Sacroiliac Joint Radiofrequency Neurotomy or Ablation

What is Sacroiliac Joint Radiofrequency Neurotomy?

Sacroiliac joint radiofrequency neurotomy, also known as sacroiliac joint radiofrequency ablation or sacroiliac joint radiofrequency denervation, is a minimally invasive procedure aimed at providing long-term relief for chronic lower back and buttock pain originating from the sacroiliac joint. Various terms are used to describe radiofrequency neurotomy, including radiofrequency ablation, denervation, lesioning, rhizolysis, or rhizotomy.

During the procedure, radiofrequency energy is used to create heat and target the nerves responsible for transmitting pain signals from the sacroiliac joint to the brain. This is typically done through the insertion of a specialised needle under fluoroscopic guidance, which allows for precise targeting of the affected nerves.

The heat generated by the radiofrequency energy disrupts the function of these nerves, essentially preventing them from transmitting pain signals. While the nerves are not completely destroyed, their ability to send pain signals is significantly reduced, leading to relief for the patient.

Sacroiliac joint radiofrequency neurotomy is often considered after more conservative treatments such as physical therapy, medication, and injections have failed to provide sufficient relief. It is generally preceded by a diagnostic sacroiliac joint block to confirm that the sacroiliac joint is the source of the pain.

The effects of the procedure can vary from person to person, but many patients experience significant pain reduction and improved function that can last for months or even years. If the pain returns over time, the procedure can be repeated as needed to maintain relief.

Overall, sacroiliac joint radiofrequency neurotomy offers a promising option for individuals suffering from chronic sacroiliac joint pain who have not found relief from other treatments.

What Does Sacroiliac Joint Radiofrequency Neurotomy Treat?

Sacroiliac joint radiofrequency neurotomy is primarily used to treat chronic lower back and buttock pain that originates from the sacroiliac joint. This type of pain often arises from conditions such as sacroiliac joint dysfunction, sacroiliitis, or arthritis affecting the sacroiliac joint.

Patients who undergo this procedure typically experience pain that is localised to the lower back, buttocks, and sometimes radiating down the legs. This pain may be chronic and debilitating, negatively impacting daily activities and quality of life.

Sacroiliac joint radiofrequency neurotomy targets the nerves responsible for transmitting pain signals from the sacroiliac joint to the brain. By disrupting the function of these nerves using radiofrequency energy, the procedure aims to provide long-term relief from sacroiliac joint pain.

Conditions that may be effectively treated with Sacroiliac Joint Radiofrequency neurotomy include:

• Sacroiliac Joint Dysfunction. Dysfunction of the sacroiliac joint, which can result from injury, inflammation, or degenerative changes, often leads to chronic pain in the lower back and buttocks.
• Sacroiliitis. Inflammation of the sacroiliac joint, commonly associated with conditions such as ankylosing spondylitis, psoriatic arthritis, or other forms of arthritis, can cause persistent pain and discomfort.
• Arthritis affecting the Sacroiliac Joint. Osteoarthritis or other forms of arthritis affecting the sacroiliac joint can lead to chronic pain and stiffness in the lower back and buttocks.
• Other Sacroiliac Joint-Related Conditions. Various structural abnormalities, ligamentous injuries, pain related to previous spinal surgeries, or mechanical issues involving the sacroiliac joint can result in chronic pain that may be responsive to sacroiliac joint radiofrequency neurotomy.

Overall, this procedure offers a targeted approach to managing chronic sacroiliac joint pain when conservative treatments have been ineffective, providing patients with improved pain relief and functional outcomes.

How Does Sacroiliac Joint Radiofrequency Neurotomy Alleviate Chronic Pain?

Sacroiliac joint radiofrequency neurotomy alleviates chronic lower back pain by targeting the nerves responsible for transmitting pain signals from the sacroiliac joint to the brain and disrupting their function.

