• Geoffrey C Speldewinde.
• Capital Pain and Rehabilitation Clinic, Canberra, Australia.
• Pain Med. 2020 Mar 1; 21 (3): 561-569.

BackgroundThere are many physical, pharmacological, and interventional therapies aimed at alleviating sacroiliac ligament/joint complex pain, including thermal neurotomy. Sacroiliac joint (SIJ) innervation, as opposed to posterior sacroiliac ligament complex innervation, remains uncertain; thus lateral branch thermal neurotomy to alleviate sacroiliac joint pain remains controversial.ObjectiveThis study aimed to compare the success rates of two lateral branch neurotomy techniques, large continuous-lesion multi-electrode radiofrequency neurotomy (RFN; Simplicity, Neurotherm Inc.) and small-lesion monopolar periforaminal, to relieve pain from sacroiliac joints, as well as whether these would alter physical and psychological health.DesignRetrospective clinical audit of prospectively gathered consecutive data.SettingA private community-based multidisciplinary pain clinic.SubjectsReferred from primary care environments.MethodsOf 96 consecutive thermal neurotomies with baseline data completed, follow-up data were found in 73 patients during the period 2011-2017. After diagnosis by dual-positive fluoroscopic intra-articular injections, 41 patients underwent 47 monopolar periforaminal neurotomies, and 32 underwent 49 large continuous-lesion multi-electrode RFNs, with >12-month follow-up. The primary outcome was 50-100% relief of pain for more than six months. Results are presented as success rates. Secondary outcomes were Functional Rating Index Depression Anxiety and Stress Scale and Patient Specific Functional Scale.ResultsFollow-up data were available for 80 (83%) of the 96 procedures. Success occurred in 69% of all procedures (39% complete >75% relief and 30% good 50-75% relief). Success was 57% with worst-case analysis. Success rates were 71% in the large continuous-lesion multi-electrode RFN group and 65% in the periforaminal group, with overlapping confidence intervals. Significant improvements also occurred in the secondary measures.ConclusionsThermal neurotomy demonstrated a 69% success rate in reduction of sacroiliac ligament/joint complex pain for more than six months equally by large continuous-lesion multi-electrode RFN and periforaminal monopolar techniques, with attendant improvement in physical and psychological function.© 2019 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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