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Use of Cooled Radiofrequency Lateral Branch Neurotomy for the Treatment of Sacroiliac Joint Mediated Low Back Pain: A Large Case Series - Compared with other Techniques

Wolfgang Stelzer, Michael Aiglesberger, Dominik Stelzer and Valentin Stelzer

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 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 (L5DR) and lateral to the S1, S2 and S3 posterior sacral foraminal aperatures. Visual analog scale (VAS) pain scores, quality of life, medication usage, and satisfaction were collected before the procedure, at 3-4 weeks post-procedure (n=97), and once again between 4-20 months post-procedure (n=105).

Results: When stratified by time to final follow-up (4-6 months, 6-12 months, >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%, 76%, and 70% reported their medication use as Less or None.

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 to 20 months following treatment. These results are consistent with previous study findings on the use of Cooled RF to treat SIJ mediated low back pain.