{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T12:14:23Z","timestamp":1764159263938,"version":"3.46.0"},"reference-count":29,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,22]],"date-time":"2025-11-22T00:00:00Z","timestamp":1763769600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Sacroiliitis is a painful inflammatory disorder of the sacroiliac joint, estimated to account for up to 25% of chronic low back pain. Treatment options are often limited, and many patients continue to experience symptoms despite conservative or interventional management. High-Intensity Focused ultrasound (HIFU) has emerged as a novel noninvasive neuromodulation technique. However, the contribution of individual lumbosacral nerve branches (L5\u2013S3) to pain generation during such interventions remains unclear. This study aimed to characterize the distribution of pain-related interruptions during HIFU procedures, with a particular focus on identifying the most pain-sensitive targets. Methods: Eight patients with clinically confirmed sacroiliitis underwent HIFU ablation targeting the L5\u2013S3 branches. Procedural data, including the total number of sonications and interruptions due to pain, were prospectively recorded. Statistical analyses were performed using chi-square tests, including overall distribution testing, pairwise branch comparisons, and an aggregated comparison of S3 versus all other branches combined. Effect sizes were calculated using Cohen\u2019s w. Results: Across 243 sonications, 162 interruptions (66.7%) occurred due to pain. Interruptions were unevenly distributed: 81% occurred at S2 and S3, with S3 alone accounting for 42%. S3 showed significantly more interruptions than L5 (p = 0.0022), S1 (p = 0.0150), S2 (p = 0.0055), and all other branches combined (p &lt; 0.001; w = 0.58, large effect). S2 also demonstrated greater sensitivity than L5 (p = 0.003) and S1 (p = 0.001). Subdivision analysis revealed uniformly high sensitivity across S3, whereas S1 and S2 displayed heterogeneous patterns. Conclusions: HIFU stimulation revealed disproportionate pain sensitivity in sacral branches, with S3\u2014and to a lesser extent S2\u2014emerging as dominant contributors. These findings provide new insight into sacroiliitis pathophysiology and suggest prioritization of S3 in targeted interventional management.<\/jats:p>","DOI":"10.3390\/jcm14238314","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T16:31:54Z","timestamp":1764088314000},"page":"8314","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Identifying S3 and S2 as Key Pain-Sensitive Targets in High-Frequency Ultrasound Therapy for Sacroiliitis"],"prefix":"10.3390","volume":"14","author":[{"given":"Itay","family":"Goor-Aryeh","sequence":"first","affiliation":[{"name":"Pain Center, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2637-8517","authenticated-orcid":false,"given":"Paz","family":"Kelmer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruth","family":"Gur","sequence":"additional","affiliation":[{"name":"Pain Center, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tal","family":"Harel","sequence":"additional","affiliation":[{"name":"Pain Center, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roee","family":"Sheinfeld","sequence":"additional","affiliation":[{"name":"Pain Center, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oded","family":"Jacobi","sequence":"additional","affiliation":[{"name":"Pain Center, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lior","family":"Ungar","sequence":"additional","affiliation":[{"name":"Pain Center, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel"},{"name":"Department of Neurosurgery, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"E305","DOI":"10.36076\/ppj.2012\/15\/E305","article-title":"A systematic evaluation of prevalence and diagnostic accuracy of sacroiliac joint interventions","volume":"15","author":"Simopoulos","year":"2012","journal-title":"Pain Physician"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"E713","DOI":"10.36076\/ppj.2015\/18\/E713","article-title":"Systematic Review of the Diagnostic Accuracy and Therapeutic Effectiveness of Sacroiliac Joint Interventions","volume":"18","author":"Simopoulos","year":"2015","journal-title":"Pain Physician"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"85","DOI":"10.5435\/JAAOS-D-17-00132","article-title":"Diagnosing Sacroiliac Joint Pain","volume":"27","author":"Thawrani","year":"2019","journal-title":"J. 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