Progressive severe kyphosis as a complication of multilevel cervical percutaneous facet neurotomy: a case report

Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI 53792, USA.
The spine journal: official journal of the North American Spine Society (Impact Factor: 2.43). 10/2012; 12(10). DOI: 10.1016/j.spinee.2012.09.037
Source: PubMed

ABSTRACT BACKGROUND CONTEXT: Percutaneous facet neurotomy is a procedure commonly used for the treatment of pain thought to originate from zygoapophyseal joint dysfunction. Some practitioners have also used this technique to treat cervicogenic headache. Previously reported complications for this procedure have been minimal and have included dysthesias and local pain. STUDY DESIGN: Case report. METHODS: Bilateral multilevel cervical percutaneous facet neurotomies were used to treat a patient suffering from a chronic headache and neck pain that had failed to respond to extensive medical management. RESULTS: Within days of completing the bilateral facet neurotomies, the patient developed head drop. Subsequent electromyography revealed denervation of the patient's paraspinous muscles. Initially the patient was managed conservatively in a cervical collar with the hope that he would recover some function. After few years, the patient developed fixed kyphotic deformity. Correction of the patient's deformity required multilevel anterior cervical discectomy and fusion followed by posterior instrumented fusion. CONCLUSIONS: When performing multilevel percutaneous cervical facet neurotomies, there is a risk of paraspinous muscle denervation, and subsequent kyphotic deformity may occur. The likelihood of this rare and previously unreported complication can probably be reduced by proper needle positioning and by minimizing the number of levels at which the procedure is performed.

6 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study was to determine the effectiveness of cervical medial branch radiofrequency neurotomy (RFN) performed by two practitioners trained according to rigorous guidelines. The study was designed as a prospective, outcome study of consecutive patients with chronic neck pain treated in a community setting. A total of 104 patients, selected on the basis of complete relief of pain following controlled, diagnostic, medial branch blocks, were treated with RFN according to the guidelines of the International Spine Intervention Society. Successful outcome was defined as complete relief of pain, or at least 80% relief, for at least 6 months, with complete restoration of activities of daily living, no need for any further health care, and return to work. Patients who failed to meet any of these criteria were deemed to have failed treatment. In the two practices, 74% and 61% of patients achieved a successful outcome. Relief lasted 17-20 months from the first RFN, and 15 months for repeat treatments. Allowing for repeat treatment, patients maintained relief for a median duration of 20-26 months, with some 60% still having relief at follow-up. Cervical RFN can be very effective when performed in a rigorous manner in appropriately selected patients. Chronic neck pain, mediated by the cervical medial branches, can be temporarily, but completely, relieved and patients fully restored to desired activities of daily living, if treated with RFN.
    Pain Medicine 03/2012; 13(5):647-54. DOI:10.1111/j.1526-4637.2012.01351.x · 2.30 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The value of radiofrequency facet rhizotomy in the treatment of patients with chronic neck and low back pain problems is assessed on the basis of experience with 117 consecutive patients. Only patients with positive responses to facet blocking with local anesthetic were selected. Overall results in 50 neck procedures were: excellent, 16%; good, 34%; fair, 18%; poor, 28%; and lost to follow-up, 4%. In the 71 lumbar rhizotomies results were: excellent, 15%; good, 20%; fair, 27%; poor, 31%; and lost to follow-up, 7%. Average follow-up time was 13.7 months. We conclude that radiofrequency rhizotomy is a valuable tool in the treatment of chronic neck and low back pain.
    International surgery 01/1978; 63(6):53-9. · 0.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Postoperative atrophy of the deep back muscles may be caused by denervation during a dorsomedian approach to the thoracolumbar spine; ensuing instability of the spine with poor clinical results, perhaps due to such muscle loss, has been observed in 11.7% of cases (Sihvonen et al., 1993, Spine 18:575--581). More specifically, this complication may be caused by damaging the medial branches of the posterior rami of the spinal nerves during lateral retraction of the muscles. To investigate the anatomic topography of the medial branches of the posterior rami of the spinal nerves, 18 carbol-formol-fixed specimens were dissected using an operation microscope; also, 3 fresh cadavers were cut in horizontal and vertical planes with a rotary cryotome to confirm the anatomic topography observed in the fixed specimens. In the thoracolumbar spine the medial branch of the posterior ramus of the spinal nerve is subject to ligamentous fixation by the strong fibers of the mammillo-accessory ligament, which extends between the mammillary process and accessory process infero lateral to the superior articular process. When the dorsomedian approach to the thoracolumbar spine is enlarged laterally to the articular processes by retracting the paraspinous muscles, the medial branches of the posterior rami of the spinal nerves are endangered. This may cause postoperative pain as well as dynamic instability beyond the corresponding segments. The results of our anatomic study suggest that the posterior surgical midline approach to the thoracolumbar spine should not be enlarged laterally to the articular processes to prevent injury to the medial branches of the posterior rami of the spinal nerves.
    Clinical Anatomy 03/2002; 15(2):77-81. DOI:10.1002/ca.1099 · 1.33 Impact Factor
Show more