SI joint radiofrequency ablation uses cooled radiofrequency technology (such as the Coolief or SIMPLICITY system) to create larger, more effective lesions on the nerves that supply the sacroiliac joint. Unlike conventional RF which produces small round lesions, cooled RF creates larger spherical lesions that more reliably capture the complex nerve supply of the SI joint.
Cooled radiofrequency probes are positioned along the lateral sacral crest targeting the lateral branch nerves (S1-S3) and the L5 dorsal ramus. Water continuously circulates through the probe during ablation, allowing the thermal lesion to extend further from the probe.
The procedure provides 6-12 months of pain relief, sometimes longer, and can be repeated when pain returns. It is appropriate for patients who have previously obtained diagnostic relief from intra-articular SI joint injections.
During cooled radiofrequency ablation, a specialized probe with an internal water-cooling system is positioned adjacent to the target nerves. The cooling allows higher energy delivery without overheating the tissue immediately adjacent to the probe, resulting in a larger, more consistent lesion that encompasses the complex and variable nerve supply of the SI joint.
The lateral branch nerves from S1-S3 and the L5 dorsal ramus are typically targeted. Multiple lesions are created along the lateral sacral crest to achieve comprehensive denervation.
The procedure is performed under conscious sedation. Multiple probe positions are required to cover the full nerve supply of the SI joint. The procedure typically takes 45-90 minutes depending on the number of targets treated.
Patients may experience soreness at the treatment sites for 3-7 days following the procedure. The full analgesic effect develops over 2-4 weeks.
Activity restrictions are minimal. Most patients can return to work and normal activities within 1-3 days. Some patients report increased pain for the first week before the therapeutic effect becomes apparent.
As with facet RFA, the treated nerves regenerate over time, and the procedure can be repeated when pain returns.
SI joint RFA is indicated for patients who have obtained significant but temporary relief from diagnostic SI joint injections. Contraindications include active infection, coagulopathy, and prior allergic reactions.
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