Safe and effective intraosseous basivertebral nerve radiofrequency neurotomy in a patient with a permanent pacemaker

Introduction

Intraosseous basivertebral nerve radiofrequency neurotomy is a fairly novel technique which is currently considered contraindicated in patients with an implanted pacemaker. Re-evaluation of this restriction is important given the comorbidity of chronic low back pain and cardiac disease.

Case

A 78-year-old male with chronic low back pain (CLBP) that had failed both conservative and operative management with work-up including MRI spine suggestive of vertebrogenic low back pain. Patient agreed to undergo this procedure using a magnet to convert the active pacemaker to asynchronous pacing, resulting in fixed ventricular rate, perioperatively. The procedure was accomplished successfully with sustained improvement of his CLBP at six months follow up.

Conclusion

This is the first published case demonstrating successful intraosseous basivertebral nerve radiofrequency neurotomy in a patient with a permanent pacemaker with appropriate precautions.