Current standard treatment modality for facet joint syndrome and pain originated from SI joint is steroid injection that is short-lived. Fluoroscopy-guided RF ablation of medial branch or lateral sacral nerve branches provides a longer-lasting effect.

1. ENDOSCOPIC SPINE SURGERY
DR. REZA AMINNEJAD

2. DR. REZA AMINNEJAD

3. The lifetime prevalence of LBP : 60-80%
The lifetime prevalence of CLBP: 4-10%
Facet joint syndrome (FJS) is responsible for 15-45% of CLBP
cases.
Sacroiliac joint (SIJ) is the source of pain in 10-33% of CLBP
cases.
Current standard treatment modality for FJS and pain originated
from SIJ is steroid injection.
Fluoroscopy-guided RF ablation of medial branch or lateral
sacral nerve branches provides a longer-lasting effect. Despite
known benefits of this treatment modality, extensive ablation can
scar adjacent muscular and ligamentous structures. Scaring itself
can become a source of CLBP.

4. INDICATIONS & CONTRAINDICATIONS
Medial Branch RFA SIJ RFA
DR. REZA AMINNEJAD

5. SURGICAL
TECHNIQUE
Prone position
Light anesthesia (IV Sedation
for maintaining patient-
physician communication)
P & D
Equipment preparation
DR. REZA AMINNEJAD

6. MEDIAL BRANCH RFA
Facet joint innervation:
Ascending medial branch at the
index level
Descending medial branch from
the level above it. (needs to be
ablated as well)
DR. REZA AMINNEJAD

7. ABLATION TARGET
POINT
Junction of the transverse
process and the base of
the SAP
DR. REZA AMINNEJAD

8. DR. REZA AMINNEJAD

9. Ablation starts at soft tissue at the
base of the transverse process.
Pain would be elicited because of
medial branch irritation in this site.
If pain is too much for the patient
to bear, injection of 0.5-1 ml of
lidocaine at the target through an
18 G. needle prior to ablation is
recommended.
The ablation is done preferably in
short bursts of 2-3 sec to prevent
excessive charring.
The process is continued until
stimulation of the previously
ablated area doesn't elicit any
significant pain.
DR. REZA AMINNEJAD

10. SIJ RFA
The C-arm transducer is
tilted cephalad 10-15
degrees and obliqued 10-15
degrees contralaterally to
optimally visualize the
posterior aspect of the SIJ.
The skin entry point is the
inferior aspect of the
posterior SIJ.
DR. REZA AMINNEJAD

11. DR. REZA AMINNEJAD

12. ABLATION
Posterior SI ligament and soft
tissue overlying it
Perforating branches innervating
the posterior capsule of the SIJ
Long strip of lesion along the line
connecting the lateral margins of
the S1-S3 sacral foramina
DR. REZA AMINNEJAD

13. PRACTICAL POINTS
DR. REZA AMINNEJAD

14. AVOIDING COMPLICATIONS
DR. REZA AMINNEJAD

15. POSTOPERATIVE CONSIDERATIONS
DR. REZA AMINNEJAD

16. THANKS FOR YOUR
ATTENTION
DR. REZA AMINNEJAD