Mustafa R. Dodurgali, MD
Resident Physician
Yale School of Medicine
New Haven, Connecticut, United States
Charles A. Odonkor, MD
Assistant Professor of Orthopaedics & Rehabilitation
Yale School of Medicine
New Haven, Connecticut, United States
Management of posterior column pain due to bony osteophytosis of the posterior longitudinal ligament and intertransverse ligament in post spinal surgery syndrome.
Case Description: A 73-year-old male with a history of lumbar spondylosis and previous spinal fusion initially presented with chronic posterior column pain. His pain was exacerbated by bony osteophytosis involving the posterior longitudinal ligament and intertransverse ligament, contributing to post spinal surgery syndrome. Despite conservative treatments, including physical therapy and medication, the patient experienced persistent lower back pain, which significantly impaired his daily activities and quality of life. In June 2021, the patient underwent right lumbar radiofrequency ablation (RFA) targeting the L3-4, L4-5, and L5-S1 facet joints, which provided immediate and complete pain relief. Following this successful outcome, a subsequent left lumbar RFA was performed later that month, resulting in sustained relief of his chronic back pain. After these procedures, the patient reported significant improvement in his pain levels and overall function for an extended period.
Discussions: Post spinal surgery syndrome is a multifactorial condition characterized by chronic pain. One contributing factor is bony osteophytosis of the posterior longitudinal and intertransverse ligaments, which can lead to mechanical irritation of surrounding tissues, including nerve structures, and complicate the recovery process. This condition often causes persistent pain and discomfort that is resistant to conservative treatments like medications, physical therapy, and joint injections. Radiofrequency rhizotomy (RFR), a minimally invasive procedure performed under fluoroscopic guidance, targets and destroys specific nerve fibers responsible for pain signal conduction and offers both immediate and long-lasting relief. RFR presents a safer and faster recovery alternative to major surgery and reduces the need for long-term medications.
Conclusions:
Radiofrequency rhizotomy can be an effective treatment for managing posterior column pain in post spinal surgery syndrome. Early intervention with RFR prevents long-term discomfort and improves the quality of life.
