Bipolar Radiofrequency Neurotomy to Treat Neck and Back Pain in Patients with Automatic Implantable Cardioverter Defibrillator

2019-04-04 10:16:47 Hu Lijuan 0

Alexander Bautista, MD1, Alisher Dadabayev, MD2, Ellen Rosenquist, MD2,and Jianguo Cheng, MD2

Pain Physician 2016; 19:E505-E509 • ISSN 2150-1149

We report 2 cases of successful treatment of neck and back pain with bipolar radiofrequency

ablation (RFA) of the cervical and lumbar facet joints in patients with an automatic implantable

cardioverter defibrillator (AICD).

Two patients with complex cardiac histories and AICD devices were treated with bipolar RFA

of the facet joints. One presented with axial neck pain and the other with axial back pain. The

histories and physical examinations were consistent with facetogenic pain. Diagnostic medial

branch block resulted in more than 70% pain relief lasting for several days, allowing patients

to perform routine daily activities without significant pain. However, we were concerned about

the use of conventional RFA of the medial branches of nerves for the fear of interference with

the function of AICD by the RF currents and energy. We took advantage of the localized and

limited current of bipolar RFA to perform this procedure for the cervical or lumbar facet joints

avoiding any interference with the function of AICD. The procedures provided long-term pain

relief to the patients, and marked improvement in their functional status without any evident

complications related to the function of their AICD.

This case report describes the safe and successful completion of bipolar RFA of the medial

branch nerves to treat cervical and lumbar facetogenic pain in patients with AICD. This modality

of treatment may be considered in patients with AICD. We are finding it to be increasingly

common that patients who present with chronic neck and back pain have AICDs in place.

Key words: Back pain, neck pain, facet, AICD, radiofrequency neurotomy, bipolar lesioning

Pain Physician 2016; 19:E505-E509

   


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