Comparison of Quadrapolar™ radiofrequency lesions produced by standard versus modified technique: an experimental model

Abstract

Lower back pain (LBP) is a global public health issue and is associated with substantial financial costs and loss of quality of life. Over the years, different literature has provided different statistics regarding the causes of the back pain. The following statistic is the closest estimation regarding our patient population. The sacroiliac (SI) joint pain is responsible for LBP in 18%–30% of individuals with LBP. Quadrapolar™ radiofrequency ablation, which involves ablation of the nerves of the SI joint using heat, is a commonly used treatment for SI joint pain. However, the standard Quadrapolar radiofrequency procedure is not always effective at ablating all the sensory nerves that cause the pain in the SI joint. One of the major limitations of the standard Quadrapolar radiofrequency procedure is that it produces small lesions of ~4 mm in diameter. Smaller lesions increase the likelihood of failure to ablate all nociceptive input. In this study, we compare the standard Quadrapolar radiofrequency ablation technique to a modified Quadrapolar ablation technique that has produced improved patient outcomes in our clinic. The methodology of the two techniques are compared. In addition, we compare results from an experimental model comparing the lesion sizes produced by the two techniques. Taken together, the findings from this study suggest that the modified Quadrapolar technique provides longer lasting relief for the back pain that is caused by SI joint dysfunction. A randomized controlled clinical trial is the next step required to quantify the difference in symptom relief and quality of life produced by the two techniques.

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Keywords:

• lower back pain
• radiofrequency ablation
• sacroiliac joint
• Quadrapolar radiofrequency ablation

Acknowledgments

A sincere thanks to Modjeh Nassaj, Arya Safakish, Aryan Safakish, and Genane Loheswaran for their assistance and contributions during the lesioning experiment. A very special thanks to Dr Gil Faclier, MD; Dr Kevin Smith, MD; Dr Tina Emadi, MD; and Dr Morley-Forster, MD, for their assistance in editing the manuscript. A very sincere thanks to Diros Technology for allowing us to use their facilities to conduct the study.

Disclosure

The author reports no conflicts of interest in this work.