Progressive severe kyphosis as a complication of multilevel cervical percutaneous facet neurotomy: a case report

Ahmed, Mostafa M.; Lake, Wendell; Resnick, Daniel K.

doi:10.1016/j.spinee.2012.09.037

Cited by 16 publications

(18 citation statements)

References 7 publications

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“…For example, the occurrence of head drop is difficult to diagnose, because it is due to abnormal muscle contraction, weakness of the posterior neck muscles, a skeletal problem, or psychosomatic factor. In such cases, we need a test to aid in the diagnosis dystonia ( 17 , 18 ).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Edrophonium Challenge Test for Cervical Dystonia

et al. 2017

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Objective To examine whether or not an edrophonium challenge test is useful for diagnosing cervical dystonia. Patients We evaluated 10 patients with cervical dystonia and 10 with hemifacial spasms (disease controls). We administered edrophonium and saline in this double-blinded study. Before and after the injection, we recorded the participants' clinical signs using a video camera to assess the objective symptoms every two minutes. Ten minutes after the saline and edrophonium injections, participants evaluated their subjective clinical signs using a visual analog scale. The objective signs on the video recordings were scored by specialists who were blinded to the treatment. The mean visual analog scale scores were compared using the Wilcoxon rank-sum test for paired continuous variables. Results The clinical signs of participants with cervical dystonia were amplified by edrophonium. In contrast, the clinical signs in participants with hemifacial spasms were not affected by the edrophonium challenge test. Conclusion The edrophonium challenge test may be useful for diagnosing cervical dystonia.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the Edrophonium Challenge Test for Cervical Dystonia

et al. 2017

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“…In both cases, the patients required treatment by surgi-cal fusion. It is suspected to have occurred due to denervation of cervical extensor muscles from too many levels being treated (11,12). There have also been reported cases of neural and vascular injury following cervical RFA.…”

Section: Discussionmentioning

confidence: 99%

Spinal Accessory Nerve Palsy following Cervical Cooled Radiofrequency Ablation: A Case Report and Review of the Literature

Weaver

2017

PMCR

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Chronic neck pain is a common cause of functional impairment in the general population. A significant percentage has a component of cervical facet arthropathy for which cervical radiofrequency ablation (RFA) has been successful in treating. We present a case of spinal accessory nerve (SAN) palsy after water-cooled cervical RFA. A 37-year-old female with history of fibromyalgia and occipital neuralgia presented with cervicalgia. Magnetic resonance imaging (MRI) revealed degenerative changes and central canal stenosis at C5-6. After positive result to diagnostic cervical medial branch blocks (MBB), she underwent staged bilateral C2-3-4-5 medial branch watercooled RFA. On subsequent follow up, she noted new left shoulder pain. On exam, difficulty with left arm abduction and scapular winging was noted. Electrodiagnostics (EDX) revealed mild denervation and mild decreased motor units on needle EMG study. Nerve stimulation study of the SAN to the upper trapezius revealed latency prolongation and amplitude reduction, consistent with an acute spinal accessory neuropathy. Repeat EDX study, 7 months later, no longer showed denervation in upper trapezius, normal latency, and improved (although still decreased) amplitude. SAN palsy after multilevel cervical RFA has not been reported in the literature to our knowledge. Cervical RFA is generally considered safe with most complications being transient and minor with no lasting adverse effects. Spinal accessory nerve palsy is one cause of scapular winging. This case highlights the importance of physical exam and knowledge of anatomical structures in promptly diagnosing SAN palsy. Key words: Spinal accessory nerve palsy, medial scapular winging, lateral scapular winging, cervical radiofrequency ablation, cervical facet arthropathy, cervical medial branch blocks, cervicalgia, water-cooled radiofrequency ablation

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“…A prone position results in superposition of the head and face during fluoroscopy and levels above C4 can become difficult to visualize. Extensive lesions might lead to muscular weakness (dropped head syndrome), although the proponents of this technique attribute this to multiple‐level denervation …”

Section: Three Current Techniques For Rf Ablation Of the Cmbmentioning

confidence: 99%

A Modified Posterolateral Approach for Radiofrequency Denervation of the Medial Branch of the Cervical Segmental Nerve in Cervical Facet Joint Pain Based on Anatomical Considerations

et al. 2016

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The cervical facet joints, also called the zygapophyseal joints, are a potential source of neck pain (cervical facet joint pain). The cervical facet joints are innervated by the cervical medial branches (CMBs) of the cervical segmental nerves. Cervical facet joint pain has been shown to respond to multisegmental radiofrequency denervation of the cervical medial branches. This procedure is performed under fluoroscopic guidance. Currently, three approaches are described and used. Those three techniques of radiofrequency treatment of the CMBs, classified on the base of the needle trajectory toward the anatomical planes, are as follows: the posterolateral technique, the posterior technique, and the lateral technique. We describe the three techniques with their advantages and disadvantages. Anatomical studies providing a topographic anatomy of the course of the CMBs are reviewed. We developed a novel approach based on the observed strengths and weaknesses of the three currently used approaches and based on recent anatomical findings. With this fluoroscopic-guided approach, there is always bone (the facet column) in front of the needle, which makes it safer, and the insertion point is easier to determine without the risk of positioning the radiofrequency needle too dorsally.

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Progressive severe kyphosis as a complication of multilevel cervical percutaneous facet neurotomy: a case report

Cited by 16 publications

References 7 publications

Evaluation of the Edrophonium Challenge Test for Cervical Dystonia

Evaluation of the Edrophonium Challenge Test for Cervical Dystonia

Spinal Accessory Nerve Palsy following Cervical Cooled Radiofrequency Ablation: A Case Report and Review of the Literature

A Modified Posterolateral Approach for Radiofrequency Denervation of the Medial Branch of the Cervical Segmental Nerve in Cervical Facet Joint Pain Based on Anatomical Considerations

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