Here is how the procedure works:

• Identification of Pain-Generating Nerves. Before the procedure, a diagnostic joint block is typically performed to confirm that the joint is in fact, causing the pain. If significant pain reduction follows the sacroiliac joint blocks, it suggests that the sacroiliac joints are contributing to the patient’s pain and are suitable targets for radiofrequency neurotomy.
• Radiofrequency Ablation. During the radiofrequency neurotomy procedure, a specialised needle is inserted under fluoroscopic guidance to precisely target the identified nerves. Once in position, the needle delivers radiofrequency energy to create heat, which is applied to the nerves. The heat generated by the radiofrequency energy disrupts the function of these nerves, essentially “switching off” their ability to transmit pain signals to the brain.
• Pain Relief. By interrupting the transmission of pain signals from the sacroiliac joint to the brain, radiofrequency neurotomy effectively reduces or eliminates the experience of chronic pain in the lower back, buttocks, and potentially down the legs. The procedure aims to provide long-term pain relief, allowing patients to experience improved function and quality of life.
• Nerve Regeneration. While the nerves are not completely destroyed during radiofrequency neurotomy, their function is temporarily disrupted. Over time, the nerves may regenerate, but the relief provided by the procedure can last for months to years. If the pain returns due to nerve regeneration or other factors, the procedure can be repeated as needed to maintain pain relief.

Sacroiliac joint radiofrequency neurotomy offers a targeted and minimally invasive approach to managing chronic sacroiliac joint pain, providing patients with significant relief and improved functional outcomes.

Why Would You Get Sacroiliac Joint Radiofrequency Neurotomy for Chronic Pain?

Sacroiliac joint radiofrequency neurotomy or denervation may be considered for chronic pain when other conservative treatments have failed to provide sufficient relief. Here are several reasons why someone might opt for this procedure:

• Chronic Sacroiliac Joint Pain. Individuals experiencing persistent lower back and buttock pain, particularly stemming from sacroiliac joint dysfunction, sacroiliitis, or arthritis affecting the sacroiliac joint, may seek relief through radiofrequency neurotomy. This pain can significantly impact daily activities and quality of life.
• Failed Conservative Treatments. Patients who have tried conservative treatments such as physical therapy, medications, steroid injections, or other interventions without significant improvement in their pain may consider radiofrequency neurotomy as an alternative for more lasting relief.
• After Diagnostic Confirmation. Prior to undergoing radiofrequency neurotomy, patients typically undergo diagnostic nerve blocks to confirm that the sacroiliac joint is the source of their pain and to identify the specific nerves responsible. If significant pain reduction is achieved with the nerve block, it suggests that radiofrequency neurotomy may provide effective and targeted pain relief.
• Desire for Longer-Term Relief. Radiofrequency neurotomy or denervation aims to provide longer-term pain relief compared to temporary treatments like steroid injections. While not permanent, the effects of radiofrequency neurotomy can last for months to years, potentially reducing the need for frequent interventions and improving overall quality of life.
• Improved Functionality. By alleviating chronic pain associated with sacroiliac joint dysfunction, radiofrequency neurotomy can enhance a patient’s ability to perform daily activities, engage in exercise, and participate in work or recreational pursuits that were previously limited by pain.
• Minimally Invasive Approach. Radiofrequency neurotomy is a minimally invasive procedure performed on a day case basis, typically requiring only local anaesthesia and sedation. This makes it an attractive option for individuals seeking effective pain relief with minimal downtime and reduced risk compared to surgery.

Overall, sacroiliac joint radiofrequency neurotomy offers a targeted and effective approach to managing chronic sacroiliac joint pain, helping chronic pain patients regain comfort, function, and quality of life.

Risks of Sacroiliac Joint Radiofrequency Neurotomy

While sacroiliac joint radiofrequency neurotomy is generally considered safe and effective, like any medical procedure, it carries certain risks and potential complications. Some of these risks include (but are not limited to):

