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Year : 2018  |  Volume : 5  |  Issue : 2  |  Page : 80-97

Sacroiliac joint denervation, the joint and ligaments: aretrospective study and algorithm

1 Department of Anesthesiology, Alexandria University, Alexandria, Egypt
2 Advanced Pain Therapeutics of Knoxville, Knoxville, Tennessee, USA

Correspondence Address:
Mohammad-Hazem Ahmad-Sabry
Department of Anesthesiology, Alexandria University, Alexandria, 21111
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/roaic.roaic_44_17

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Introduction We included patients who had sacroiliac joint complex pain (SIJCP) and failing all conservative approaches to alleviate SIJCP, all had SI joint procedure with fluoroscopic guidance. Some had more than 3 months of better than 50% with SI steroid injection (62/144 patients), others became candidates for sacroiliac joint complex sensory radiofrequency (RF) denervation for long-term pain relief (24 patients), with facet denervation (22 patients) or with piriformis injection (19 patients). Materials and methods In all, 170 patient charts were reviewed, and 17 were excluded for unclear block results and 26 for discogenic pathology. Fluoroscopy and 10 or 15-mm active tip RF cannula was used. An imaginary stripline was drawn about 3–5 cm medial and parallel to the joint line. Posterior primary sensory denervation was then carried out through 10–15 mm segments in series. Denervation was repeated 9–12 months later if greater than 50% of original pain had returned (first repeat and second repeat). The denervation process was then expanded to other sets of patients having (II) SIJCP plus ipsilateral lumbar facet pain and (III) SIJCP plus ipsilateral piriformis syndrome exclusively. Results All groups showed an increase in activities of daily living (through Oswestry Scores), better pain score, and at least 45 weeks improvement of pain score after RF denervation. Conclusion SIJCP can be effectively (50% or better) reduced for 4.5 months with steroid injection, or 10–12 months with denervation. The procedures were repeated once or twice with the same effectiveness. The method of pain management through our approach is effective, safe, simple, and reproducible.

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