Use of Cooled Radiofrequency Lateral Branch Neurotomyfor the Treatment of Sacroiliac Joint-Mediated Low Back Pain: A Large Case Series
Wolfgang Stelzer, MD,* Michael Aiglesberger, Mag. BScN,*† Dominik Stelzer,*‡ and Valentin Stelzer*§
*MedizinischesZentrumSchmerzLOSand Baden/Vienna, Austria
†UMIT Study-Center, Linz-Austria
‡Medical University of Vienna, Austria
§University USI Salzburg, Austria
Reprint requests to: Wolfgang Stelzer, MD, Medizinisches Zentrum SchmerzLOS, Linz 4020,
Austria. Tel: 0043-732-9010-1040; Fax: 0043-732-9010-1048; E-mail:
Background. The sacroiliac joint (SIJ) complex has been identified as a common source of chronic low back pain. Radiofrequency (RF) neurotomy has been investigated in recent years as a minimally invasive treatment option for SIJ-mediated low back pain. A number of RF neurotomy methodologies have been investigated, including the use of cooled RF.
Objective. To retrospectively evaluate the use of cooled RF lateral branch neurotomy (LBN) to treat chronic SIJ-mediated low back pain in a large European study population.
Study Design. The electronic records of 126 patients with chronic low back pain who underwent treatment with cooled RF LBN were identified. Subjects were selected for treatment based on physical examination and positive response (50% pain relief) to an intra-articular SIJ block. Cooled RF LBN involved lesioning the L5 dorsal ramus and lateral to the S1, S2, and S3 posterior sacral foraminal apertures. Visual analog scale (VAS) pain scores, quality of life, medication usage, and satisfaction were collected before the procedure, at 3–4 weeks postprocedure (N = 97), and once again between 4 and 20 months postprocedure (N = 105).
Results. When stratified by time to final follow-up (4–6, 6–12, and >12 months, respectively): 86%, 71%, and 48% of subjects experienced 50% reduction in VAS pain scores, 96%, 93%, and 85% reported their quality of life as much improved or improved, and 100%, 62%, and 67% of opioid users stopped or decreased use of opioids.
Conclusions. The current results show promising, durable improvements in pain, quality of life, and medication usage in a large European study population, with benefits persisting in some subjects at 20 months after treatment. These results are consistent with previous study findings on the use of cooled RF to treat SIJ-mediated low back pain.
Key Words. Chronic Pain; Sacroiliac Joint; Cooled Radiofrequency; Intra-articular SIJ Block; L5 Dorsal Ramus (L5DR); Low Back Pain; S1-S3 Dorsal Rami
Journal of Pain Research
Cooled radiofrequency denervation for treatment of sacroiliac joint pain: two-year results from 20 cases
Mohamed Abdul Hadi2
1Pain Management Centre, Raffles Hospital, 2Pain Management Centre, Singapore General Hospital, Singapore
Background: Sacroiliac joint pain is a common cause of chronic low back pain. Different techniques for radiofrequency denervation of the sacroiliac joint have been used to treat this condition. However, results have been inconsistent because the variable sensory supply to the sacroiliac joint is difficult to disrupt completely using conventional radiofrequency. Cooled radiofrequency is a novel technique that uses internally cooled radiofrequency probes to enlarge lesion size, thereby increasing the chance of completely denervating the sacroiliac joint. The objective of this study was to evaluate the efficacy of cooled radiofrequency denervation using the SInergy™ cooled radiofrequency system for sacroiliac joint pain.
Methods: The charts of 20 patients with chronic sacroiliac joint pain who had undergone denervation using the SInergyTMcooled radiofrequency system were reviewed at two years following the procedure. Outcome measures included the Numeric Rating Scale for pain intensity, Patient Global Impression of Change, and Global Perceived Effect for patient satisfaction.
Results: Fifteen of 20 patients showed a significant reduction in pain (a decrease of at least three points on the Numeric Rating Scale). Mean Numeric Rating Scale for pain decreased from 7.4 ± 1.4 to 3.1 ± 2.5, mean Patient Global Impression of Change was “improved” (1.4 ± 1.5), and Global Perceived Effect was reported to be positive in 16 patients at two years following the procedure.
Conclusion: Cooled radiofrequency denervation showed long-term efficacy for up to two years in the treatment of sacroiliac joint pain.
Keywords: ablation, chronic low back pain, intervention, neurotomy, sacroiliitis
Correspondence: Kok-Yuen Ho585 North Bridge Road, Raffles Pain Management Centre, Level 13, Singapore 188770Tel +65 6311 2310Fax +65 6311 2373Email email@example.com
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