Sacroiliac Joint Injections and Radiofrequency Neurotomy

The sacroiliac joint and its associated extraarticular ligaments are accepted anatomic source of chronic low back pain affecting on average 15% of patients. The abundant complex innervation network that supplies both intraarticular and extraarticular structures make this diarthrodial joint a potentially long-term painful anatomic structure. Very recent human anatomical and histological data from cadaveric investigations identifies the extraarticular posterior sacral neural network consisting of lateral sacral branches (S1–S3) as a primary pain pathway. The diagnosis of sacroiliac joint-related pain remains challenging and cannot be definitely diagnosed by history, physical exam, and imaging. There is moderate to good evidence to support appropriately conducted diagnostic intraarticular sacroiliac joint injections in carefully selected patients to establish the diagnosis of sacroiliac pain. Precise and accurate dual diagnostic block procedures can reduce false positives and identify true cases of sacroiliac joint pain. More recent retrospective cohorts and prospective randomized controlled trials (RCTs) have demonstrated superiority of sacral lateral branch radiofrequency (RF) in reducing pain intensity and improving function comparted to either sham procedures and or intraarticular steroid injections out to 12 months. The optimal patient selection criteria, ablation nerve targets, and RF technology remain variable in the current literature with no superior methodology.