FactFinders for patient safety: Understanding potential procedure-related complications: RFN/multifidus atrophy, intradiscal biologics, and facet cyst rupture

Minh Nguyen; Mathew Saffarian; Clark C Smith; Eric K Holder; Haewon Lee; Benjamin J Marshall; Ryan Mattie; Jaymin Patel; Byron Schneider; Zachary L McCormick; Spine Intervention Society's Patient Safety Committee

doi:10.1016/j.inpm.2023.100248

FactFinders for patient safety: Understanding potential procedure-related complications: RFN/multifidus atrophy, intradiscal biologics, and facet cyst rupture

Interv Pain Med. 2023 May 31;2(2):100248. doi: 10.1016/j.inpm.2023.100248. eCollection 2023 Jun.

Affiliations

¹ University of Texas Southwestern, Department of Physical Medicine and Rehabilitation, Dallas, TX, USA.
² Michigan State University, Department of Physical Medicine and Rehabilitation, East Lansing, MI, USA.
³ Columbia University Medical Center, Rehabilitation and Regenerative Medicine, New York, NY, USA.
⁴ Yale University School of Medicine, Department of Orthopedics and Rehabilitation, New Haven, CT, USA.
⁵ University of California, San Diego, Department of Orthopedic Surgery, San Diego, CA, USA.
⁶ Department of Physical Medicine and Rehabilitation, University of Colorado, School of Medicine, Denver, CO, USA.
⁷ Providence Cedars-Sinai Tarzana Medical Center, Department of Interventional Pain & Spine, Los Angeles, CA, USA.
⁸ Emory University, Department of Orthopaedics, Atlanta, GA, USA.
⁹ Vanderbilt University Medical Center, Dept of Physical Medicine & Rehabilitation, Nashville, TN, USA.
¹⁰ Vanderbilt University Medical Center, Center for Musculoskeletal Research, Nashville, TN, USA.
¹¹ University of Utah, Division of Physical Medicine and Rehabilitation, Salt Lake City, UT, USA.

Abstract

This series of FactFinders presents a brief summary of the evidence and outlines recommendations to improve our understanding and management of several potential procedure-related complications. The evidence in support of the following facts is presented: (1) Multifidus Atrophy After Lumbar Medial Branch Radiofrequency Neurotomy (LMBRFN) -- There is no conclusive published literature indicating that LMBRFN leads to increased multifidus atrophy relative to natural history. High-quality prospective studies with a natural history comparison group evaluating immediate pre-procedure as well as post-procedure longitudinal cross-sectional imaging are needed to accurately assess for any possible influence of LMBRFN on multifidus atrophy as well as the clinical relevance. (2) Intradiscal Biologics -- Although the available evidence on intradiscal biologic interventions is limited, it nonetheless shows a non-zero risk of complications. Until larger sample sizes are reported, the actual magnitude of the risk cannot be ascertained. In the meantime, physicians who perform intradiscal injections of biologics should conscientiously consider the risk-benefit of these procedures. (3) Lumbar Facet Synovial Cyst Rupture -- There have been few reports of complications secondary to lumbar facet synovial cyst rupture. Risks of may include increased pain, infection, and nerve root compression.