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Final Program


Final Program

1019 - Unique Challenges of Treating Low Back Pain in the Setting of Underlying Desmoid Tumor: A Case Report

Thursday, February 27, 2025
5:00 PM - 6:30 PM MST

    Presenting Author(s)

  • TK

    Tanner Kimball, DO

    Resident Physician
    HCA Tristar Skyline
    Nashville, Tennessee, United States

    • Co-Author(s)

  • AG

    Alexander S. Goggins, MD

    Resident Physician
    TriStar Skyline GME
    Nashville, Tennessee, United States

  • AS

    Alex Schmidt, MD

    Attending Physician
    Premier Pain and Spine Center
    Nashville, Tennessee, United States

Case Diagnosis: lumbar spondylosis and levoscoliosis related to benign desmoid tumor

Case Description: A 39-year-old female with a benign desmoid tumor presented with right-sided low back, flank, and hip pain, but without neurological symptoms or saddle anesthesia. MRI revealed a 10.7 x 13.1 x 7.9 cm hypointense lesion near the right iliac crest, affecting adjacent structures. Lumbar X-rays showed levoscoliosis centered at L4, with corresponding facet arthropathy. Despite undergoing two chemotherapy regimens, the patient experienced minimal tumor shrinkage or symptom relief. Orthopedic oncology deemed mass resection or radiation unsuitable. Despite conservative management, the patient experienced ongoing pain from multiple sources: tumor-related, myofascial, and lumbar facet-mediated. Interventional treatment with bilateral L2-4 medial branch radiofrequency ablation (RFA) was performed, resulting in significant relief of axial low back pain lasting several months.

Discussions:

This case underscores the complexities of managing low back pain in the context of desmoid tumors and associated levoscoliosis. Desmoid tumors are rare, benign tumors characterized by local invasion without metastasis. They can cause significant anatomical displacement, nerve compression, altered biomechanics, and persistent pain. This can complicate treatment approaches. Radiofrequency ablation (RFA) is an effective treatment for low back pain; however, its application becomes particularly complex in this setting. The spinal curvature can alter the anatomical position of the medial branches, making accurate targeting of the nerves more challenging, especially in the presence of a desmoid tumor. Additionally, there is concern that repeated RFA might accelerate degenerative changes in patients with pre-existing spinal pathologies due to the medial branch's innervation of postural muscles.

Conclusions:

This case highlights the need for a personalized treatment approach, emphasizing the importance of careful monitoring and consideration of potential complications. Addressing the interplay between desmoid tumors, levoscoliosis, and RFA treatment requires a nuanced strategy to effectively manage low back pain while minimizing risks and optimizing outcomes.