Sacroiliac Joint Radiofrequency
The anatomy of the sacroiliac joint
Sacroiliac joint radiofrequency neurotomy is a procedure performed in the management of sacroiliac joint pain. It involves the creation of a heat lesion as part of the procedure, targeting specific nerves and interrupting pain signals which are sent to the brain.
The lateral branch nerves carries pain signals from the sacroiliac joints to the brain. The targeted lesioning disrupts pain signals for a variable period of 9 – 24 months. Radiofrequency Neurotomy of these nerves will be performed when there is demonstrable benefit from diagnostic or therapeutic sacroiliac joint injections.
The sacroiliac joints are located next to the spine on both sides; they connect the hip to the sacrum. Sacroiliac joint pain can have several causes. The joint could become inflamed through injury, wear and tear(aging), or through a problem developed through an activity which an individual undertakes regularly, such as forms of physical exercise or manual work.
Damage to the ligaments of the sacroiliac joint is another possible reason for the joint dysfunction, while a type of arthritis known as ankylosing spondylitis can damage the sacroiliac joint. Pregnancy can cause the release of hormones which alter joint movement and cause pain. And a discrepancy in leg length has also been identified as a possible cause of sacroiliac joint pain.
Causes of sacroiliac joint pain
There are several causes of sacroiliac joint pain. The joint could become inflamed through injury, wear and tear(ageing), or through a problem developed through an activity which an individual undertakes regularly, such as forms of physical exercise or manual work.
Damage to the ligaments of the sacroiliac joint is another possible reason for the joint dysfunction, while a type of arthritis known as ankylosing spondylitis can damage the sacroiliac joint.
Pregnant women can suffer from sacroiliac joint pain due to the release of hormones which have the ability to alter joint movement and cause pain. It has also been found that an uneven leg length can disrupt the rhythm of strides while walking and lead to sacroiliac joint pain.
Sacroiliac joint injection procedure
It is performed using fluoroscopy (live X-ray) to help guide the needle accurately and avoid any nerve injury. The procedure will take place in theatre under full aseptic conditions with the patient on his or her stomach. A small needle in the back of your hand can be used to administer sedation or in case of an emergency. The skin is well cleaned before a small amount of local anaesthetic is applied in order to numb the injection area. For the injection itself, the physician would use fluoroscopy in order to guide the radiofrequency needle as accurately as possible to the lateral branch nerves and performs precision and safety tests. The targeted nerves are then numbed, a heat lesion is created by radiofrequency waves on the tip of the needle, allowing the lesion to disrupt pain signals. A small mixture of steroid (anti-inflammatory medication) and anaesthetic is then injected.
Patients are then monitored in a recovery area before transfer to the ward and discharge home. Patients may experience a numb feeling for a few hours. Pain at the injection site may increase for seven or more days. It is advisable to rest for 24 hours and resume stretches and exercises when the pain eases. It is important to utilise the window of relief to perform strengthening exercises.
This window of pain relief should be utilised for performance of strengthening exercises and rehabilitation physiotherapy.
Complications
There is a variable response to injection treatment. It is important to discuss both the benefits and risks of the procedure with your doctor before any agreement to undergo the procedure is reached. Although the chance of any complications is generally low, as with all surgical procedures, there is an element of risk involved with Radiofrequency neurotomy including failure to get benefit or pain aggravation. There may be an allergic reaction to the steroid or any of the medications, or that the injection causes an infection or bleeding. Side effects can include a new burning sensation or numbness around the site or bottom. Paralysis or nerve damage is extremely rare.