Cooled Radiofrequency Ablation for Lumbar Facet Pain in Context of Lumbar Instrumentation and Cardiac Pacemaker: A...

Many patients with severe axial lumbar pain due to the facet joints (i.e., facet arthropathy) have pain refractory to lumbar surgical instrumentation. Patients who have facet-mediated pain refractory to surgical management may benefit from radiofrequency ablation (RFA) of any remaining medial branch nerves, but RFAs in proximity to spinal instrumentation can cause thermal damage. In addition, many of these patients are older and potentially have cardiac implantable electrical devices (CIEDs). RFAs generate electromagnetic interference, which may damage or interrupt the function of CIEDs. Pain physicians may have safety concerns regarding performing RFAs for patients with lumbar instrumentation and CIEDs.

We describe a case in which we safely performed 2 lumbar cooled RFAs in a staged fashion in a patient who had previous lumbar instrumentation, as well as a cardiac pacemaker. The patient reported near-complete bilateral pain relief without periprocedural pain, and no changes on electrocardiography or complications were observed.

RFAs may be safely performed in patients with CIEDs and pre-existing instrumentation if society-based practice guidelines are followed.