Curr Rev Musculoskelet Med (2009) 2:10–14 DOI 10.1007/s12178-008-9038-z Review article: radiofrequency neurotomy for the treatment of sacroiliac joint syndrome Stasia Bochnowski Muhlner Published online: 31 March 2009 The Author(s) 2009. This article is published with open access at Springerlink.com Abstract We review here the latest studies on efﬁcacy of and techniques employed in radiofrequency neurotomy of the sacroiliac joint. Radiofrequency neurotomy has been shown to have limited evidence in treating sacroiliac joint syndrome. Variability in results has been attributed to individual nerve patterns, improper diagnosis, and selec- tion 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. Keywords Sacroiliac joint Low back pain Radiofrequency neurotomy Radiofrequency ablation Radiofrequency denervation Radiofrequency nerve block Introduction For the general practitioner, sacroiliac joint syndrome (SIJS) can sometimes be overlooked as a cause of low back pain [1]. However, a recent systematic review by Hansen et al. [2] revealed that the sacroiliac joint (SIJ) is estimated by a double nerve block paradigm to be a source of low back pain in 10–27% of people with chronic low back pain. Painful conditions of the SIJ are known to result from infection [3], malignancy [4], pregnancy [5], and either acute or repetitive trauma [5]. Symptoms include low back, buttock, and thigh pain, and sometimes sciatic-like radi- ating pain. SIJS has been shown to occur bilaterally or unilaterally [6]. S. B. Muhlner (&) Keck School of Medicine at USC, Los Angeles, CA, USA e-mail: smuhlner@usc.edu The review by Hansen et al. [2] concluded that while there are no historical, physical, or radiological features to deﬁnitively diagnose SIJ pain, comparative, controlled anesthetic blocks have moderate evidence of validity in diagnosis. Comparative controlled anesthetic blocks used in the studies covered by the review consisted of a 2% lidocaine injection to screen for SIJ dysfunction, followed by a 0.5% bupivicaine injection in patients who had a positive response to the lidocaine block, in order to conﬁrm true SIJ dysfunction. A positive response to either block was considered to be relief of pain, though studies differed on the amount and duration of pain relief that qualiﬁed as a positive response. The innervation of the SI joint ranges from the posterior primary rami of L-4 through S-3 and the anterior primary rami from L-2 through S-2 [7]. Innerva- tion is variable; therefore, presentations of symptoms are often variable as well. In addition, pain may be referred from dermatomes or adjacent structures, and different sections of the SI joint may be damaged, also accounting for symptom variability [8] (Fig. 1). Diagnosis There are a variety of physical exam tests that have been used to help elucidate whether the SI joint may be a con- tributing or isolated cause of low back pain. These include the FABER test, distraction test, the compression test, the Gaenslen’s test, and the Patrick’s test, among others. However, there has been documented poor inter- and intra- tester reliability with these tests. In addition, Dreyfuss et al. [9] found positive results in up to 20% of asymptomatic patients, suggesting poor speciﬁcity of using such exams for diagnosis. Slipman et al. [10], however, demonstrated a positive predictive value of 60% in diagnosing SIJS in patients with a minimum of three positive provocative SIJ