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Systematic Review and Meta-Analysis of the Effectiveness of Radiofrequency Ablation of the Sacroiliac Joint

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Abstract

Purpose of Review

To evaluate the effectiveness of radiofrequency neurotomy in managing sacroiliac joint pain utilizing a systematic review with meta-analysis of randomized controlled trials (RCTs) and observational studies.

Recent Findings

The prevalence of sacroiliac joint pain is estimated at around 25% of low back pain cases, and its diagnosis lacks a gold standard. Treatments include exercise therapy, injections, ablation, and fusion, with variable effectiveness. COVID-19 altered utilization patterns of interventions, including sacroiliac joint procedures, and the evidence for these interventions remains inconclusive. Recently, Medicare has issued its local coverage determinations (LCDs) in the United States, which provides noncoverage of sacroiliac joint radiofrequency neurotomy. Additionally, a recent systematic review of sacroiliac joint injections showed Level III or fair evidence.

Summary

The sacroiliac joint, a critical axial joint linking the spine and pelvis, contributes to low back pain. Its complex innervation pattern varies among individuals. Sacroiliac joint dysfunction, causing pain and stiffness, arises from diverse factors.The present systematic review and meta-analysis aimed to evaluate radiofrequency neurotomy's effectiveness for sacroiliac joint pain management by applying rigorous methodology, considering both RCTs and observational studies. Despite methodological disparities, the evidence from this review, supported by changes in pain scores and functional improvement, suggests Level III evidence with fair recommendation for radiofrequency neurotomy as a treatment option. The review's strengths include its comprehensive approach and quality assessment. However, limitations persist, including variations in criteria and technical factors, underscoring the need for further high-quality studies in real-world scenarios.

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Acknowledgements

The authors wish to thank Bert Fellows, MA, Director Emeritus of Psychological Services at Pain Management Centers of America, for manuscript review, and Tonie M. Hatton and Diane E. Neihoff, transcriptionists, for their assistance in preparation of this manuscript.

Funding

There was no external funding in preparation of this manuscript.

Author information

Authors and Affiliations

  1. Roger Williams Medical Center, Boston University, Providence, RI, USA

    Rajesh Naidu Janapala

  2. College of Liberal Arts and Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA

    Emilija Knezevic

  3. Department of Anesthesiology, Advocate Illinois Masonic Medical Center and College of Medicine, University of Illinois, Chicago, IL, USA

    Nebojsa Nick Knezevic

  4. College of Medicine, University of Illinois, Chicago, IL, USA

    Nebojsa Nick Knezevic

  5. University of Kentucky, Lexington, KY, USA

    Rachana Pasupuleti

  6. Pain Management Centers of America, Paducah, KY, USA

    Mahendra R. Sanapati, Vidyasagar Pampati & Laxmaiah Manchikanti

  7. Pain Management Centers of America, Evansville, IN, USA

    Mahendra R. Sanapati, Vidyasagar Pampati & Laxmaiah Manchikanti

  8. LSU School of Medicine, New Orleans, LA, USA

    Alan D. Kaye

  9. Tulane School of Medicine, New Orleans, LA, USA

    Alan D. Kaye

  10. LSU Health Sciences Center, Ochsner Shreveport Hospital and Interventional Pain Clinic Feist-Wieller Cancer Center, ShreveportShreveport, LA, USA

    Alan D. Kaye

  11. LSU School of Medicine, Shreveport, LA, USA

    Alan D. Kaye

  12. Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport LA, 1501 Kings Highway, Shreveport, LA, 71103, USA

    Alan D. Kaye & Sahar Shekoohi

  13. University of Louisville, Louisville, KY, USA

    Laxmaiah Manchikanti

  14. Department of Anesthesiology, School of Medicine, LSU Health Sciences Center, Shreveport, LA, USA

    Laxmaiah Manchikanti

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  1. Rajesh Naidu Janapala
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  9. Laxmaiah Manchikanti
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Correspondence to Sahar Shekoohi.

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Appendix

Appendix

Table 7 Sources of risk of bias and Cochrane Review rating system
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Table 8 Item checklist for assessment of randomized controlled trials of IPM techniques utilizing IPM-QRB
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Table 9 IPM checklist for assessment of nonrandomized or observational studies of IPM techniques utilizing IPM-QRBNR
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9

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Janapala, R.N., Knezevic, E., Knezevic, N.N. et al. Systematic Review and Meta-Analysis of the Effectiveness of Radiofrequency Ablation of the Sacroiliac Joint. Curr Pain Headache Rep (2024). https://doi.org/10.1007/s11916-024-01226-6

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