64625 Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)

Name of the Procedure:

Radiofrequency Ablation of Nerves Innervating the Sacroiliac Joint with Image Guidance (Fluoroscopy or Computed Tomography)

Summary

Radiofrequency ablation (RFA) is a minimally invasive procedure used to reduce pain by targeting and disabling specific nerves. In this context, it focuses on the nerves that supply the sacroiliac (SI) joint, which is located in the lower back. The procedure uses imaging techniques like fluoroscopy or computed tomography (CT) for precise needle placement.

Purpose

• Medical Condition: Chronic lower back pain originating from the sacroiliac joint.
• Goals: To provide long-term pain relief by disrupting the nerve signals from the affected sacroiliac joint, thereby improving mobility and quality of life.

Indications

• Persistent sacroiliac joint pain unresponsive to conservative treatments like physical therapy or medications.
• Diagnosed sacroiliac joint dysfunction confirmed by diagnostic block injections.
• Patients who experience significant but temporary pain relief from diagnostic nerve blocks.

Preparation

• Patients may need to fast for a few hours before the procedure.
• Adjustments in current medications (e.g., blood thinners) as advised by the physician.
• Pre-procedure imaging and diagnostic nerve blocks may be required to confirm the source of pain.

Procedure Description

1. Initial Preparation: The patient lies on an examination table. IV access may be established for fluids or medications.
2. Anesthesia: Local anesthesia is applied to numb the area; sedation may be offered for patient comfort.
3. Imaging Guidance: Fluoroscopy or CT scan is used to guide the placement of the needle.
4. Needle Insertion: A thin needle is inserted through the skin, guided to the nerves around the sacroiliac joint.
5. Radiofrequency Ablation: A radiofrequency electrode is inserted through the needle, delivering heat to the targeted nerves to disrupt their function.
6. Completion: The equipment is removed, and a small bandage is applied to the insertion site.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

• Hospital
• Outpatient clinic
• Surgical center

Personnel

• Pain management specialist or interventional radiologist
• Radiologic technologist for imaging
• Nurses for assistance and patient care
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Common: Localized pain or discomfort, infection at the insertion site.
• Rare: Bleeding, nerve injury, allergic reaction to medications, failure to relieve pain.

Benefits

• Significant pain reduction in the sacroiliac joint.
• Improved mobility and overall quality of life.
• Reduced need for pain medications.
• Pain relief typically realized within a few days to weeks after the procedure.

Recovery

• Post-procedure observation for a short period.
• Instructions to rest and limit strenuous activities for a day or two.
• Gradual return to normal activities as tolerated.
• Follow-up appointments to assess pain relief and overall outcome.

Alternatives

• Physical therapy
• Medications (NSAIDs, muscle relaxants)
• Sacroiliac joint injections
• Surgical options in severe cases
• Each alternative has its own risks and benefits, and the choice depends on the individual's condition and response to previous treatments.

Patient Experience

• During: Patients might feel pressure or slight discomfort during needle insertion, but the area will be numbed.
• After: Temporary soreness at the needle site; the full effect on pain relief may take a few days.
• Pain management: Local anesthesia during the procedure and over-the-counter pain relievers post-procedure if needed.