Curr Rev Musculoskelet Med (2009) 2:10–14 et al. [2] recently completed a systematic review of SIJ interventions and found limited evidence for the usefulness of radiofrequency neurotomy in managing SIJ pain. The investigators found ﬁve retrospective reports of radiofre- quency ablation of the SIJ that met key Agency for Healthcare Research and Quality (AHRQ), Quality Assessment for Diagnostic Accuracy Studies (QUADAS), and Cochrane Review Group criteria for studies, including a requirement for greater than 3 months of follow-up. Three of the studies showed positive short-term (less than 3 months) and long-term (greater than or equal to 3 months) pain relief, while one study by Vallejo et al. showed positive short-term and negative long-term relief, and another study by Ferrante et al. showed negative short- term and negative long-term relief. Ferrante studied records of 33 patients with SIJS who were diagnosed by a single anesthetic block and found that only 36% of patients had greater than a 50% decrease in visual analog pain scores at 6 months [25]. The results were judged to be negative by Hansen’s systematic review, and Yin et al. [21] asserts that some of the patients in Ferrante’s report may have had other causes of their back pain, since only a single diagnostic block was used. Vallejo et al. found in their prospective case series of 22 patients with SIJS diagnosed by comparative anesthetic blocks who had failed physical therapy and SIJ injections, 16 patients (73%) had pain relief from radiofrequency neurotomy. Of these 16 patients, 4 patients had relief for 6–9 weeks, 5 patients had relief for 10–16 weeks, and 7 patients had relief for 17–32 weeks [22]. Pain relief was measured by visual analog score (VAS) and was consid- ered to be adequate if greater than 50% reduction in VAS was achieved. The technique used the treatment of radio- frequency neurotomy was PRFN of the medial branch of L4, posterior primary rami of L5, and lateral branches of S1 and S2. PRFN consisted of radiofrequency current at short bursts as opposed to continuous current, in order to allow cooling of tissues between pulses and less tissue destruction and therefore less pain from the procedure. The authors contend that the temperature of the surrounding tissues does not impact the effectiveness of the procedure and that the mechanism by which radiofrequency neurot- omy works is unclear. Burnham and Yasui evaluated nine patients with SIJ pain conﬁrmed by a local anesthetic block. The investi- gators treated the patients with radiofrequency neurotomy, consisting of radiofrequency strip lesions adjacent to the lateral dorsal foraminal aperture and conventional mono- polar lesioning at the L5 dorsal ramus. Signiﬁcant reductions of back and leg pain and analgesic intake evaluated by patient questionnaire were found at 1, 3, 6, 9, and 12 months of follow-up [26]. 13 Yin et al. in a retrospective chart review studied 14 patients with SIJS conﬁrmed by double anesthetic blocks and found that 64% experienced relief of pain after sensory- stimulation guided sacral lateral branch radiofrequency neurotomy. Pain relief was deﬁned as greater than 60% subjective relief and greater than 50% decrease in visual integer pain score, and the follow-up period was 6 months. The investigators also found that 34% of the patients reported complete relief [21]. Cohen and Abdi performed radiofrequency neurotomy on nine patients with SIJS conﬁrmed by 50% pain relief after nerve blocks of the L4–5 primary dorsal rami and S1–S2 lateral branches. The investigators found that 89% of the nine patients obtained 50% or greater pain relief after radiofre- quency neurotomy of the affected joint at 9 months [27]. Conclusion Radiofrequency neurotomy has been shown to have limited evidence in treating SIJS. There are no randomized, con- trolled trials to evaluate this procedure. Variability in results has been attributed to individual nerve patterns, improper diagnosis, and selection of patients, as well as variability in the procedure itself. Future studies will be needed to focus on the type of radiofrequency neurotomy and positioning of electrodes to better evaluate efﬁcacy. Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which per- mits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. References 1. Leblanc KE. Sacroiliac sprain: an overlooked cause of back pain. Am Fam Physician. 1993;48(8):1388–90. 2. Hansen HC, McKenzie-Brown AM, Cohen SP. Sacroiliac joint interventions: a systematic review. Pain Physician. 2007;10: 165–84. 3. 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