Disclosures: Nicholas Donohue, MD: No financial relationships or conflicts of interest

Case Description: A 36-year-old male was admitted to inpatient rehabilitation to address new lower extremity weakness and bowel/bladder control issues. The patient had undergone bilateral radiofrequency ablation (RFA) of the medial branches of the T2-5 dorsal rami by an outside pain physician one month prior to admission. In the interim, he had presented six times to local emergency departments complaining of new, severe thoracic back pain associated with bilateral lower extremity weakness and paresthesias. Magnetic Resonance Imaging (MRI) two weeks after his procedure only showed edema of the thoracic paraspinals at the levels of the ablations. Repeat MRI six weeks after the RFA, however, showed a new hyperintense signal in the spinal cord at the T4 level suggestive of myelomalacia. Various blood and spinal fluid analyses were negative for autoimmune or infectious etiologies. Six months following discharge, the patient was still requiring a wheelchair for long-distance mobility and otherwise used knee-ankle-foot orthotics at all times. He also still required intermittent catheterization for voiding and scheduled spasticity medications.

Setting: An inpatient rehabilitation unit and physiatry clinic at an academic medical center

Patient: 36-year-old healthy male who experienced acute thoracic pain associated with bilateral lower extremity weakness and paresthesias following thoracic RFA. Assessment/

Results: This patient was diagnosed with a new ASIA D T4 spinal cord injury following a recent thoracic RFA that could not be attributed to any other cause.

Discussion: Neurological deficits following spinal medial branch RFA are rare, and if they occur, almost universally involve the exiting nerve root. Damage to the spinal cord itself has rarely, if ever, been recorded in available literature.

Conclusion: The injury presented in this case may call into question the current protocol for thoracic RFA and is a grave reminder of the importance of needle tip placement in such procedures.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-rare-case-of-spinal-cord-injury-following-thoracic-radiofrequency-ablation/