Table 3. Characteristics of studies of denervation for sacroiliac joint pain.
| Author (year) |
Study design | Study population |
Previous treatment | Confirmed diagnosis | Denervation description |
Follow-up mean (range) | Outcomes |
|---|---|---|---|---|---|---|---|
| Cohen (2008) | Randomized controlled trial | N = 14 patients Unilateral (n = 13) Bilateral (n = 1) Age: 51.9 (27–75) Male: 35.7% n = 14 placebo denervation |
Physical therapy, pharmacotherapy, back surgery | Injections containing 2 mL of 0.5% bupivacaine and 1 mL of 40 mg/mL of depo-methylprednisolone | Cooled radiofrequency (RF) denervation of L4–5 primary dorsal rami and S1–3 lateral branches performed only after + 75% pain relief with L4–5 and S1–3 lateral branch blocks. | 6 months (NR*) |
Numerical rating score (NRS) for pain: improved average of 3.5 points from baseline (6.1 ± 1.8) to (2.6 ± 2.2) Oswestry disability index: improved average of 14.5 points from baseline (37.1 ± 10.6) to (22.6 ± 10.6) Global perceived effect: 7/14 (50%) at 6 months Medication reduction: 5/14 (36%) at 6 months Complications: – Only procedure-related pain and/or temporary neuritis reported – Transient non-painful buttock parasthesias (n = 1) |
| N = 11/14 of placebo patients crossed over to radiofrequency denervation after failed placebo denervation at 3 months Age: 51.8 (31–74) Male: 42.8% |
Physical therapy, pharmacotherapy, back surgery, placebo denervation | Injections containing 2 mL of 0.5% bupivacaine and 1 mL of 40 mg/ mL of depo-methylprednisolone | Conventional (non-cooled) RF denervation of L4–5 primary dorsal rami and S1–3 lateral branches performed only after failed placebo denervation | 6 months (NR) |
NRS for pain: improved average of 3.4 points from baseline (6.5 ± 1.9) to 6 months post-denervation (3.1 ± 2.1) Oswestry disability index: improved average of 23.6 points from baseline (47.9 ± 9.3) to 6 months post denervation (24.3 ± 21.0) Global perceived effect: 5/11(46%) at 6 months Medication reduction: 3/11 (27%) at 6 months |
||
| Cohen (2003) | Randomized controlled trial | N = 9 patients Unilateral (NR) Bilateral (NR) Age: 50.0 (31–81) Male: 53.9% |
Physical therapy, previous blocks, back surgery, pain medicine management | Injections performed with 80 mg triamcinolone acetonide steroid and 1 to 3 mL 0.5% ropivacaine or 0.5% bupivacaine | RF denervation of L4–5 primary dorsal rami and S1–3 lateral branches performed only after >50% pain relief with L4–5 and S1–3 lateral branch blocks | 9 months (NR) |
Visual analog scale (VAS) for pain: improved average of 4.1 points from baseline (6.3) to 9 months post denervation (2.2) Complications: No complications with any of the procedures |
| Yin (2003) | Case series | N = 14 patients Unilateral (NR) Bilateral (NR) Age: 53.7 (35–79) Male: 28.6% |
Physical therapy, medical therapy, manual therapy, home-based flexibility and exercise programs, TENS, anesthetic injections, back surgery (lumbar discectomy, fusion or laminectomy) | Two separate deep interosseous ligamentous injections with 5 mL of 0.5% bupivacaine containing 4 mg/mL of triamcinolone | Sensory stimulation-guided RF denervation of L5 posterior sensory branch and the lateral branches of S1–3 | 6 months (NR) |
Visual integer pain score (VIPS): 64% successful outcome (defined as 60%
consistent subjective relief and greater than a 50% consistent decrease in VIPS,
maintained for at least 6 months) Complications: – No identifiable surgical complications – Cutaneous numbness over one buttock lasting 6 months (n = 1) – Most patients with transient buttock cutaneous dysesthesia – No bowel or bladder dysfunction – No postprocedure infections |
| Burnham (2007) | Case series | N = 9 patients Unilateral (n = 8) Bilateral (n = 1) Age: 54.6 (38–82) Male: 22.2% |
Back exercises, manual therapy, physical therapy, medical therapy, injections | Local anesthetic joint block | RF denervation of posterior sensory nerves | 12 months (NR) |
Patient satisfaction: 8/9 (89%) NRS for pain: improved average of 3.5 points from baseline (mean = 8) to 12 months post-denervation (mean = 4.5) Revised Oswestry disability index: improved average of 18 points from baseline (mean = 56) to 12 months postdenervation (mean = 38) Complications: – Numbness and itchiness of skin overlying treated sacroiliac joint (n = 3) |
| Vallejo (2006) | Case series | N = 22 patients Unilateral (NR) Bilateral (NR) Age: 55.9 ( ± 14) Male: 18.2% |
Physical therapy, medical therapy | Two or more fluoroscopically guided injections of corticosteroid/local anesthetic | Pulsed RF denervation of medial branch of L4, posterior rami of L5, and the lateral branches of S1–2. | 6 months (NR) |
VAS pain score: improved average of 4.9 points from baseline (7.6 ± 1.7) to 6 months postdenervation (2.7 ± 1.8) (P < .0001) FACIT quality of life scores: – Physical well-being: baseline (1.6 ± 0.7) and 6 months post-denervation (1.1 ± 0.5) (P< .0001) – Social-well being: baseline (3.1 ± 0.9) and 6 months post-denervation (3.2 ± 0.9) (P = .039) – Emotional well-being: baseline (1.3 ± 0.5) and 6 months post-denervation (1.0 ± 0.4) (P = .014) – Functional well-being: baseline (1.4 ± 0.8) and 6 months post-denervation (2.1 ± 1.0) (P < .0001) Complications: No complications directly or indirectly related to procedure |
*
NR = not reported