1122 - Cooled Radiofrequency Ablation for New-Onset, Refractory Spasticity in an Athlete with Chronic Spinal Cord Injury: A Case Report

Hip flexor and adductor spasticity secondary to degenerative joint changes of the hip and spine

Case Description: A 51-year-old male adaptive athlete with chronic T11 paraplegia presented with new-onset back pain with trunk, left hip, and thigh spasms significantly limiting his participation in handcycling. Acute medical issues including infection, fracture, and syrinx were ruled out. Symptoms persisted despite trials of multiple antispasmodics and neuropathic pain medications along with additional modalities such as physical therapy, transcutaneous electrical nerve stimulation, and trigger point injections. Imaging revealed severe L2-3 spinal stenosis with foraminal narrowing and degenerative left hip changes with osteoporosis. Traditional surgical interventions were contraindicated due to poor bone quality and chronic non-weightbearing status.
Following partial improvement with botulinum toxin injections to hip flexors and adductors, the patient underwent CT-guided cooled radiofrequency ablation of the left femoral and obturator nerve articular branches, resulting in significant symptom improvement.

Discussions: As individuals with spinal cord injuries age, they may develop symptoms related to degenerative changes, altered biomechanics, and chronic overuse of compensatory muscle groups. These patient-specific factors often require individualized treatment approaches given the unique anatomic and physiologic changes resulting from decades of living with a spinal cord injury. This case highlights the importance of considering innovative interventional techniques, particularly for adaptive athletes whose functional demands extend beyond standard activities of daily living. When conventional therapy for degenerative joint-related spasticity in chronic spinal cord injury patients fails, cooled radiofrequency ablation may serve as an effective treatment option for pain reduction and symptom improvement.

Conclusions:

Clinicians caring for aging spinal cord injury patients should consider multimodal approaches and emerging interventional techniques when standard treatments prove inadequate for maintaining quality of life and functional independence. Cooled radiofrequency ablation offers a minimally invasive treatment that may address complex pain and spasticity patterns in patients with chronic spinal cord injury.