Radiofrequency denervation for treatment of sacroiliac joint pain-comparison of two different ablation techniques

Simon Heinrich Bayerl; Tobias Finger; Petra Heiden; Nazli Esfahani-Bayerl; Christopher Topar; Vincent Prinz; Johannes Woitzik; Julius Dengler; Peter Vajkoczy

doi:10.1007/s10143-018-1016-3

Radiofrequency denervation for treatment of sacroiliac joint pain-comparison of two different ablation techniques

Neurosurg Rev. 2020 Feb;43(1):101-107. doi: 10.1007/s10143-018-1016-3. Epub 2018 Jul 31.

Authors

Simon Heinrich Bayerl¹, Tobias Finger¹, Petra Heiden², Nazli Esfahani-Bayerl³, Christopher Topar⁴, Vincent Prinz¹, Johannes Woitzik¹, Julius Dengler¹, Peter Vajkoczy⁵

Affiliations

¹ Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
² Department of Neurosurgery, University of Cologne, Cologne, Germany.
³ Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
⁴ ORTHO EINS Orthopäden, Berlin, Germany.
⁵ Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany. peter.vajkoczy@charite.de.

PMID: 30066034
DOI: 10.1007/s10143-018-1016-3

Abstract

The radiofrequency treatment (RFD) for sacroiliac joint pain (SIP) is well-established, but there is still scarce evidence on its clinical outcome. The classical monopolar RFD is limited by a high recurrence rate. This might be caused by an incomplete denervation of the dorsal rami. The Simplicity III probe was invented to optimise pain fibre recruitment by its multi-electrode design. However, the clinical superiority of this procedure was never proven. The aim of this study was to illustrate the effectiveness of RFD and to compare both denervation techniques. One hundred twenty-one patients were included, and their clinical course was analysed. Fifty-seven patients received conventional treatment with multiple percutaneous monopolar RFDs (monolesion probe group, MoLG) and 64 patients with the Simplicity III probe (multilesion probe group, MuLG). All patients were followed 1, 3, 6 and 12 s after RFD. Clinical outcome scores were analysed (numeric pain rating scale (NPRS), Roland-Morris Disability Questionnaire, Oswestry Disability Index (ODI), Odom's criteria, Short Form 36 score). The MuLG showed a clearly advanced improvement concerning the clinically relevant pain relief (≥ 50%) (1 month/3 months /6 months/12 months = 72%, 55%, 36%, 27% vs. 1 month/3 months/6 months/12 months = 39%, 28%, 16%, 11%) as well as an advanced improvement of pain-associated disability and a higher satisfaction rating compared to the MoLG (NPRS_MuLG__preop = 8,3; NPRS_MuLG__12months = 5.8; NPRS_{MoLG_preop} = 7,7; NPRS_{MoLG_12months} = 5.8; ODI_{MuLG_preop} = 52; ODI_{MuLG_12months} = 42; ODI_{MoLG_preop} = 52; ODI_{MoLG_12months} = 47; ODOMS_{MuLG_good/excellent} = 54%; ODOMS_{MoLG_good/excellent} = 28%). RFD of the SIP with the Simplicity III probe is effective and delivers a distinct pain reduction even after 1 year of treatment. This technique shows clear advantages compared to the conventional monolesion technique and is a useful treatment for patients with recurrent SIP.

Keywords: Chronic low back pain; Quality of life; Radiofrequency denervation; Sacroiliac joint; Sacroiliac joint pain.

MeSH terms

Ablation Techniques*
Adult
Aged
Aged, 80 and over
Arthralgia / surgery*
Catheter Ablation / methods*
Denervation / methods*
Disability Evaluation
Electrodes
Equipment Design
Female
Humans
Low Back Pain / surgery*
Male
Middle Aged
Pain Management / methods
Patient Satisfaction
Quality of Life
Sacroiliac Joint / surgery*
Treatment Outcome