Dr Thomas E Smith MBBS (Hons) MD FRCA FFPMRCA
What are sacroiliac joints?
Sacroiliac joints are a pair of small joints which join the spine to the pelvis. We normally are unaware of then, but they are important joints which bare heavy loads. They normally do not move very much at all, but combine stability with a little cushioning effect. They may become painful either due to wear and tear (also called degenerative change) or injury. Pain is felt around the sacroiliac joints and can spread into the buttocks and legs.
What is sacroiliach joint denervation ?
Sacroliac joint denervation treatment involves placing a special needle (radiofrequency probe) next to the sacroiliac joint nerves. A radiofrequency current is passed down the probe. A very small area of heat is created that burns the adjacent section of nerves. This procedure does not affect any other part of the body. The treatment is usually performed after previous “test” injections of local anaesthetic to these nerves were “positive” – which means they reduced the pain for a short time.
In order to make sure that the probe is the correct position, x-ray imaging is used to carefully site the needles and electrical nerve stimulation tests are performed before burning.
Each joint is supplied by several nerves and a scaroliliac joint denervation requires several separate needle placements and burns.
What is the aim of sacroliliac joint joint denervation?
The aim of the treatment is to reduce pain coming from the sacroiliac joints. This will, in turn, help to reduce spasm in the muscles, improve mobility and reduce stiffness. The nerves grow back very slowly and this treatment aims to give a year or more of relief.
What are the risks?
Sacroliliac joint denervation is a commonly performed procedure and is generally safe and effective. No procedure is risk free, and sacroiliac joint denervation carries a small risk of the following side effects or complications:
- Bleeding / bruising at the injection site
- Temporary numbness / weakness from the local anaesthetic that is injected during the procedure – this usually resolves in two to three hours
- Stiffness and soreness for a few days after the treatment due to local trauma from the burns and needles – this can last for two weeks. You should take your normal painkillers regularly and do gentle stretches
- Skin infection where the needle is inserted, estimated to be one per 1000 cases
- Allergy to injected drugs – estimated to be one case per 40,000.
- Nerve injury which can cause temporary numbness or weakness – this occurs in around one in 1,000 cases and resolves in days-weeks
- Permanent nerve injury to a nerve supplying the leg or trunk, which is rare. A figure of one case per 30,000 procedures is suggested
Are there any alternatives?
The denervation procedure is usually considered after trying less invasive treatments, such as:
- physiotherapy
- medication
Giving your consent
If you decide to go ahead, you will be asked to sign a consent form that states that you agree to have the treatment and you understand what it involves. But you can still ask questions and change your mind after this.
If you take blood thinning drugs or diabetes medication, then please inform the pain service at least two weeks before your injection, to help us manage these.
What happens on the day of the procedure?
Please remember to bring with you:
- dressing gown and slippers
- any medication you normally would take (unless already advised not to)
- something to read and your mobile phone.
A nurse will admit you. You will be given a gown to change into. You can put your own dressing gown on over this gown while you wait.
Please note the time stated on your letter will not be the time of your actual procedure. Your appointment time is set early to make sure that there is time for you to be prepared and ready for your procedure. Sometimes there is an additional delay due to procedure room availability. A friend or relative will be able to stay with you while you wait.
All women of child-bearing age will be asked to provide a urine sample, for us to test to rule out pregnancy. You must tell us if you could be pregnant. X-rays are safe for adults, but may harm your developing baby, so they aren’t usually done during pregnancy.
Will I feel any pain?
The procedure may be performed either with you awake or sedated. This will be discuss this with you in advance. Local anaesthetic will be used but some brief pain with the injections can be expected.
What happens after the procedure?
You will need to stay in the procedure facility for at around 30 minutes after your procedure so that your recovery can be monitored and we are sure that it is safe for you to go home.
Please arrange for a responsible adult to accompany you home. You must not drive until the next day.
You will be able to leave when our team are satisfied that you are well enough and that there is a responsible adult to accompany you.
What do I need to do after I go home?
After the procedure and for the rest of the day, it is important for your safety that you follow the advice below:
Although you might feel fine, your reasoning, reflexes, judgement and co-ordination skills can be affected for up to 12 hours after your procedure (24 hours with sedation) . Please rest at home for the remainder of the day.
For 12 hours after the procedure (24 if your have sedation), do not:
- drive any vehicle, including a bicycle
- operate machinery
- cook, use sharp utensils or pour hot liquids
- drink alcohol
- smoke
- make any important decisions or sign contracts
Some people feel pain relief immediately after the procedure. Some people feel no immediate change but pain relief develops over subsequent days. If you experience some initial soreness you should take your usual painkillers and rest until it settles.
Will I have a follow-up appointment?
Yes. A clinic or telephone follow up appointment will be arranged.