The use of radiofrequency ablation for the management of refractory lower extremity pain associated with lumbar spondylosis: illustrative case.

backgroundThe lumbar spine is a common cause of referred pain to the lower extremities. Standard conservative treatments (i.e., physical therapy and pharmacotherapy) can provide only partial or temporary relief, in which case injections might be used. This often consists of epidural steroid injections to treat possible radicular pain. When symptoms still persist, radiofrequency ablation (RFA) to treat facet-mediated pain can offer a viable option before surgical intervention. OBSERVATIONS: In this illustrative case, a patient presenting with a complex array of worsening symptoms in the lower extremities, secondary to lumbar spondylosis, was treated using RFA. Conservative treatments resulted in partial, temporary relief. A facet-mediated source of pain was suspected, and diagnostic blocks indicated that the patient would be a candidate for bilateral RFA of the medial branches at L3, L4, and L5. Following the RFA procedure, the patient had full resolution of her lower extremity pain and paresthesias. LESSONS: RFA procedures are typically performed to address low back pain rather than concomitant lower extremity pain and paresthesias. This case provides evidence indicating that, in the face of appropriate conservative management and diagnostic testing, RFA of the medial lumbar branches can address lower extremity pain secondary to lumbar spine pathology. https://thejns.org/doi/10.3171/CASE24837.