A Rare Case of Spinal Cord Injury Following Thoracic Radiofrequency Ablation

Cureus, 2021 · DOI: 10.7759/cureus.15380 · Published: June 1, 2021

Neurology Pain Management Rehabilitation

Simple Explanation

A 37-year-old male experienced progressive lower-extremity weakness and paresthesias after undergoing thoracic radiofrequency ablation (RFA) for back pain. He also developed urinary retention. MRI showed myelomalacia at the T3-T4 level, suggesting spinal cord injury. Extensive testing ruled out other causes, leading to the conclusion that the RFA procedure likely contributed to the injury. The patient was treated with neuromodulators and rehabilitation. One year post-injury, the patient required knee-ankle-foot orthoses for short distances and a wheelchair for longer distances but no longer needed catheterization, indicating some recovery.

Study Duration

1 Year

Participants

1 Male

Evidence Level

Case Report

Key Findings

1
The patient experienced paresthesias below the nipple line and progressive lower-extremity weakness within one week of the procedure.
2
MRI showed focal cord short T1 inversion recovery (STIR) signal abnormality at the T3-T4 level, favored to represent myelomalacia.
3
An extensive laboratory and imaging workup was otherwise unrevealing, making it difficult to pinpoint the exact cause of the spinal cord injury.

Research Summary

This case report describes a rare instance of spinal cord injury (SCI) following thoracic radiofrequency ablation (RFA). The patient, a 37-year-old male, developed paresthesias, weakness, and urinary retention after the procedure, with MRI evidence of myelomalacia. Despite extensive investigation, the exact mechanism of injury remains unclear, but the timing and location strongly suggest a causative relationship with the RFA procedure.

Practical Implications

Increased Awareness

This case highlights the rare but potential risk of spinal cord injury following thoracic RFA, urging clinicians to be aware of this complication.

Careful Patient Selection

Emphasizes the importance of careful patient selection and technique during thoracic RFA procedures to minimize the risk of complications.

Further Research

Calls for further research to understand the mechanisms of injury and identify risk factors associated with SCI following RFA.

Study Limitations

1
Single case report limits generalizability.
2
Unclear mechanism of injury makes definitive conclusions difficult.
3
Patient had a family history of multiple sclerosis, potentially confounding the diagnosis.

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