Sacroiliac joint injections and radiofrequency ablation for pain management: A clinical review

Table 1 A comparison of various radiofrequency ablation techniques

Technique	Target/approach	Lesion size and coverage	Procedure complexity	Typical duration of effect	Ref.
Conventional RFA	Lateral branches of sacral dorsal rami ± L5 dorsal ramus	Small focal lesions. Requires multiple needle placements	Moderate. Precise needle placement. Fluoroscopy	3-6 months. 50%-70% achieve. ≥ 50% pain relief	[61]
Cooled RFA	Similar targets. Uses an internally cooled electrode	Larger spherical lesions. Better covers anatomical variability	Higher. Specialized equipment. Longer lesion cycle	6-12 months. Better sustained benefit	[65]
PRF	Modulates nerve without thermal lesion	Very small/non-destructive lesions	Low-moderate. Shorter procedure. Lower risk	3-6 months. Repeatable. Useful for fragile nerves	[65,75]
Bipolar ‘Palisade’ RFA	Two parallel electrodes create linear lesions. Targets multiple nerves	Larger continuous strip lesions. Broader nerve coverage	Higher. Requires dual electrode placement. Faster	About 12 months. Reported higher rates of pain relief	[65,87]
Endoscopic-guided RFA	Direct visualization of target nerves with an endoscope	Precise lesioning under visual control	High. Specialized training and equipment are required	About 6-12 months. > 80% patient satisfaction	[66,84]

RFA: Radiofrequency ablation; PRF: Pulsed radiofrequency.