Disclosures: Alex D. Schmidt, MD: Nothing to disclose

Case Description: Radiofrequency neurotomy performed on a patient with a congenital fusion of the C2-C3 vertebrae.

Setting: Outpatient spine clinic

Patient: 73-year-old female presented with 5-month history of right-sided neck pain with cephalad referral.

Assessment/Results: MRI revealed congenital fusion of the C2 and C3 posterior elements and grade 1 C3-4 anterolisthesis. X-ray revealed 1mm of translation at C3-4 with flexion/extension. After failing to improve with physical therapy, she was referred for medial branch block (MBB). MBB using contrast under live fluoroscopy was performed, demonstrating medication coverage over the fused posterior elements of C2 and C3, and at the mid-point of the articular pillar at C4. She reported 55% pain relief after the first MBB. A second MBB resulted in the same response. Radiofrequency neurotomy was performed using a 20-gauge electrode with a 10 mm active curved tip via a parasagittal approach. The C4 medial branch was targeted at its traditional location. Five additional lesions were performed sequentially cephalad to this target, with the most cephalad target being the midpoint of the fused C2-3 foramen. At her 2-month follow-up she reported persistent but more localized pain, subjectively graded as 30% improvement though also noting the degree of improvement was concordant with the degree of relief experienced after MBB. She also noted 50% decrease in acetaminophen use.

Discussion: Klippel-Feil syndrome is a rare congenital disorder characterized by fusion of two or more adjacent cervical vertebrae that is estimated to occur in 1 in 50,000. (I). In patients with a single fused cervical segment, 36% present with axial symptoms (II). In the setting of this rare anatomy, the location of the third occipital nerve and respective medial branches remains unknown. Without the traditional osseous fluoroscopic targets for RFN, multiple lesions were attempted to maximize lesion size.

Conclusion: Patients with Klippel-Feil syndrome provide technical challenges when considering RFN.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/performing-a-radiofrequency-neurotomy-on-patient-with-previously-undiagnosed-klippel-feil-syndrome/