(Kiosk 5) Radiculitis Following Basivertebral Nerve Ablation: A Case Report

Case Diagnosis: Post-procedural L5 Radiculitis following treatment for vertebrogenic low back pain.

Case Description or Program Description: A 66-year-old woman presented with history of chronic low back pain predominantly axial in nature but with intermittent radicular features. Previously, she underwent lumbar transforaminal epidural steroid injections which provided relief of her radicular symptoms, but residual axial lumbar pain remained. MRI lumbar spine revealed Modic Type 1 and 2 changes at L4-L5. The patient was deemed to be a candidate for L4 and L5 basivertebral nerve (BVN) ablation, also known as the Intracept procedure. Intracept was performed, with right sided pedicle access for L4, and left sided pedicle access for L5. No intraoperative or immediate postoperative complications were noted. Approximately 5 days following the procedure, the patient reported burning pain and hyperesthesia between the left knee and ankle, suggestive of L5 radiculitis.

Setting: Academic institution in an interventional spine clinic.

Assessment/Results: The patient was recommended to increase gabapentin dose, and prescribed methylprednisolone. At follow-up 1 month after Intracept, her radicular symptoms had completely resolved, and she additionally reported 80% reduction in her axial low back pain following the intracept procedure.

Discussion (relevance): Prior studies have reported post-BVN ablation leg pain/radiculitis as a potential adverse event (3-11%). One study noted that the majority of these cases were thought to be related to medial pedicle breach based on follow up MRI imaging, but to our knowledge no other studies have examined alternative risk factors or potential causes, such as degree of pre-procedural foraminal narrowing or presence of spondylolisthesis.

Conclusions: Radiculitis is a potential adverse event following lumbar BVN ablation, but etiologies have not been thoroughly explored. More research is needed to reveal potential causes of this adverse event, especially in the absence of obvious pedicle breach intra-operatively. Further studies should assess potential causes, risk factors, appropriate treatment, and expected duration of post-BVN radiculitis.