Focus of the Report: The focus of this Health Technology Assessment (HTA) is to evaluate the effectiveness and safety of conventional (i.e., continuous, thermal) radiofrequency ablation (RFA) for sacroiliac joint (SIJ) denervation for the treatment of chronic low back pain (CLBP) thought to arise from the SIJ.

Technology Description: RFA is a percutaneous outpatient procedure involving the use of radiofrequency (RF) energy to heat tissue to the point of destruction. It is intended to prevent transmission of pain signals from the sensory nerves to the central nervous system.

Controversy: The main controversy surrounding SIJ pain is the lack of consensus regarding the exact innervation of the joint and the particular contributions of the various nerves. The anatomy of the SIJ is variable between patients and can even differ from 1 side to the other within the same person. Therefore, the consensus is that multiple lesions throughout the SIJ should be created. There are also several techniques for the placement of RF probes, and there is controversy as to which is the best technique. In addition, the effects of RFA are not permanent; the nerves will regenerate, and the pain may recur. Finally, some studies of spinal interventions have revealed the possibility of a substantial placebo effect with sham procedures, including RFA.

Key Questions:

  1. Is conventional RFA effective for the treatment of CLBP originating from the SIJ in adults?

  2. How does conventional RFA compare with other treatments, including steroid injections, cooled RFA, pulsed RF, and joint fusion for the treatment of CLBP originating from the SIJ?

  3. Is conventional RFA safe for use in patients with CLBP originating from the SIJ?

  4. Have definitive patient selection criteria been identified for conventional RFA for the treatment of CLBP originating from the SIJ?

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