title: Neuroaugmentation in the management of sacroiliac joint pain. Report of two cases.
abstract: METHODS
  A report of two cases of severe sacroiliac pain that were resistant to conventional management techniques. Both patients had undergone lumbar fusion. This appeared to be a predisposing factor.
  
  
  OBJECTIVE
  To define the source of pain in these patients by performing a series of diagnostic blocks under fluoroscopic guidance to determine if these patients were candidates for neuroaugmentation.
  
  
  BACKGROUND
  Mild to moderate sacroiliac joint pain can be managed conservatively with analgesics, anti-inflammatory drugs, and physical therapy. Severe sacroiliac joint pain can be incapacitating and more challenging to manage. Fluoroscopically guided intra-articular local anesthetic-steroid injections, followed by joint manipulation, can be effective, intracapsular injections of glycerin, glucose, and phenol also may be beneficial in some patients. The use of neuroaugmentation to manage pain of synovial origin has not been reported previously. Sacral nerve root stimulation in particular has been used to manage urinary bladder dysfunction and pain, but not sacroiliac joint pain.
  
  
  METHODS
  Two patients with severe sacroiliac joint pain were treated by implanting a neuroprosthesis at the third sacral nerve roots. The patients had undergone lumbar fusion for back pain that developed as a result of work-related injuries. Stimulation was tried for 1 week with bilateral, percutaneously implanted, cardiac pacing wires at the third sacral nerve roots.
  
  
  RESULTS
  Both patients experienced relief of approximately 60% of their pain during the trial period. Therefore, a neuroprosthesis (Medtronics, MN) was implanted permanently bilaterally at the third sacral nerve root in both patients. The use of analgesics was reportedly the same after implantation, but significantly more effective, and the patients' daily living activities were more tolerable.
  
  
  CONCLUSIONS
  Two cases of refractory sacroiliac joint pain are reported that were managed with permanently implanted neuroprostheses at the third sacral nerve roots. The authors suggest that neuroaugmentation can be a reasonable option in selected patients with refractory sacroiliac pain.
authors.affiliation: Department of Anesthesiology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: O
authors.initials: O
authors.lastname: Calvillo
authors.forename: S I
authors.initials: SI
authors.lastname: Esses
authors.forename: C
authors.initials: C
authors.lastname: Ponder
authors.forename: C
authors.initials: C
authors.lastname: D'Agostino
authors.forename: E
authors.initials: E
authors.lastname: Tanhui
mesh_terms: D000328:Adult; D018771:Arthralgia / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods; D011859:Radiography; D012446:Sacroiliac Joint / Q000000981:diagnostic imaging; D013123:Spinal Fusion / Q000009:adverse effects; D013126:Spinal Nerve Roots; D016896:Treatment Outcome