve fibers in the SI joint that may be responsible for pain are thus deactivated.

Diagram courtesy of Baylif Pain Management

Dual Electrode Radiofrequency Neurotomy

This variant of the same procedure involves the formation of "strip lesions" between each 2 probes, from site to site. The simplest way of explaining this is, the goal is to 'connect-the-dots' between each orange dot in the diagram above. Some practitioners believe this will more completely ablate the pain fibres we are targeting.

The subtle differences between the above two procedures may be discussed with your treating physician.

Benefits

Overall, satisfaction with the SIJ RF procedures is high. Approximately 65% of patients experience maintained pain relief at 12 months post-procedure.

Risks

The risks of the procedure are low. The most serious risk is for an infection or bleeding at the procedure site. The estimated risk is ~ 1/100,000.

A more common risk is the temporary development of irritating symptoms, experienced as a patch of itchiness and numbness of the skin overlying the treated sacroiliac joint. The post-operative symptoms can last anywhere from 1 week to 3 months after the procedure is completed. Usually, these symptoms can be managed with simple medication until they disappear. Approximately 5% of patients may require a repeat SIJ neurotomy to remove these persistent aggravating sensations.