Case Report: Lumbar Facet Joint pain

Spine & Nerve

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves present a case of a relatively young patient with lumbar facetogenic pain in the setting of spondylolisthesis with some level of dynamic instability. There is strong evidence for the treatment of lumbar facetogenic pain with lumbar medial branch radiofrequency ablation (RFA), including a recent study published in Pain Medicine in 2020 demonstrating sustained benefit after RFA for over 2 years (Conger et al., Pain Medicine. 2020). However, when the anatomy is considered including the fact that the medial branch targeted with RFA also innervates the multifidus musculature; one may hypothesize that RFA could potentially negatively impact spinal stability. This negative impact on spine stability would be of particular concern in a young patient with listhesis and dynamic instability. The available published literature investigating this topic has demonstrated that RFA does not result in a significant negative impact on listhesis or instability. As providers considering, ordering, and/or performing these procedures, it is important to be aware of the relevant neuroanatomy and the published research regarding this matter; and importantly to discuss these risks/benefits with the patient. Listen as the doctors talk through this case, and discuss some of the recent literature including a study out of Emory University School of Medicine investigating RFA’s impact on spondylolisthesis / spinal stability. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve. References: 1. Patel T, Watterson C, McKenzie-Brown AM, Spektor B, Egan K, Boorman D. Lumbar Spondylolisthesis Progression: What is the Effect of Lumbar Medial Branch Nerve Radiofrequency Ablation on Lumbar Spondylolisthesis Progression? A Single-Center, Observational Study. J Pain Res. 2021;14:1193-1200. 2. Conger A, Burnham T, Salazar F, Tate Q, Golish M, Petersen R, Cunningham S, Teramoto M, Kendall R, McCormick ZL. The Effectiveness of Radiofrequency Ablation of Medial Branch Nerves for Chronic Lumbar Facet Joint Syndrome in Patients Selected by Guideline-Concordant Dual Comparative Medial Branch Blocks. Pain Med. 2020 May 1;21(5):902-909.