Shreya N. Patel, DO
Resident Physician
MedStar/Georgetown National Rehabilitation Hospital
Arlington, Virginia, United States
James Pendleton, MD
Attending Physician, Pain Medicine
MedStar National Rehabilitation Hospital
Washington, District of Columbia, United States
A 53 year old female with spastic quadriplegic cerebral palsy (CP) and history of anterior cervical discectomy and fusion (ACDF) at C5-7 in 2015 presented with worsening right sided cervical pain, significantly limiting her ability to use head and neck controls on her powered wheelchair. Physical exam and imaging confirmed significant cervical spondylosis. After discussing technical concerns related to positioning and spasticity, she opted for a right C3-6 medial branch block (MBB) and radiofrequency ablation (RFA) pathway. Preparations were made to accommodate anticipated difficulties in patient positioning and spasticity. The patient experienced >80% pain relief from two MBBs and RFA, which lasted 8 months. This resulted in improved wheelchair control, mobility, independence, and quality of life. This case underscores the importance of physician adaptability in tailoring procedures to different patient populations.
Discussions:
Cervical spondylosis, a common degenerative condition, can cause significant pain and disability, particularly in patients with pre-existing conditions like CP. Managing cervical spondylosis in spastic quadriplegic CP is challenging due to increased muscle tone and positioning difficulties. The patient could not lay prone, had forward flexed cervical posturing, and exhibited significant spasticity with light palpation. Therefore, each procedure, including the RFA, was performed with left lateral decubitus positioning. The patient was pretreated with Diazepam 5 mg and gentle traction was applied to the right upper extremity during spastic episodes. Additionally, the presence of ACDF hardware obstructed the radiographic view, requiring a deep understanding of anatomy and proficiency in interpreting images in unconventional orientations. These adaptations emphasize the importance of physician flexibility in overcoming procedural challenges and achieving optimal outcomes.
Conclusions:
MBB and RFA can effectively manage cervical spondylosis in spastic quadriplegic CP patients with a history of ACDF. Flexible procedural approaches are essential to address spasticity and positioning challenges, highlighting the need for adaptable, individualized care.
