Cervical Radiofrequency Ablation Results in Spinal Accessory Mononeuropathy

Case Overview

This case study involves an adult patient with a medical history of Factor V Leiden, hypertension, migraines, and cervicalgia. The individual was undergoing warfarin anticoagulation therapy and receiving radiofrequency (RF) ablations from their interventional pain management physician to manage cervicalgia. Notably, the patient had no prior history of cervical spinal surgery.

The patient underwent a C3-C7 RF ablation procedure. Following this intervention, they experienced significant pain and range-of-motion limitations in their right arm.

Despite multiple visits to the emergency room and neurology department, the patient’s condition did not improve. An electromyography (EMG) test revealed severe acute right spinal accessory mononeuropathy distal to the innervation of the right sternocleidomastoid muscle and proximal to the innervation of the trapezius.

Questions to the expert and their responses

How often do you perform radiofrequency (RF) ablations of the cervical spine for cervicalgia?

I have performed approximately 20 cervical RF ablations per year for 15 years.

What are the most pertinent measures that interventional pain management physicians can perform to minimize the incidence of spinal accessory nerve damage when performing RF ablations of the cervical spine?

The selection process is crucial in minimizing complications such as spinal accessory nerve damage. The needle must be placed correctly to avoid this complication. With appropriately placed needles, there should be no risk of ablation of the wrong nerve.

Have you reviewed a case similar to above? If so, please briefly describe.

I have published two review papers on cervical medial branch RF ablation, including complications. I also contributed to the Spine Intervention Society spinal intervention guidelines.

About the expert

This expert has an extensive background in anesthesiology and interventional pain medicine, with nearly 15 years of experience. They are board-certified in both anesthesiology and pain medicine, having completed a prestigious residency and fellowship at renowned universities. The expert is active in academia, publishing on topics related to their field, and currently serves as an adjunct lecturer of pain medicine while also operating a private practice specializing in pain management.