Alexander Bautista, MD1, Alisher Dadabayev, MD2, Ellen Rosenquist, MD2,and Jianguo Cheng, MD2
Pain Physician 2016; 19:E505-E509 • ISSN 2150-1149
We report 2 cases of successful treatment of neck and back pain with bipolar radiofrequency
ablation (RFA) of the cervical and lumbar facet joints in patients with an automatic implantable
cardioverter defibrillator (AICD).
Two patients with complex cardiac histories and AICD devices were treated with bipolar RFA
of the facet joints. One presented with axial neck pain and the other with axial back pain. The
histories and physical examinations were consistent with facetogenic pain. Diagnostic medial
branch block resulted in more than 70% pain relief lasting for several days, allowing patients
to perform routine daily activities without significant pain. However, we were concerned about
the use of conventional RFA of the medial branches of nerves for the fear of interference with
the function of AICD by the RF currents and energy. We took advantage of the localized and
limited current of bipolar RFA to perform this procedure for the cervical or lumbar facet joints
avoiding any interference with the function of AICD. The procedures provided long-term pain
relief to the patients, and marked improvement in their functional status without any evident
complications related to the function of their AICD.
This case report describes the safe and successful completion of bipolar RFA of the medial
branch nerves to treat cervical and lumbar facetogenic pain in patients with AICD. This modality
of treatment may be considered in patients with AICD. We are finding it to be increasingly
common that patients who present with chronic neck and back pain have AICDs in place.
Key words: Back pain, neck pain, facet, AICD, radiofrequency neurotomy, bipolar lesioning
Pain Physician 2016; 19:E505-E509