Sacroiliac Joint Radiofrequency Ablation Therapy After Sacroiliac Joint Fusion

Sacroiliac joint dysfunction (SIJD) is a significant contributor to lower back pain, and the condition often mimics other lower back pain syndromes, necessitating accurate diagnosis through history, physical examination, provocative tests, and imaging studies. We present a 67-year-old man with a history of sarcoidosis, deep vein thrombosis, prostate cancer, and chronic low back pain, who experienced persistent right-sided back and hip pain despite multiple surgeries, including bilateral sacroiliac joint (SIJ) fusion. Conservative treatments provided only partial relief. A diagnostic SIJ injection with bupivacaine confirmed SIJD as the primary pain source, leading to a radiofrequency ablation (RFA) procedure. The SIJ RFA provided a significant pain reduction. The treatment algorithm for SIJD prioritizes conservative approaches such as nonsteroidal anti-inflammatory drugs, physical therapy, and SI belts. When these fail, interventional techniques, including joint injections and RFA, are considered before surgery. This case highlights the importance of reassessing SIJD treatment even after SIJ fusion, demonstrating that interventional strategies like repeat RFA can provide meaningful pain relief in select patients. Effective management of SIJD requires a stepwise approach, with diagnostic injections playing a key role in confirming pain sources. This case underscores the need for individualized treatment strategies, particularly for patients with persistent pain despite prior surgical interventions.