Radiofrequency ablation involving the sacroiliac joint

Low back pain (LBP) has consistently been one of the leading causes of years lived with disability, both globally and in the United States. Within the population that suffers from LBP, there are patients with nonspecific low back pain stemming from the sacroiliac joint (SIJ). This diarthroidal joint is susceptible to dysfunction and being the primary pain mediator in many patients, particularly those with risk factors such as leg length discrepancy, gait abnormalities, prior spinal fusions, and pregnancy. Accurately diagnosing the SIJ as the source of a patient’s LBP is complicated, but an accurate history and physical exam followed by a gold standard diagnostic intraarticular SIJ block with a local anesthetic can help confirm the SIJ as the primary pain mediator in this patient population. Once the SIJ is confirmed as the primary cause of pain, radiofrequency ablation (RFA) of the lumbar and sacral nerves innervating the posterior SIJ can help alleviate pain coming from this joint. Various types of RFA and techniques have been developed when performing this procedure, which we will further explore in this chapter.