Radiofrequency Ablation of the Costotransverse Joint in a Case of Chronic Thoracic Back Pain

The source of thoracic back pain is often challenging to diagnose and manage, as there exist multiple potential etiologies and treatment strategies. Costotransverse joints are small synovial joints that may be prevalent and overlooked pain generators in the thoracic spine. Intra-articular steroid injections are commonly utilized as non-surgical therapeutic interventions for costotransverse joint pain; however, they have variable efficacy. We describe the first use of thermal radiofrequency ablation for the symptomatic management of chronic thoracic back pain in a 35-year-old female with costotransverse joint arthropathy. The patient presented with thoracic hypomobility, severe pressure sensation, and dull pain in the T7-10 region bilaterally between the medial border of the scapulas. Initial treatment with physical therapy, pain medications, and a thoracic epidural steroid injection were ineffective. Computed tomography thoracic spine imaging revealed isolated arthropathy of the costotransverse joints at T8 and T9 bilaterally. Initial treatment with an intra-articular steroid injection provided significant short-term pain relief and was followed by a diagnostic block, which resulted in over 80% pain relief. Thereafter, thermal radiofrequency ablation of the nerves to the costotransverse joints at T8 and T9 was performed. The patient experienced three months of pain relief, resulting in functional improvement and reduced pain medication requirements. This case underscores the importance of considering costotransverse joint pathology in the differential diagnosis of thoracic back pain, the critical role of radiographic imaging in establishing prevalence, and the need for further anatomic studies describing the complete innervation of the costotransverse joints to optimize thermocoagulation treatments.