Long-Term Treatment Outcomes and Predictors of Treatment Success Following Sacral Lateral Branch Radiofrequency Neurotomy for Sacroiliac Joint Pain: A Real-World Cohort Study

Background and/or Objectives: Sacral lateral branch radiofrequency neurotomy (SLBRFN) has been demonstrated as a safe and effective treatment for dorsal sacroiliac joint complex (SIJC) pain. The objective of this study was to expand on the current body of literature to evaluate the effectiveness of SLBRFN in the treatment of SIJC pain in a real-world cohort.

Design: Single-center cross-sectional cohort study

Setting : Academic outpatient interventional spine clinics

Participants : Consecutive patients, 18 years or older with suspected SIJ pain who underwent SLBRFN between January 2020 and November 2023, were identified by CPT code query.

Interventions: SLBRFN

Main Outcome Measures: Follow-up data were collected by standardized telephone survey and compared to pre-procedural baseline data obtained by chart review. Treatment success was defined as ≥50% numeric rating scale (NRS) pain score reduction from pre-procedural baseline. Secondary outcomes included 2-point reduction in NRS pain score and patient global impression of change (PGIC) of “much improved” or greater.

Results: 145 of 194 patients (74.7%) were successfully contacted and completed the outcome survey. Demographics of participants included a mean age of 62.2 years (standard deviation [SD]±13.6); 72.4% female; mean follow-up time of 20.7 months (SD±10.5). 22.6% of patients were taking opioid analgesics prior to SLBRFN. Among patients included in the study, 34.5% (95% CI: 26.7%–42.2%) reported ≥50% NRS reduction and 52.4% (95% CI: 44.3%–60.6%) reported ≥2 point NRS reduction. 57.2% (95% CI: 49.1%–69.3%) reported they “much improved” or greater on the PGIC. Among patients taking prescribed opioids at time of the procedure, 36% (n=12) had discontinued opioids at follow-up.

Conclusions: In a real-world population, SLBRFN was associated with clinically meaningful pain reduction and patient-perceived global improvement. While the proportion of patients achieving large magnitude improvement was lower than reported in previous trials, the duration of pain relief observed amongst responders appeared to be longer. These findings highlight the need for further analysis of factors that impact treatment outcome.