Introduction and Background
Chronic spinal pain affects over 820 million people globally, with sacroiliac joint (SIJ) pain being one of the main contributors involving degenerative changes, nerve sensitisation, and functional impairment. When conservative management fails, radiofrequency ablation (RFA) is a key interventional option, using minimally invasive electromagnetic energy to modulate pain-transmitting neural structures. Although RFA produces meaningful pain reduction, its effects are limited to six to twelve months as it does not address underlying degenerative pathology. There is thus growing interest in combining RFA with platelet-rich plasma (PRP), with preliminary studies showing superior outcomes. The literature remains limited, consisting of small-scale studies with no established protocol for patient selection, procedure, or outcome measurement. This review examines pain outcomes to analyse the utility of combining RFA with PRP and presents the rationale and proposed methodology for a comparative study.
Materials and Methods
A narrative literature review was conducted examining pain outcomes of RFA with and without adjunctive PRP across SIJ pain substrates. The proposed prospective comparative cohort study will include patients with chronic facet joint and SIJ pain at a single tertiary neurosurgical centre, divided into RFA-alone and RFA-with-PRP groups. Diagnosis will be confirmed via intra-articular block for SIJ dysfunction. All procedures will follow a standardised protocol. Patients will complete the VAS, ODI, RMDQ, and EQ-5D-5L at baseline, six weeks, three, six, and twelve months. Statistical analysis will include paired t-tests, ANCOVA, multivariable linear regression, and Kaplan-Meier survival analysis with log-rank testing.
Results
RFA produces time-limited pain reductions across spinal levels.For SIJ pain, Patel et al. reported 47% meeting the 50% reduction criterion at three months, declining to 38% by six months, with recurrence attributed to sacral lateral branch regeneration. Overall certainty of evidence is rated very low to moderate by GRADE-applying systematic reviews, limited by heterogeneous selection, variable technique, and inconsistent diagnostic protocols; 30–53% of patients failed to achieve the 50% threshold at three months in sham-controlled trials using dual diagnostic block confirmation. For combined RFA and PRP, Singh et al. demonstrated VAS scores of 0.47 at three months and 0.07 at six months, with ODI declining from 32.3 to 8.9, consistently outperforming the RFA-alone arm. All combined studies received GRADE Level IV classification. No trial has followed a combined cohort beyond six months, no controlled study has examined the combination at the SIJ, and PRP preparation remains unstandardised.
Conclusion
RFA provides insufficient and time-limited relief due to its inability to address underlying spinal degeneration. PRP targets this gap by delivering growth factors to the pathological structure, yet this remains inadequately investigated in spinal contexts. Available evidence shows a consistent trend of better pain outcomes with combined RFA and PRP, but cannot resolve whether this reflects durable attenuation of pathology or delayed recurrence of equivalent magnitude. A comparative study with standardised diagnostic selection, RFA protocols, and twelve to twenty-four months of follow-up is required.