Low Back and Pelvic Pain: Treating Sacroiliac Joint Pain Using Bipolar Radiofrequency Neurotomy
Steven Richeimer, M.D.
USC Pain Management, USC Medical Center
Los Angeles, CA, USA
Desert Hot Springs, CA, USA
Chronic low back pain may be caused by dysfunction of or disease that affects the sacroiliac joint, which is commonly referred to as the "SI joint". Sometimes pain originating at the SI joint involves the low back, pelvic area (hips), buttocks, and thighs. In some cases, the pain may be described to be sciatic-like. The incidence of pelvic pain may make a proper diagnosis elusive. Therefore, patients with chronic low back and pelvic pain may find it wise to see a physician who specializes in pain management of spinal disorders.
What is the sacroiliac joint?
The sacroiliac joint is located on either side of the sacrum, which is in the low back and the pelvic areas. The SI joints are a pair of joints that connect the sacrum to the ilium, the large pelvic bone. Unlike other joints in the body, the surfaces of the SI joint are covered in two types of cartilage; one slick and the other spongy. The movement of the SI joint is minimal and results from stretching and is sometimes described as a gliding joint unlike the knee (hinge-type motion) or hip (ball and socket) joints.
Sacroiliac Joint 2
Coccyx (tailbone) 3
What causes the SI joint to become painful?
Similar to other joints in the body, strong ligaments made of tough bands of connective tissue hold the SI joint together. Degenerative arthritis (e.g. osteoarthritis, rheumatoid arthritis) and injury are two common causes of SI joint dysfunction and pain. Pregnancy may be particularly taxing on the SI joints, and may put women at risk for developing SI joint problems later in life, especially if they have had multiple pregnancies.
How can Bipolar Radiofrequency relieve symptoms?
Bipolar Radiofrequency Neurotomy is a minimally invasive procedure that disables and prevents specific spinal nerve branches from transmitting pain signals. Bipolar radiofrequency is a modified version of a procedure termed Radiofrequency Therapy (RT), a procedure developed more than 30 years ago. Bipolar radiofrequency is still fairly new, but more pain management specialists are performing this procedure to treat painful sacroiliac joints.
Like its predecessor, bipolar radiofrequency applies a precisely targeted electrical field to create a lesion (change in the body''s tissue) - in this case, in small branches of spinal nerves, rendering them incapable of transmitting pain signals. The difference with the bipolar radiofrequency is that two needles are used to guide the electrical energy in a line between the two needles. This allows the pain specialist to "mold" the location and shape of the lesion to exactly match the SI joint. The applied electrical field can then target these tiny nerves just as they enter the SI joint.
What are the possible complications with Bipolar Radiofrequency?
As with any medical procedure, there are risks and potential complications. Although complications rarely occur, patients need to know what could happen. The following list is not conclusive: bleeding, infection, nerve injury, increased pain, allergic or other reaction to medications used (e.g. anesthetic).
Is the pain relief permanent?
For many patients who suffer chronic low back pain, bipolar radiofrequency of the SI joint is an effective treatment that may provide relief for months or longer. Even when the target nerves regenerate (grow back), pain relief may continue. If the patient responded well to the first bipolar radiofrequency, a second may be considered if pain resumes. Of course, each patient is unique and it must be remembered that what works well for one person, may not workwell or at all for another.
How is the procedure performed?
Medicine to relax the patient is administered through an IV (intravenous line) and the patient is positioned face down on a padded x-ray table. The skin over the injection site is thoroughly cleaned and then numbed using an anesthetic. The entire procedure is performed using fluoroscopic guidance. Fluoroscopy is similar to a real-time x-ray and allows the physician to see the patient''s anatomy while guiding and positioning the special radiofrequency needles.
Once the needles are positioned, the joint is numbed to minimize the patient''s discomfort while the nerves are lesioned (tissue changed to disable the nerve''s ability to transmit pain signals). This procedure is repeated several times along the surface of the SI joint. In most cases, the pain during the procedure is mild and patients may report a mild ache or pulsating feeling in the area during lesioning.
What should patients expect?
Like other minimally invasive outpatient procedures, some post-procedural pain or discomfort should be expected. Usually an over-the-counter NSAID is sufficient to relieve this discomfort. In some cases, post-procedural pain may increase and the physician will prescribe needed medication (e.g. anti-inflammatory). The physician may recommend certain range of motion exercises to begin several days following the procedure.
In general, patients can expect a significant reduction of their pre-procedural pain in one to four weeks.