Physician 1st Quarter 2016 Interventional Pain IRR - Case Study #3
39-year-old female with low back pain with numbness, tingling, stinging of the legs at night and while driving. She has taken Neurontin, Flexeril, Percocet, epidural steroid injections, physical therapy, and TENS. She underwent repeat transforaminal epidurals at L3-4, L4–5, and L5–S1 without benefit. She had L3–4, L4–5 and L5–S1 facet block without noted benefit although there was a 4 month gap until the patient returned to the provider. Medial branch nerves blocks at L3, 4, and 5 gave 50% relief at 4 hours.
Initial physical examination showed decreased sensation in legs and straight leg raising positive. Later physical examinations showed strongly positive facet pain. MRI of 5/12/15 showed central and slightly right herniated nucleus pulposis. The provider requests radiofrequency ablation of the medial branch nerves of left L3–S1.
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