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Radiographic changes induced after cervical facet radiofrequency denervation
Michelle Smith1, Gene Ferretti, Steven Mortazavi
1Pain Management Center, St. Luke's Hospital, 801 Ostrum Street, Bethlehem, PA 18015, USA.
Background Context:
Paraspinal infections after zygapophyseal (facet) radiofrequency denervation (RFD) are a serious but rare complication of this procedure. We are aware of only one case report of an epidural abscess after facet joint injection.
Purpose:
To report post-procedure inflammatory changes after cervical facet RFD.
Study Design:
Case report.
Patient Sample:
A 35-year-old Caucasian female.
Methods:
Retrospective case review.
Results:
The patient underwent cervical RFD and was admitted to the hospital 7 days after her procedure with severe neck pain. Magnetic resonance imaging (MRI) with contrast revealed what appeared to be evidence of a paraspinal muscle abscess although blood tests were negative. She was treated with antibiotic therapy, yet she never developed systemic signs of infection. A follow-up MRI without contrast revealed no evidence of infection, and she was discharged home on hospital day 6. At her first follow-up visit, she was still experiencing scalp pain and paraspinal muscle spasm. During subsequent follow-up visits, she has continued to improve clinically without experiencing signs of infection. Another follow-up MRI 6 weeks after her discharge home revealed persistent minimal left paraspinal enhancement at C2-3, possibly representing post-procedure granulation tissue with no evidence of abscess.
Conclusions:
Post-procedural MRI findings after radiofrequency lesioning can resemble radiographic findings associated with a paraspinal abscess. Patients with radiographic findings consistent with abscess should only be treated if clinical signs or symptoms of systemic infection are present.
