What is Sacroiliac Joint Radiofrequency Ablation?
Sacroiliac joints (SI joint) are present in the lower back region, where the sacrum and ilium bones join. Even though these joints are small and have limited motion, they have an important role in connecting your spine to the pelvic bone and the lower part of your body. They perform an important function of absorbing injurious shock forces of the upper portion of your body. Any inflammation or irritation in the SI joints may cause pain in the lower back, abdomen, groin, buttocks, or legs. This is known as sacroiliac joint dysfunction or sacroiliac joint pain and is one of the common causes of lower back pain.
Radiofrequency Ablation (RFA), also called rhizotomy or neurotomy, is a novel non-surgical technique for treating pain. This technique employs radiofrequency waves to produce heat which damage the nerves transmitting pain signals to the brain.
Sacroiliac joint radiofrequency ablation is a minimally invasive procedure performed to treat sacroiliac joint dysfunction or sacroiliac joint pain in which radiofrequency waves are used to produce heat to damage the nerves conveying pain signals from the sacroiliac joint to the brain.
Indications for Sacroiliac Joint Radiofrequency Ablation
Sacroiliac joint radiofrequency ablation may be recommended for those individuals who have experienced short-term pain relief after receiving an SI joint injection with a local anesthetic (numbing medication) but have had unsuccessful outcomes with other treatments or therapy.
Preparation for Sacroiliac Joint Radiofrequency Ablation
Preoperative preparation for sacroiliac joint radiofrequency ablation will involve the following steps:
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You may need to refrain from vitamins and supplements or medications such as blood thinners or anti-inflammatories for at least a week prior to the procedure.
- It is also important to inform your doctor if you are pregnant or might be pregnant, diabetic, asthmatic, or have any other medical conditions.
- You should refrain from alcohol or tobacco at least a few days prior to the procedure.
- You should not consume any solids at least 6 hours prior to the procedure. A small quantity of clear liquids is okay up to 2 hours before the procedure.
- You should arrange for someone to drive you home after the procedure.
- A written consent will be obtained from you after the pros and cons of the procedure have been explained in detail.
Procedure for Sacroiliac Joint Radiofrequency Ablation
Sacroiliac joint radiofrequency ablation is usually performed as an outpatient procedure in a clinic setting under fluoroscopic guidance. Fluoroscopy is similar to a real-time x-ray and enables your doctor to visualize the internal body structures while guiding and positioning the radiofrequency ablation (RFA) needles.
In general, the procedure may involve the following steps:
- You will be positioned on your stomach on a padded x-ray table.
- An IV line is placed to administer fluids and sedation to keep you relaxed during the procedure.
- The skin over the injection site (back and buttocks) is thoroughly cleaned with an antiseptic solution and a local anesthetic such as lidocaine is used to numb the treatment area.
- Under fluoroscopic guidance (live x-ray), your physician guides the RFA needles towards the lateral branch nerves in the SI joint. The lateral branch nerves are the nerves that convey pain impulses from the SI joint(s) between the sacrum and ilium in the pelvis to the brain.
- Once the needles are in accurate position, an active electrode is placed through the needles and a small quantity of electrical current is passed beside the target nerve at a safe interval from other nerves. This electrical current may briefly trigger painful symptoms that you normally experience.
- Once the target nerve is confirmed, a heat lesion is created on the nerve using radio waves to disable the nerve's capacity to transfer pain signals to the brain.
- This procedure is repeated many times along the surface of the SI joint and you may report a pulsating sensation or mild pain in the treatment area during lesioning. This procedure may last for about 30 minutes to an hour.
Post-procedure Care and Recovery
In general, post-procedure care and instructions after sacroiliac joint radiofrequency ablation will involve the following steps:
- You will be transferred to the recovery area where your nurse will monitor your vital signs and for any allergic reaction. You will be discharged once you are stable on the same day of the procedure.
- You may experience some pain, swelling, and discomfort in the sacroiliac joint area. Pain and anti-inflammatory medications and cold packs are recommended as needed. Pain relief may take at least 2 to 3 weeks post procedure.
- Warm showers are recommended over bathing for the first 2 to 3 days.
- Most individuals are able to walk immediately post procedure and you may return to work in a day or two.
- Refrain from smoking for a specific period of time as this may hamper proper healing.
- Refrain from strenuous activities and lifting heavy weights for the first couple of weeks.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Sacroiliac joint radiofrequency ablation is a relatively safe procedure; however, as with any procedure, possible risks and complications may occur, including:
- Temporary nerve pain
- Damage to nerve and adjacent structures
- Localized numbness
- Skin sensitivity
- Allergic reactions