Case Report: Lumbar Medial Branch Radiofrequency Neurotomy in a Patient with Deep Brain Stimulator

Abstract

Background: The prevalence of implantable electronic devices, particularly deep brain stimulators (DBS), is increasing worldwide. To date, there has been limited research on the safety of radiofrequency neurotomy for lumbar facet joint pain in patients with implanted DBS. Furthermore, there are no clear guidelines on the management of DBS prior to radiofreqeuency neurotomy. Case Report: We present the case of a patient with Parkinson’s disease status post implantation of DBS for management of symptoms. Appropriate safety precautions were taken prior to and following the treatment procedure for the patient. Prior to the procedure, consultation with a device technical representative took place and the patient’s device was switched to “surgery mode.” This patient then underwent bipolar radiofrequency denervation of the bilateral lumbar medial branches with significant improvement in her pain and without any adverse effects upon postprocedure exam. Conclusion: We propose several steps and precautions when employing radiofrequency denervation in a patient with history of prior DBS implantation. By taking these precautions, radiofrequency denervation can safely be used in patients with DBS for the management of lower back pain. Key words: Deep brain stimulator, denervation, low back pain, Parkinson’s, radiofrequency neurotomy, safety