Determination of the Success Rate of the Palisade Lateral Branch Technique Using Multi-tined Needles for Sacro-iliac Joint Radiofrequency Ablation

Single center, prospective cohort study. all patients presenting to the Maisonneuve-Rosemont's Pain center with chronic low back pain of SIJ origin who are candidates for SIJ RFA during a two year period will be invited to participate in this study. SIJ RFA will be performed using the palisade technique using 3-tined needles. The patients will be followed for a period of 10 months to determine pain relief, opioid use, satisfaction and impact on disability.

Study design: Prospective, cohort study Population: Patients who are scheduled to receive a SIJ RFA at the Maisonneuve-Rosemont Hospital's Chronic Pain Clinic Duration of study: 2 years Patient included in the study will be followed up for 10 months. Sample size: Approximately 30 patients (anticipated)

General Study procedure This study's methodology will follow the standard practice for treating patients with SIJ pain at the Maisonneuve-rosemont Hospital First, an intraarticular SIJ injection of local anesthetic with a corticosteroid is offered to patients presenting with pain of presumed SIJ origin (predominantly axial low back pain, below the L5 vertebrae, positive SIJ provocation maneuvers). Patients who experience significant pain relief but lasting less than 3 months are offered a SLBB. According to standard practice, all patients receiving a SLBB file a pain diary that evaluates the pain intensity over a 36h period following the block (see Annex 1). This diary is sent back by e-mail to the treating physician and will be deemed positive if >50% pain relief is reported for at least 2h but lasting less than 24h. Patients with a positive SLBB are always considered for SIJ RFA. Patients with a negative SLBB may or may not undergo SIJ RFA, depending on the treating physician. Indeed, although SLBB have been suggested as a more appropriate method for selecting patients who should undergo SIJ RFA, its predictive value has not been formally evaluated and many physicians feel that not performing SIJ RFA in patients with negative SLBB may lead to withholding an effective treatment from patients. Thus, the standard practice is to proceed with SIJ RFA even with a negative SLBB because its prognostic value is not clear.

For the purpose of this study, all patients experiencing >50% pain relief after an intra articular SIJ injection of local anesthetic and corticosteroid but lasting less than 3 months and who wish to undergo SIJ RFA, as suggested by their treating physician, will be considered for inclusion in the study. Then, following general procedure, all patients will undergo a SLBB performed according to the previously described technique. The data from all the diaries will be collected to determine the rate of positive SLBBs among patients who had significant but not sustained pain relief from intraarticular SIJ injection. Then, all patients will proceed to SIJ RFA.

Recrutement: