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


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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