Sometimes the pain in the sacroiliac joint makes physical therapy and exercise too difficult to perform. In this instance, a procedure to remove the pain involves cutting or disabling the nerve that sends pain signals to the brain. With the nerve disabled, exercises can be done without pain, so when the nerve grows back, the painful issue will hopefully be resolved.
Video presented by Zinovy Meyler, DO
This video accompanies the article: Facet Rhizotomy and Sacroiliac Joint Block Injections.
Another option in non-surgical treatment of sacroiliac joint dysfunction is radiofrequency rhizotomy. Now, what that is is that technique itself has been researched a lot and mostly has been researched in treatment for the facet joints - the hinge-like joints of the spine - and that really applies to the whole spine (the lumbar, thoracic, and cervical spine). We have a lot of literature supporting its use. The theory is that in order for you to feel pain coming from a joint, that joint has to be supplied by a nerve; in other words, that communication has to occur. If we can definitively diagnose sacroiliac joint as being the cause of the pain, what we can do is eliminate the small branches that feed that information from the joint and, thereby, reduce or eliminate the pain.
Now, it used to be a very involved procedure and the reason for that is in the spine, this little branch really takes a precise and predictable path. It is held down by what is called memola accessory ligament and, therefore, we can always pinpoint its anatomical location. In the sacroiliac joint, that's not so because there is a very complicated contour to the bone. That nerve - that little branch - can take a variety of paths, so what we used to do is actually create several points of treatments that would have to be very precisely placed, pretty much hoping that we would actually get the nerve as it exits the foramen before it gets to the joint. At times we were pretty successful, and sometimes it became a somewhat frustrating procedure and halt progress both for the physician and for the patient. In recent developments, there is a new technique and a new way to do this procedure and that rhizotomy is performed by placing a probe along the path that separates the foramen and the actual joint and, by creating this barrier, we can actually eliminate those little branches.
What actually happens during the procedure is that this probe is placed and it itself has three active sites. When those three active sites are aligned, the technology is taken over and it creates treatment areas that burn the little portions of the nerve, terminating that connection. That whole procedure takes approximately eight minutes to complete once the probe is placed appropriately and then the nerves actually retreat back to their origin, which usually takes anywhere between two and four weeks before the actual relief is felt and achieved, but that provides a much longer pain relief allowing people to participate in the appropriate physical therapy exercise program, restoring the function so when the nerves do grow back, that pain may no longer be there and even though we don’t have as much literature on this, there are currently a lot of studies that are ongoing and showing a lot of promise and clinically we see really good outcomes with this procedure.