1. Injection Site Reactions. Some patients may experience temporary pain, discomfort, or bruising at the injection site.
2. Flare up of pain. There may be a temporary flare up of pain which can last for up to 1-2 weeks after the procedure. This is often related to inflammation at the injection site or temporary irritation of the nerves. You will be provided with analgesia after the procedure to assist with this flare up of pain. 
3. Infection. There is a risk of infection at the injection site, although this is rare. Signs of infection include increased pain, swelling, redness, or drainage from the injection site.
4. Bleeding. There is a risk of bleeding at the injection site, especially for patients taking blood-thinning medications. This can lead to hematoma (collection of blood) at the injection site.
5. Allergic Reactions. Allergic reactions to the medications used in the injection, such as local anaesthetics or corticosteroids are possible but uncommon. If a contrast dye is used during the procedure, there is a slight risk of an allergic reaction to the dye, which may include rash, itching, or more severe reactions like anaphylaxis.
6. Hypersensitivity/ Numbness. You may experience an area of increased sensitivity or numbness in the region of the procedure. This is usually temporary and resolves within 6-8 weeks.
7. Nerve Damage. Although rare, there is a small risk of nerve damage due to needle placement (direct trauma), the medication injected, infection or bleeding. Symptoms may include numbness, tingling, weakness, or increased pain or neurological symptoms. 
8. Spinal Cord or Nerve Root Injury. Although extremely rare, there is a risk of injury to the spinal cord or nerve roots during the injection, which can lead to neurological deficits, bowel and bladder dysfunction, numbness and paralysis. .
9. Exposure to X-Rays and CT. Minimal doses of radiation are used to reduce the lifetime risk of long term complications (such as cancer) due to exposure to X Ray and/ or CT scanning.
10. Incomplete Pain Relief/ Failure. While many patients experience significant pain relief following radiofrequency denervation, the procedure may not provide complete relief for everyone. Factors such as individual pain tolerance, underlying conditions, or nerve regeneration over time can affect the outcome. Hence, the procedure may not provide the expected result or benefit.
11. Sedation anaesthesia. There are risks of undergoing the sedation anaesthetic which is discussed on the day by the anaesthetist. Anaesthesia is generally very safe but there may be increased risk depending on your specific medical conditions.

It is essential to discuss the potential risks and benefits of sacroiliac joint radiofrequency denervation with your physician before undergoing the procedure. Additionally, these procedures must be performed by trained and experienced healthcare professionals in a controlled medical setting to minimise risks and ensure your safety.

The Process of Getting Sacroiliac Joint Radiofrequency Neurotomy

The process of getting sacroiliac joint radiofrequency neurotomy typically involves multiple steps, which are outlined here:

1. Consultation with a Healthcare Provider. The journey begins with a consultation with a healthcare provider, usually a pain management specialist or an interventional radiologist. During this consultation, the provider will review the patient’s medical history, perform a physical examination, and discuss the nature and severity of the pain experienced by the patient.
2. Diagnostic Evaluation. To determine if the sacroiliac joint is the source of the pain, the healthcare provider may order diagnostic tests such as X-rays, MRI scans, or CT scans. Additionally, a diagnostic sacroiliac joint injection may be performed. This involves injecting a local anaesthetic into the sacroiliac joint to temporarily numb the nerves and assess pain relief.
3. Confirmation of Pain Source. If the diagnostic sacroiliac joint injection provides significant pain relief, it confirms that the sacroiliac joint is the source of the pain. This step is crucial in determining if the patient is a suitable candidate for Sacroiliac Joint Radiofrequency neurotomy.
4. Preparation for the Procedure. Once the decision is made to proceed with sacroiliac joint radiofrequency neurotomy, the patient will be provided with instructions for preparation. This may include fasting for a certain period before the procedure, discontinuing certain medications that can increase bleeding risk, and arranging transportation to and from the clinic or hospital. The procedure is generally performed as a day case in a hospital setting under sedation anaesthesia. The procedure is performed one side at a time on separate days to minimise the extent of inflammation caused.
5. Procedure Day. On the day of the procedure, the patient will arrive at the clinic or hospital, where they will be greeted by the medical team. The patient will be taken to the procedure room and positioned on the examination table, typically lying face down. Sedation anaesthesia is then administered by the anaesthetist.
6. Anaesthesia. Local anaesthesia will be administered to numb the skin and underlying tissue around the area where the needle will be inserted. 
7. Procedure. Under fluoroscopic guidance (real-time X-ray imaging), the healthcare provider will insert specialised needles near the targeted area of the sacroiliac joint. Once the needles are properly positioned, radiofrequency energy will be delivered through the needles to create heat and disrupt the function of the nerves responsible for transmitting pain signals.
8. Post-Procedure Recovery. After the procedure is completed, the patient will be monitored for a short period in the recovery area. Once stable, the patient will be discharged with post-procedure instructions, which may include restrictions on certain activities and recommendations for pain management. The patient will also be provided with a Pain chart to complete over the following 6 weeks to assess the effectiveness of the procedure.
9. Follow-Up. Follow-up appointments will be scheduled to assess the patient’s response to the procedure and to monitor for any complications. The patient may also be referred for additional treatments or therapies as needed.

