407 - Cold is the new Hot topic in Low Back Pain Relief

Case Diagnosis: Lumbar Facetogenic Back Pain

Case Description: 42 y/o Male presented to outpatient PM&R/Sports Medicine clinic with a history of fall off a mountain bike causing extreme low back pain worse in extension, rated as 8/10, and not improved with physical therapy, medications, and modalities. Radiographs and MR scan showed moderate L4-S1 spondylosis and no disc or bony pathology. Patient underwent L4-S1 bilateral medial branch blocks which relieved 100% of his low back pain. He was not interested in steroid based or Radiofrequency type procedures due to long term risk profile and young age at diagnosis. Patient elected to trial fluoroscopically-guided cryoneurolysis for his pain management and had immediate as well sustained relief at 12 months of his low back pain.

Discussions: Cryoneurolysis is a thermal-based treatment that uses precise placement of ice to reversibly denervate specific nerves to help with chronic pain management. In contrast to many other ablative techniques, cryoneurolysis causes grade two sunderland classification nerve injury in comparison to deeper nerve injury levels occurring with RFA. One example of the many nerves that can benefit from this treatment is the medial branch nerves. This technique has specific advantages in comparison to radiofrequency ablation which include the following: immediate improvement post treatment and lack of post-RFA increased pain as well as repeatability of the procedure due to lack of collateral sprouting that occurs with RFA treatments.

Conclusions: Although more research is needed on this topic, this case highlights the great potential benefits of  instant relief, repeatability with reliable results of multiple treatments, and long-lasting improvements through use of cryoneurolysis for the management of low back pain.