Objective:

We aimed to compare the efficacy, procedure time, radiation exposure, and adverse event profile of cooled and tined radiofrequency ablation (RFA) needles in the treatment of Sacroiliac joint (SIJ) pain.

Background:

SIJ pain frequently causes low back discomfort, often managed non-surgically with physical therapy, medications, injections, or RFA. RFA needle designs—cooled versus tined—create different lesion patterns: cooled needles produce a long, single thermal lesion, while tined needles use deployable electrodes for a wider, bipolar lesion.

Design/Methods:

The data was gathered via a retrospective chart review spanning from November 2023 to February 2024. The primary endpoints for this investigation were the total procedure time and the fluoroscopy (radiation) exposure. Secondary endpoints included changes in pain and physical function over a one-year period, as documented in the Clinical Use of Patient Reported Outcomes database. Statistical methods employed included descriptive statistics, T-tests, the Mann-Whitney U test, and Chi-square tests to analyze adverse events and changes in medication usage. 

Results:

We analyzed 267 patient records; 85 provided sufficient data on pain and functional outcomes. The internally cooled needle group demonstrated significantly longer surgical times (55.4±13.7 minutes vs. 36.9±12.3 minutes; P<0.001). Patients treated with cooled needles experienced a greater number of fluoroscopy events (140.0±77.0 vs. 111.0±60.2; p<0.001). Total radiation exposure was also higher in the cooled needle group (1.68±0.83 minutes vs. 1.30±0.87 minutes; p<0.001). Both needle types achieved a reduction in pain at the one-year mark, with no statistically meaningful difference between the groups in overall pain relief. The cooled needle group maintained significant improvements on the numeric rating scale (pain), while the tined needle group showed significant enhancements in physical function at both two weeks and one year.

Conclusions:

The use of cooled needles necessitates more operative time and greater radiation exposure without providing any distinct advantage in long-term pain relief or functional improvement compared to tined needles.