An Unexpected Complication Resulting from Radiofrequency Ablation for Treating Facet Joint Syndrome: A Case Report

Abstract

Lumbar facet joints have been identified as a potential source of chronic low back pain (LBP) in 15% to 45% of patients, with the prevalence of such pain varying based on specific populations and settings examined. Lumbar facet joint interventions are useful in the diagnosis as well as the therapeutic management of chronic LBP. Radiofrequency ablation (RFA) of medial branch nerves is recognized as a safe and effective therapy for chronic facet joint pain in the lumbosacral spine, and its efficacy has already been established. The use of RFA is currently widespread in the management of spinal pain, but it is noteworthy that there have been works in the literature reporting complications, albeit at a very low frequency. We present a case of third-degree skin burns following radiofrequency ablation (RFA) for the management of facet joint syndrome. Postoperatively, the patient's skin encircling the needle displayed a pallor and exhibited deterioration in conjunction with the anatomical anomaly. The affected area required approximately 5 months to heal completely. During RFA, heat can induce burns not only at the point of contact with the RF electrode but also along the length of the needle. Vigilant attention is necessary to ensure patient safety and to address any potential complications that may arise during the procedure, including the possibility of minor technical errors.

Keywords: burn; chronic pain; complication; facet joint; lumbosacral region; needle; nerve block; radiofrequency ablation; spinal pain; surgery.

Figure 1

Magnetic resonance (MR) images obtained from the patient. (a) Sagittal and (b) Axial images show that the metal fixations at the L4/5 level are completely removed by the previous surgery and there are also not any neurological abnormalities.

Figure 2

Images display each condition for the present case. (a) Performing RFA using hemostatic forceps with needle hub (arrows) and shaft (arrowheads), the former has an intended effect, while the latter can occur as an unexpected side effect due to some damage to the needle shaft. (b) Finding incidentally that some part of a needle is uninsulated after finishing the procedure; (c) Finding third-degree skin burns in the patient; (d) Applying surgical care to the patient by a plastic surgeon; (e) Observing the wound repair process; (f) Wound recovered completely.