CAC meeting questions

Sacroiliac Joint Nerve Blocks and Sacroiliac Joint Destruction Procedures
CAC Meeting Questions

1. What clinical criteria or validated scoring systems should be required to confirm SIJ (Sacroiliac Joint) pain prior to authorizing interventional procedures?
2. Are there specific comorbid conditions (e.g., inflammatory arthropathies, prior spine surgery) that predict better or worse outcomes following SIJ nerve blocks?
3. Are there specific comorbid conditions (e.g., inflammatory arthropathies, prior spine surgery) that predict better or worse outcomes following radiofrequency ablation (RFA)?
4. What are the risks and benefits of performing bilateral SIJ nerve blocks in the same session, and does literature support medical necessity for bilateral treatment?
5. What does the evidence indicate regarding the appropriate frequency of SI joint injections and any recommended limitations on the total number of injections over a defined period?
6. What does the evidence indicate regarding the appropriate frequency of SIJ RFA and any recommended limitations on the total number of RFA over a defined period?
7. Is there evidence-based guidance on when to transition from therapeutic SIJ nerve blocks to RFA—i.e., after how many injections or what degree of relief?
8. Is there updated literature to support any patient-specific factors (age, duration of symptoms, psychosocial factors) that influence the success rates of SIJ nerve blocks?
   1. Is there literature to support any patient-specific factors that influence the success rates of SIJ RFA?
9. What are the comparative complication rates for SIJ nerve blocks and SIJ RFA, and does the evidence suggest specific procedural precautions to reduce risk?
10. Would a repeat diagnostic block be indicated after a prolonged period without SIJ treatment?
    1. If yes, what duration of time would be considered a ‘prolonged period’?
    2. Is a past positive diagnostic block sufficient to proceed with further interventions?
11. Is there literature supporting post-procedure care protocols (e.g., activity restrictions, physical therapy timelines) that improve durability of relief after SIJ nerve block or RFA?
12. What evidence exists regarding the long-term outcomes of SIJ blocks in patients with prior lumbar fusion, and should these patients follow a modified diagnostic or therapeutic pathway?
13. Are there validated outcome measures specific to SIJ interventions that should be required for documentation of treatment response (e.g., pain scales, functional assessments)? If so, what are they?
14. Is there a way to determine intra- or extra- articular pathology? If so, how?
15. Do you feel that the duration and frequency of 2 RFAs in 12 months is appropriate?
16. What evidence exists to support the use of ‘cooled’ RFA, cryoneurolysis, or chemical destruction in the treatment of SIJ pain?
    1. What type of patient would this treatment be beneficial for?
    2. What is the frequency for these treatments?
    3. What are the risks associated with these procedures?