Combination therapy of radiofrequency lumbar facet joint denervation and epidural spinal cord stimulation for failed back surgery syndrome

Abstract

An 81-year-old woman with failed back surgery syndrome (FBSS) was treated using a combination of percutaneous radiofrequency (RF) lumbar zygapophysial joint denervation and epidural spinal cord stimulation (SCS). She had undergone a staged laminectomy for narrowing of the spinal canal from L1 to S1 and degenerative spondylolisthesis at the L3-4 level. Postoperatively, in addition to low back pain (LBP) induced by dynamic motion, she began to experience intractable leg pain with a burning sensation, presumably caused by damage to the cauda equina. She initially underwent RF lumbar zygapophysial joint denervation for the LBP and subsequently underwent SCS via dual electrode leads for the leg pain. This combination therapy of RF denervation and SCS relieved the LBP almost entirely and relieved the leg pain by approximately 50%. The combination of these two minimally invasive interventions is particularly effective for severe leg pain and LBP in elderly patients or medically compromised cases with contraindications against general anesthesia, as well as in patients with FBSS.