Sean Hendrix, MD
Physiatry Resident
Charles Drew University
Long Beach, California, United States
Calvin Ho, MD
Associate Program Director
Charles R. Drew University of Medicine and Science
Los Angeles, California, United States
Sara Buckley, DO
Resident Physician
Charles Drew University
long, California, United States
Eric Poole, MD
Resident Physician, PGY-2
Charles Drew University of Medicine & Science
Long Beach, California, United States
Agnes Wallbom, MD
Professor
Charles R. Drew University
Los Angeles, California, United States
Richard Thai, DO
Clinical Assistant Professor
Charles Drew University
Los Angeles, California, United States
Adjacent Segment Disease due to Vertebral Body Auto-Fusion
Case Description:
63 y/o male referred to Pain Clinic for chronic low back pain refractory to physical therapy, oral and topical medications. Based on history, exam, and imaging, presentation was suspicious for lumbar facet-mediated pain. Bilateral lumbar L3, L4, L5 medial branch blocks (MBB) and radiofrequency ablation (RFA) was recommended. Patient underwent MBB with 100% relief, however, RFA failed to provide meaningful relief. He returned 6 months later with unrelieved low back pain. Review of the lumbar spine MRI noted a vertebral body auto-fusion of lumbar L3-L4. Given concerns of adjacent segment disease MBB was reattempted at the facet joints above the fusion; L1, L2 medial branches (MB) targeting L2/L3 facet joints, and below the fusion; L3, L4 MB for L4/L5 facet joints. With 100% pain relief from the block, bilateral Lumbar L1, L2, L3 and L4 MB RFA completed. Four months after the procedure, patient reported continued pain relief of 60%.
Discussions:
Failed back syndrome after lumbar fusion is commonly escalated to neuromodulation, however, there have been case studies highlighting successful RFA for adjacent segment disease. This is the first reported case of RFA in adjacent segment disease due to lumbar vertebral body auto-fusion.
Conclusions:
FA has been shown to be a successful modality in treating chronic low back pain due to facet-mediated pain. There have been case studies demonstrating the efficacy of RFA in treating patients with adjacent segment disease due to surgical fusion. RFA for adjacent segment syndrome should be considered for patients with lumbar vertebral auto-fusion with axial low back pain.
