Evaluation of an Ultrasound-Assisted Longitudinal Axis Lateral Crest Approach to Radiofrequency Ablation of the Sacroiliac Joint

Objective: The aim of the study was to evaluate the effectiveness and procedural characteristics of a novel, ultrasound/fluoroscopically guided technique (longitudinal axis sacroiliac joint radiofrequency ablation) for sacroiliac joint denervation. Design: A single-arm cohort with historical cohort comparison was used in this study. Methods: Thirty-seven participants underwent longitudinal axis sacroiliac joint radiofrequency ablation after 50% or more pain reduction after diagnostic dual-block criterion. Outcomes were the proportion of participants with 50% or more pain reduction and mean Pain Disability Quality of Life Questionnaire change. Subanalysis included longitudinal axis sacroiliac joint radiofrequency ablation procedural and fluoroscopy times compared with participants previously treated with palisade radiofrequency ablation technique. Results: Primary outcome worst case analysis demonstrated a responder rate of 64.9% (95% confidence interval = 48.8%-78.2%) and 59.5% (95% confidence interval = 43.5%-73.7%) at 3 and 6 mos. There was significant decrease in mean Pain Disability Quality of LifeQuestionnaire at 3 (45.6 +/- 9.5 to 21.4 +/- 16.0, P < 0.001) and 6 mos (45.6 +/- 9.5 to 23.0 +/- 16.5, P < 0.001). Longitudinal axis sacroiliac joint radiofrequency ablation required more procedure time than the palisade technique (38.2 +/- 7.9 vs. 32.1 +/- 6.9 mins, P = 0.031) but less fluoroscopy time (35.0 +/- 11.8 vs. 57.6 +/- 16.8 secs, P < 0.001). Conclusions: Longitudinal axis sacroiliac joint radiofrequency ablation resulted in improvement in pain, disability, and quality of life at 3 and 6 mos. Compared with the palisade technique, longitudinal axis sacroiliac joint radiofrequency ablation required greater procedure time but less fluoroscopy time.