Cervical Medial Branch Radiofrequency Ablation Using Bipolar Multi-Tined Cannulae in a Patient with an Implanted Cervical Spinal Cord Stimulator: A Case Report.

Abstract

Background: Cervical medial branch radiofrequency ablation (RFA) is an established treatment for chronic cervical facet joint pain. However, RFA procedures generate electromagnetic interference (EMI) that can pose a significant safety risk, potentially leading to spontaneous activation or damage of implanted electronic devices, such as spinal cord stimulators (spinal cord stimulation [SCS]). Previous reports have highlighted the successful use of conventional bipolar RFA, but data are limited regarding large-volume lesioning techniques in patients with SCS implants.

Case report: A 70-year-old man, who had a prior C7-T1 fusion and an implanted cervical SCS for refractory radicular pain, presented with axial neck pain. Following confirmation via diagnostic medial branch blocks (MBBs), the patient underwent cervical medial branch RFA using a bipolar multi-tined cannula technique. Strict protocols, including turning off the SCS device and performing neurophysiological monitoring, ensured the procedure was completed safely without complications or device malfunction.

Conclusions: This case demonstrates the safe and effective application of bipolar multi-tined RFA, a large-volume lesioning technique, in a patient with a cervical SCS implant. This approach leverages bipolar configuration and minimizes current dispersion, offering clinicians an important alternative to mitigate EMI risks and achieve durable pain relief in this complex patient population.