Burnham Robert S, Yasui Yutaka
Division of Physical Medicine and Rehabilitation, University of Alberta, Alberta, Canada.
Reg Anesth Pain Med. 2007 Jan-Feb;32(1):12-9. doi: 10.1016/j.rapm.2006.08.008.
The sacroiliac joint (SIJ) can be a source of chronic refractory mechanical spine pain. Few previous studies have described radiofrequency (RF) sensory denervation of the SIJ; results have been inconsistent and technically demanding. This uncontrolled, prospective, cohort study evaluates the effects of an innovative method of RF ablation of the posterior sensory nerves of the SIJ on pain, analgesic use, disability, and satisfaction of patients suffering with chronic mechanical SIJ pain.
Nine subjects with SIJ pain, confirmed by a local anesthetic joint block, were studied. Subjects were treated with a series of RF strip lesions performed adjacent to the lateral dorsal foraminal aperture plus conventional monopolar lesioning at the L5 dorsal ramus. Each subject completed a questionnaire twice before and at 1, 3, 6, 9, and 12 months after the procedure. The questionnaire evaluated pain intensity and frequency, analgesic intake, disability, satisfaction (with current pain level and the RF procedure), and procedure complications. Data were analyzed by using linear mixed model analysis.
After the procedure, significant reductions of back and leg pain frequency and severity, analgesic intake, and dissatisfaction with their current level of pain occurred. Complications were minimal. Overall, 8 of 9 subjects were satisfied with the procedure.
RF sensory ablation of the SIJ using bipolar strip lesions is a technically uncomplicated and low-risk procedure. The resulting effects on pain, disability, and satisfaction are promising. Further evaluation of this technique, including randomized controlled trials, is recommended.
骶髂关节（SIJ）可能是慢性难治性机械性脊柱疼痛的一个来源。此前很少有研究描述骶髂关节的射频（RF）感觉神经去神经支配；结果一直不一致且技术要求高。这项非对照、前瞻性队列研究评估了一种创新的骶髂关节后感觉神经射频消融方法对慢性机械性骶髂关节疼痛患者的疼痛、镇痛药物使用、功能障碍和满意度的影响。
对9名经局部麻醉关节阻滞确诊为骶髂关节疼痛的受试者进行了研究。受试者接受了一系列在外侧背侧椎间孔附近进行的射频带状损伤以及在L5背支进行的传统单极损伤治疗。每位受试者在手术前以及手术后1、3、6、9和12个月各完成一次问卷调查。该问卷评估了疼痛强度和频率、镇痛药物摄入量、功能障碍、满意度（对当前疼痛水平和射频手术）以及手术并发症。采用线性混合模型分析对数据进行分析。
手术后，背部和腿部疼痛的频率和严重程度、镇痛药物摄入量以及对当前疼痛水平的不满程度均显著降低。并发症极少。总体而言，9名受试者中有8名对该手术感到满意。
使用双极带状损伤进行骶髂关节射频感觉神经消融是一种技术上不复杂且风险低的手术。其对疼痛、功能障碍和满意度产生的效果很有前景。建议对该技术进行进一步评估，包括随机对照试验。
