Cooled radiofrequency (RF) of L5 dorsal ramus for RF denervation of the sacroiliac joint: technical report.
OBJECTIVE
The sacroiliac joint is a common source of chronic low back pain. We recently described the use of cooled radiofrequency (RF) electrodes for performing lateral branch neurotomy to treat sacroiliac joint pain. The procedure involves lesioning the lateral branches of the posterior primary rami at S1-S3, and the L5 dorsal ramus (L5DR). While the cooled RF electrode has been adopted as a means for lesioning the lateral branches, conventional RF electrodes are used to lesion the L5DR. The objective of this technical report is to evaluate the acute safety of denervating the L5DR using cooled RF electrode.


METHODS
Electronic chart review was conducted on 100 consecutive RF procedures. Data collected included age, sex, years of pain, body mass index, post-procedural pain, numbness, weakness, and other complications.


RESULTS
Of 100 procedures 82 were completed using cooled electrode for sacral lateral branches and L5DR. Of the 82 procedures completed using cooled RF to L5DR, 24 were reported to be of high difficulty and 19 with poor visualization (bowel gas). There were no major complications related to the procedure. Four patients reported increased pain: two from the conventional RF of L5DR group and two from the cooled RF group. All of the pains were transient and returned to the baseline within 6 weeks. There were two patients experiencing localized numbness over the upper medial quadrant of the buttock, both in cooled RF group. There was no reported weakness of the lower extremity. Two patients complained of increased lower back pain and two of prolonged itching.


CONCLUSIONS
This review demonstrates the acute safety of using cooled RF for L5DR denervation with no report of significant or unusual patient complications. To establish frequency of complication associated with the treatment, a larger registry is required.
Kapural
Leonardo
L
Department of Pain Management, Cleveland Clinic, Cleveland, Ohio 44195, USA. Kapural@ccf.org
Stojanovic
Milan
M
Sessler
Daniel I
DI
Bensitel
Toula
T
Zovkic
Paulina
P
D003714:Denervation / Q000009:adverse effects / Q000295:instrumentation; D004566:Electrodes; D005500:Follow-Up Studies; D005727:Ganglia, Spinal / Q000601:surgery; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000601:surgery*; D008160:Lumbosacral Plexus; D011537:Pruritus; D016634:Radiosurgery / Q000009:adverse effects / Q000295:instrumentation; D012189:Retrospective Studies; D012446:Sacroiliac Joint; D016896:Treatment Outcome