It is important to communicate openly with your doctor throughout the process and to ask any questions or express any concerns you may have. This helps ensure that the procedure is performed safely and effectively, leading to optimal outcomes.

Preparing for Sacroiliac Joint Radiofrequency Neurotomy

Preparing for a sacroiliac joint radiofrequency denervation at the Persistent Pain Solutions clinic will require close communication with Dr Mittal and her team. 

Be sure to disclose all medications you may be taking and note that you may have to discontinue some or all of them immediately prior to the procedure.

Prior to your appointment, please inform us if:

• You are currently taking antibiotics.
• You have a pacemaker or defibrillator.
• You have any allergies.
• You have diabetes.
• You are taking any blood thinning medications.
• You are feeling unwell, as we may need to reschedule your procedure.

You must also avoid eating or drinking anything in the six hours leading up to the procedure. However, you may continue to take medications with a small sip of water on the morning of the procedure. You will be advised to cease some other medications such as those for diabetes and blood thinning medications.

For your safety, we recommend arranging transportation to and from your appointment, as driving yourself is not advised within the 24-hour period following the procedure.

We generally recommend you take leave from work on the day of the procedure AND for 1-2 weeks after the procedure, to rest and recover from the procedure. 

If you are receiving sacroiliac joint radiofrequency denervation, we advise you to refrain from undergoing any additional medical procedures, such as dental treatments or colonoscopies, within 48 hours before or after undergoing the sacroiliac joint radiofrequency denervation procedure.

Dr. Meena Mittal and her team will provide specific guidance tailored to your situation. It’s important to adhere to your instructions diligently. If you have any concerns or queries, don’t hesitate to ask—we’re here to support you throughout the process.

After Getting Sacroiliac Joint Radiofrequency Neurotomy (Follow-Up)

Following your sacroiliac joint radiofrequency denervation procedure, you are free to return home. 

There are no specific restrictions on your day-to-day activities. However, it is advisable to prioritise rest and engage in gentle activities during the initial 24-48 hours after your procedure. Due to sedation administered during the treatment, please refrain from driving for at least 24 hours afterwards.

You may commence physiotherapy 2-4 weeks after the procedure. You may return to hydrotherapy or a swimming pool/ spa 2-4 weeks after the procedure. 

We do not recommend any long distance or overseas travel for at least 2-4 weeks after the procedure. This is such that any issues or complications can be monitored and addressed in a timely manner. 

A follow-up appointment will be scheduled at 6 weeks post procedure to assess your response to the radiofrequency denervation procedure. You will be requested to bring the post procedure Pain Chart such that the results can be analysed by Dr Mittal and next steps in your treatment plan can be discussed with you.

Finding a Doctor Who Performs Sacroiliac Joint Radiofrequency Neurotomy Near You

If you are suffering from chronic lower back pain, then a pain specialist who can perform sacroiliac joint radiofrequency neurotomy may be able to provide some relief. 

Asking your general practitioner for a referral to a pain specialist who provides sacroiliac joint radiofrequency neurotomy and similar treatments is an essential first step towards alleviating your pain; you can also speak to family members, friends, or support groups (both online and in real life) for recommendations from those who have dealt with similar chronic pain-related challenges. 

Sacroiliac Joint Radiofrequency Neurotomy at Persistent Pain Solutions

Dr. Meena Mittal and her team at Persistent Pain Solutions provide sacroiliac joint radiofrequency neurotomy as well as sacroiliac joint injections, procedures designed to alleviate chronic lower back pain. 

These methods target the network of nerves around the sacroiliac joint, which is located at the base of the spine. Sacroiliac joint radiofrequency neurotomy, also known as radiofrequency ablation (RFA) utilises ablation, a technique where a small portion of nerve tissue is incapacitated. This effectively interrupts pain signals, providing long-lasting pain relief for our patients.