Selective Neurotomy of Sacral Lateral Branches for Pain of Sacroiliac Joint Dysfunction.

Kim, Hyo Joon; Shin, Dong Gyu; Kim, Hyoung Ihl; Shin, Dong A

Original Article

Journal of Korean Neurosurgical Society 2005;38(5): 338-343.

Hyo Joon Kim, Dong Gyu Shin, Hyoung Ihl Kim, Dong A Shin

Department of Neurosurgery, Presbyterian Medical Center, Jeonju, Korea. hyoungihl@hotmail.com

ABSTRACT

OBJECTIVE
The sacroiliac joint complex is often related with functionally incapacitating pain in old aged people. The purpose of this study is to delineate the investigation strategies and to determine the long-term effect of radiofrequency (RF) neurotomies for pain arising from sacroiliac joint dysfunction(SIJD) METHODS: Sixteen patients were diagnosed as having chronic pain from SIJD by comparative controlled blocks on L5 dorsal rami, sacroiliac joints and deep interosseous ligaments. After confirming the positive response (more than 50% of pain relief), sensory stimulation was applied to detect the `pathological' branches. Subsequently, RF neurotomies were performed on the selected nerve branches. Surgical outcome was graded as successful, moderate improvement, and failure after a 6month follow-up period. RESULTS: Stimulation intensity was 0.45V to elicit pain response in the L5 dorsal rami and lateral sacral branches. The number of RF-lesioned nerve branches was 6per patient. The average number of lesions for each branch was 1.3. Most commonly selected branches were L5 dorsal ramus (88%) and S2-upper division (88%). Ten patients (63%) reported a successful outcome according to the outcome criteria after 6months of follow-up, and five patients (31%) reported complete relief (100%). Five patients (31%) showed moderate improvements. One patient reported failure.
CONCLUSION
RF neurotomy of lateral sacral branches is an excellent treatment modality for the pain due to SIJD, provided that comparative controlled block shows a positive response.

Key Words: Pain; Sacroiliac joint; Radiofrequency; Neurotomy