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Lateral branch neurotomy for sacroiliac joint pain improves pain and physical function
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September 2013
Lateral branch neurotomy for sacroiliac joint pain improves pain and physical function
Study Type:Therapy
OE Level Evidence:2
Journal Level of Evidence:N/A
A randomized, placebo-controlled study to assess the efficacy of lateral branch neurotomy for chronic sacroiliac joint pain
Pain Med. 2012 Mar;13(3):383-98. doi: 10.1111/j.1526-4637.2012.01328.x. Epub 2012 Feb 2Did you know you're eligible to earn 0.5 CME credits for reading this report? Click Here
OE EXCLUSIVE
Dr. Patel discusses the use of lateral branch neurotomy for sacroiliac joint pain improves pain and physical function
Synopsis
51 patients experiencing sacroiliac joint (SIJ) pain were randomized on a 2:1 basis into two groups to either receive lateral branch radiofrequency (RF) neurotomy or a sham treatment. Following assessments over a 9 month period, results indicated that patients who underwent lateral branch RF neurotomy treatment noticed a significant decrease in pain, disability, and an increase in physical function.
Publication Funding Details
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Funding:
Non-funded
Conflicts:
None disclosed
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Yes = 1
Uncertain = 0.5
Not Relevant = 0
No = 0
The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.
3/4
Randomization
4/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.
Why was this study needed now?
Sacroiliac joint (SIJ) pain is a common form of lower back pain. Intra-articular SIJ injections are normally used to treat the condition, but sometimes this method is ineffective or only provides short-term pain relief. Lateral branch RF neurotomy has been suggested as an alternative treatment for SIJ pain, but few studies have assessed the efficacy of this method. This study aimed to determine the effectiveness of lateral branch RF neurotomy in pain management of SIJ pain.
What was the principal research question?
Did lateral branch radiofrequency neurotomy significantly decrease sacroiliac joint pain and increase physical function, when measured over a 9 month period?
Study Characteristics
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Population:
51 patients with chronic axial back pain below the L5 vertebrae lasting for more than 6 months, and that had a positive response to dual lateral branch blocks. A positive response entailed receiving 75% or more pain relief between 4 hours and 7 days after receiving bilateral injections (Age range: 18-88)
Intervention:
Lateral Branch Neurotomy Group: Patients underwent lateral branch neurotomy, in which radiofrequency electrodes were applied to the S1-S3 lateral branches and the L5 dorsal ramus (Mean age: 56 +/- 15) (Age range: 18-88) (n=34)
Comparison:
Sham Group: Patients underwent the same procedure as the intervention group, with the only difference being that the RF energy was not applied during the treatment (Mean age: 64 +/- 14) (Age range: 43-84) (n=17)
Outcomes:
The outcomes measured were pain (measured using a numerical rating scale (NRS)), physical function and bodily pain (both measured using the Short Form (SF-36)), disability (measured using the Oswestry disability index (ODI)), global perceived effect (GPE) (measured by assessing index pain using a 7-item scale), and quality of life (measured using the Assessment of Quality of Life (AQoL) tool)
Methods:
RCT: prospective; single center; double blinded
Time:
All outcomes in the Lateral Branch Neurotomy group were measured at 1, 3, 6, and 9 months following treatment, while outcomes in the Sham group were measured at 1 and 3 months
What were the important findings?
- The mean improvement in NRS pain score at the 3 month assessment was significantly higher in the Lateral Branch Neurotomy group (-2.4 +/- 2.7) than in the Sham group (-0.8 +/- 2.4) (p=0.035)
- The mean improvements in SF-36 for bodily pain at the 1 and 3 month assessments were significantly higher in the Lateral Branch Neurotomy group (Month 1: 15 +/- 17, Month 3: 16 +/- 26) than in the Sham group (Month 1: 2 +/- 11, Month 3: -1 +/- 13) (Month 1: p=0.006, Month 3: p=0.019)
- The mean improvements in SF-36 for physical function at the 1 and 3 month assessments were significantly higher in the Lateral Branch Neurotomy group (Month 1: 10 +/- 17, Month 3: 14 +/- 19) than in the Sham group (Month 1: 5 +/- 12, Month 3: 3 +/- 12) (Month 1: p=0.238, Month 3: p=0.040)
- The mean improvements in ODI at the 1 and 3 month assessments were significantly higher in the Lateral Branch Neurotomy group (Month 1: -12 +/- 14, Month 3: -11 +/- 17) than in the Sham group (Month 1: -4 +/- 11, Month 3: 2 +/- 6) (Month 1: p=0.046, Month 3: p=0.011)
- The percentage of patients who had a positive GPE score (positive defined as “pain has decreased a lot”) at the 3 month assessment was significantly higher in the Lateral Branch Neurotomy group (47%) than in the Sham group (8%) (p<0.05)
- The mean AQoL score at the 3 month assessment was significantly higher in the Lateral Branch Neurotomy group (0.69 +/- 0.21) than in the Sham group (0.56 +/- 0.21) (p=0.048)
What should I remember most?
Patients who underwent lateral branch RF neurotomy experienced significant improvements in SIJ pain, disability, physical function, and quality of living compared to those who underwent the sham treatment.
How will this affect the care of my patients?
Patients who have failed to get pain alleviation after taking intra-articular SIJ injections are may benefit from lateral branch RF neurotomy. Further research with larger sample sizes and longer follow-up are required to confirm the benefits.
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