In cases of SI joint pain that are chronic and do not respond to more conservative treatments like physical therapy or chiropractic care, a treatment option called radiofrequency ablation is sometimes used. Radiofrequency ablation is a minimally invasive procedure that introduces radiofrequency waves and heat to the irritated nerve(s) surrounding the dysfunctional SI joint, with the goal of permanently disrupting the pain signals being sent to the brain by the affected nerves. When those pain signals can be disrupted or eliminated, so can the pain.

Radiofrequency ablation, also sometimes called a radiofrequency neurotomy, is designed to destroy the function of the nerves surrounding the SI joint that are causing pain. The nerves in question do not govern any muscles or other sensation in the arms or legs, so treating them with radiofrequency ablation poses little risk.

How is Radiofrequency Ablation Performed?

Before the radiofrequency ablation procedure, a physician will first perform what is commonly referred to as a “nerve block” on the nerves that are suspected to be causing the SI joint pain. The purpose for this step is to ensure that these are the exact nerves that are in fact causing the pain. Once confirmed, preparation for the radiofrequency ablation procedure includes the patient lying on their stomach on a procedure table while the area to be treated is properly cleaned. At this time, a mild sedative may be given intravenously (IV) to help with relaxation. Once these steps have been taken, a local anesthetic is usually given to help numb the injection site.

After preparation is complete the procedure is ready to begin. As in therapeutic SI joint injection treatment, radiofrequency ablation is performed under the guidance of fluoroscopy. Fluoroscopy is a special type of X-ray that helps the physician to see the needle and confirm that it is in the SI joint.

The needle is inserted into the appropriate site and radiofrequency waves are pulsed through so that the tip of the needle is heated. The heated tip of the needle is then used to create a heat lesion on the nerve that is producing the SI joint pain. Once this process has been completed, it is repeated for each nerve suspected to be causing pain.

Is Radiofrequency Ablation Successful in Treating SI Joint Pain?

Radiofrequency ablation success rates can vary widely. There are many nerves in and around the SI joint, and disabling all of them can be very difficult. However, approximately 30% to 50% of people who undergo the procedure for lower back pain may experience substantial relief for up to two years. Of the remaining people who undergo the treatment, about 50% will experience some level of pain relief for a shorter period of time. As with any procedure, there are some SI joint pain sufferers who experience no pain relief after radiofrequency ablation. Overall, when radiofrequency ablation is successful, the pain relief period lasts between 9 and 14 months. This is generally the timeframe that it takes for the offending nerve to regrow and sometimes as a result, for the pain to return.

For those patients who haven’t experienced adequate relief from pain using radiofrequency ablation or other more conservative SI joint pain treatments, a physician may recommend SI joint fusion to correct the condition that is causing the pain. Learn more about SI joint fusion with SImmetry here