Background and Objectives of Lateral Branch Blocks:
Pain arising from the sacroiliac (SI) joint is a common cause of low back pain for which there is no universally accepted, long-term treatment. Previous studies have shown radiofrequency (RF) procedures to be an effective treatment for other types of spinal pain. The purpose of this study was to determine the efficacy of reducing SI joint pain by percutaneous RF lesioning of the nerves innervating the SI joint.
What are Sacral Lateral Branches?
The sacral lateral branches are small sensory nerves that supply the sacroiliac joint (SIJ). The SIJ is the joint that connects the pelvis to the lower part of the spine. Sometimes, when the SIJ is dysfunctional or irritated, the sacral lateral branches carry pain signals to your brain.
Why do Sacral Lateral Branches Matter?
Radiofrequency denervation (a minimally invasive procedure offered here at Specialty Spine/Northeast Rehab) can sometimes be performed on the sacral lateral branch nerves to help alleviate pain coming from the SIJ.
In order to determine if a patient is a candidate for radiofrequency denervation of the sacral lateral branch nerves, a diagnostic procedure called a “lateral branch block” is first performed. This procedure entails putting a tiny amount of numbing medication along the lateral branch nerves to determine if the patient’s SIJ pain is reduced. If the pain is reduced significantly following the “lateral branch block” procedure, the patient could be considered a candidate for radiofrequency denervation.
Methods Involving Lateral Branch Blocks:
Eighteen patients with confirmed SI joint pain underwent nerve blocks of the L4-5 primary dorsal rami and S1-3 lateral branches innervating the affected joint. Those who obtained 50% or greater pain relief from these blocks proceeded to undergo RF denervation of the nerves.
The Results of Lateral Branch Blocks:
Thirteen of 18 patients who underwent L4-5 dorsal rami and S1-3 lateral branch blocks (LBB) obtained significant pain relief, with 2 patients reporting prolonged benefit. At their next visit, 9 patients who experienced >50% pain relief underwent RF lesioning of the nerves. Eight of 9 patients (89%) obtained >/=50% pain relief from this procedure that persisted at their 9-month follow-up.
Conclusions:
In patients with SI joint pain who respond to L4-5 dorsal rami and S1-3 LBB, RF denervation of these nerves appears to be an effective treatment. Randomized, controlled trials are needed to further evaluate this procedure.
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