Radiofrequency nerve ablation for lower back pain, Case Report

Introduction: Back pain is a common condition that many people experience. In fact, over 80% of the world's population will have lower back pain at some point in their life.1 Radiofrequency ablation, also called rhizotomy, is a nonsurgical, minimally invasive procedure that uses heat to reduce or stop the transmission of pain, it is an emerging treatment option for chronic low back pain.2 Case description: A 65-year-old patient with lumbar spine pain comes in for an examination at a pain management facility, which is part of Anesthesiology, intensive care medicine and pain management clinic of the Clinical hospital centar Rijeka. At the first examination, the patient complains of severe pain in the lumbar spine with propagation in the left leg, and also complains of pain in both sacroiliac joints. The pain is chronic and intensifies during walking or standing. According to the performed MR, diagnoses of degenerative changes on vertebral segments from L2 - S1 are made. Additional physician finding, efflorescence of herpes zoster on the sacral region. The patient used tramadol chloride / paracetamol 37.5mg / 325mg 3 to 4 times daily and celecoxib 100mg twice daily, orally. Within period of pain management, 3 facet joint blocks, one medial branch block, and an acupuncture procedure were performed. There is a satisfactory reduction in pain for the next 3 months after each procedure and return to full mobility, with discontinuation of oral therapy. The patient underwent radiofrequency ablation of the medial branch nerve at L2, L3, L4, L5 vertebrae bilateral, due to the long-lasting analgesic effect. The ablation procedure proceeds smoothly without neurological outbursts, loss of sensation and mobility of the lower limbs with a corresponding long-lasting analgesic effect with the cessation of oral therapy. Discussion: Radiofrequency ablation is a safe and long-lasting treatment option for patients who have experienced successful pain relief after a diagnostic nerve/pain receptor block injection. Conclusion: Pain relief after medial branch nerve ablation may last from 9 months to more than 2 years. It is possible the nerve will regrow through the burned lesion that was created by radiofrequency ablation. If the nerve regrows, it is usually 6-12 months after the procedure. The procedure can be repeated if needed.