Successful Lumbar Radiofrequency Denervation for Severe Degenerative Low Back Pain
⚡ Chronic Mechanical Low Back Pain: Successful Lumbar Radiofrequency Denervation (Case Report)
Chronic low back pain related to age-associated degenerative spinal change can be profoundly limiting,
particularly when symptoms persist despite conservative care. This case illustrates a structured, stepwise approach
using diagnostic lumbar medial branch blocks followed by lumbar radiofrequency denervation, resulting in significant improvement in pain, mobility, and quality of life.
🧩 Background & Presentation
An 80-year-old patient presented with a long-standing history of severe low back pain that had worsened over time.
The pain was mechanical in nature, typically aggravated by standing and walking, with a meaningful impact on
function, independence, and day-to-day activity.
- Persistent, severe mechanical low back pain
- Exacerbated by standing and walking
- Significant limitation of mobility and daily activities
The clinical pattern was consistent with mechanical low back pain, with a high index of suspicion for
facet-joint contribution in the context of degenerative spinal change.
🧠 Imaging Context
Spinal imaging demonstrated advanced multilevel degenerative changes throughout the lumbar spine,
including significant facet joint arthropathy. There were also features of degenerative spinal deformity (e.g. degenerative scoliosis and kyphotic elements), consistent with age-related wear and tear.
Given the degree of degeneration and deformity, a non-surgical interventional pain management pathway
was considered most appropriate.
⚠️ Why Degenerative Low Back Pain Is Difficult to Treat
Degenerative low back pain can be challenging because multiple pain generators may coexist,
and structural change does not always predict symptom severity. Treatment often requires
careful clinical correlation and a stepwise approach.
- Multifactorial pain mechanisms (facet joints, discs, biomechanical factors)
- Coexisting spinal deformity complicating pain patterns
- Medication side effects limiting escalation, particularly in older patients
Even with technically successful intervention, the extent of degeneration may influence the
degree and durability of symptom improvement.
💊 Previous Treatments
Prior to interventional management, the patient had trialled an appropriate range of
conservative strategies, including analgesic and neuropathic pain medications and
activity modification, without sustained relief.
🩺 Pain Clinic Assessment
The patient was assessed by Dr Krishna at Pain Spa, and a structured interventional pathway was agreed.
Based on clinical features and imaging findings, facet-mediated pain was felt to be a
significant contributor.
Confirm facet joint involvement with diagnostic lumbar medial branch blocks before progressing
to radiofrequency denervation for longer-term benefit.
💉 Interventional Management
The patient initially underwent diagnostic lumbar medial branch blocks and reported a
positive response, supporting a facet-joint pain generator. This was followed by
lumbar radiofrequency denervation, performed under fluoroscopic (X-ray) guidance
as a day-case procedure.
Radiofrequency denervation targets the small sensory nerves supplying the facet joints,
reducing pain signalling while preserving normal spinal movement.
🌟 Outcome and Follow-Up
At follow-up, the patient reported significant improvement in pain and function, with benefits
becoming apparent relatively quickly. Mobility, sleep quality, and overall day-to-day
function all improved.
- Marked reduction in low back pain
- Improved mobility and walking tolerance
- Improved sleep quality
- Reduced reliance on pain medication
Despite advanced multilevel degenerative change, the patient achieved meaningful and
sustained pain relief with clear functional improvement.
🏥 Experience at Pain Spa
Radiofrequency denervation is a challenging procedure, particularly in patients with
multilevel degenerative changes or degenerative scoliosis, where anatomy may be distorted
and target localisation technically demanding.
Accurate performance requires excellent knowledge of fluoroscopic anatomy and a clear
understanding of each procedural step.
• Careful patient selection
• Stepwise progression (diagnostic blocks → radiofrequency treatment)
• High-quality fluoroscopic technique
• Clear counselling regarding expectations and recovery
At Pain Spa, Dr Krishna has extensive experience in performing radiofrequency treatments,
including in patients with complex, multilevel degenerative spinal disease and
degenerative scoliosis. This expertise supports safe, accurate lesioning and optimises
the likelihood of a good clinical outcome.
🌱 Key Learning Points
✔ Diagnostic medial branch blocks help confirm facet-mediated pain
✔ Lumbar radiofrequency denervation can provide sustained pain relief in selected patients
✔ Complex spinal anatomy requires expert fluoroscopic knowledge and technique
Confidentiality notice: This case report is fully anonymised and shared for educational
and informational purposes only.