Eric Poole, MD
Resident Physician, PGY-2
Charles Drew University of Medicine & Science
Long Beach, California, United States
Sean Hendrix, MD
Physiatry Resident
Charles Drew University
Long Beach, California, United States
Sara Buckley, DO
Resident Physician
Charles Drew University
long, California, United States
Calvin Ho, MD
Associate Program Director
Charles R. Drew University of Medicine and Science
Los angeles, California, United States
Richard Thai, DO
Clinical Assistant Professor
Charles Drew University
Los Angeles, California, United States
Agnes Wallbom, MD
Professor
Charles R. Drew University
Los Angeles, California, United States
Lumbar Spondylosis Secondary to L5-S1 Spondylolisthesis with Bilateral L5 Pars Defect
Case Description:
A 61-year-old male presented to the pain clinic with lower back pain exacerbated by driving but relieved through exercise, stretching, and riding his tricycle. He described axial pain just above the PSIS, more pronounced on the right side, with no radicular symptoms. Radiographic imaging from 2019 revealed a bilateral L5 pars defect, 2 mm retrolisthesis at L4/L5, and 6 mm anterolisthesis at L5/S1. Initial treatment with bilateral L3-L5 medial branch blocks (MBB) provided significant relief for about five years with interdisciplinary care and multimodal analgesia. Upon return, the patient reported worsening symptoms but no bladder or bowel issues. A follow-up radiograph from 2024 showed progression of spondylolisthesis to 4 mm at L4/L5 and 7 mm at L5/S1. He then underwent bilateral lumbar L3-L5 pulse radiofrequency ablation under fluoroscopy, resulting in 60-70% relief of his symptoms.
Discussions:
The progression rate of degenerative lumbar spondylolisthesis remains uncertain. Despite prior attempts at achieving long-term relief through multidisciplinary care, pulse radiofrequency ablation offered immediate symptom improvement. This case highlights the efficacy of radiofrequency ablation for pain management. Further follow-up imaging is necessary to determine if this treatment accelerates spondylolisthesis progression. Furthermore, the natural baseline progression rate without intervention also requires further investigation.
Conclusions:
Medial branch nerve radiofrequency ablation appears to present minimal risk for advancing spondylolisthesis in patients with degenerative lumbar spondylosis and facet arthropathy, likely similar to the natural disease progression without intervention. This suggests that radiofrequency ablation is generally safe for pain management in patients with chronic back pain. However, additional research is needed to evaluate whether this therapy may contribute to increased spondylolisthesis progression in certain patient populations.
