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
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.
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ABSTRACT: Radiofrequency (RF) is a minimally invasive, target-selective technique that has demonstrated success in reducing pain in several chronic pain conditions. The lack of standard continuous RF ablation protocols for specific targets makes it difficult to compare the percentage of complications of RF between different studies addressing the same pain syndrome. The present article reviews the most frequent complications associated with the most widely used percutaneous continuous RF techniques in pain treatment, and the strategies used to minimize such complications.Techniques in Regional Anesthesia [amp ] Pain Management 04/2014; 18(1-2):25-34. DOI:10.1053/j.trap.2015.01.005
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ABSTRACT: Objective To determine the effectiveness and risks of fluoroscopically-guided cervical medial branch thermal radiofrequency neurotomy (CMBTRFN) for treating chronic neck pain of zygapophysial joint origin.DesignSystematic review of the literature with comprehensive analysis of the published data.InterventionsFour reviewers formally trained in evidence-based medicine searched the literature on CMBTRFN. Each assessed the methodologies of studies found and appraised the quality of evidence presented.Outcome MeasuresThe primary outcomes assessed were 100% relief of pain 6 and 12 months after treatment. Other outcomes were noted if reported. The evidence was evaluated in accordance with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system.ResultsThe searches yielded eight primary publications on the effectiveness of the procedure. The evidence shows a majority of patients were pain free at 6 months and over a third were pain free at 1 year. The number needed to treat for complete pain relief at 6 months is 2. The evidence of effectiveness is of high quality according to the GRADE system. Twelve papers were found reporting unwanted effects, most of which are minor and temporary. No serious complications have ever been reported from procedures performed according to the published guidelines. The evidence of risks is of low quality according to the GRADE system.Conclusions If performed as described in the International Spine Intervention Society Guidelines, fluoroscopically-guided CMBTRFN is effective for abolishing zygapophysial joint pain and carries only minor risks.Pain Medicine 09/2015; DOI:10.1111/pme.12928 · 2.30 Impact Factor
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