Objective: Extensor truncal dystonia in majority of cases leads to significant low, mid back pain and discomfort secondary to muscle spasms and early degenerative spinal involvement that is refractory to treatment

Background: Benefit of muscle chemodenervation with botulinum toxin is well established in different types of focal and segmental dystonia, including truncal dystonia. Symptomatic management with trigger point injections, botulinum toxin in lumbar paraspinal muscles gives temporal relief of abnormal posture and pain.

Here we present a patient with facetogenic back pain secondary to sustained lumbar paraspinal muscle spasms in the setting of primary idiopathic truncal dystonia non responsive to standard conservative treatment. Lumbar facet medial branch radiofrequency ablation gave the patient longstanding back pain relief and significantly improved muscles spasms for the same period of time.

Methods: Case report of 42 y/o man with PMH of primary idiopathic extensor truncal dystonia, presents to interventional pain clinic secondary to left sided chronic low back pain. He had trialed multiple medications, trigger point injections for his back pain without success. Pain is a sharp, localized to left low back that is a constant 10/10. Movement increases pain. MRI lumbar spine revealed moderate – severe facet arthropathy most significant at L4 & L5. Left Lumbar Medial Branch Blocks (MBB) at L3/4 & L4/5 was performed with dramatic temporary pain reduction and subsequent lumbar RFA decreased the patient pain for about 6 months.

Results: Patient had repeated left lumbar RFA two times per year for the past 3 years for his chronic left low back pain secondary to truncal dystonia. He reports ongoing pain reduction by greater than 90% and increase in function. 

Conclusions:  RFA is an effective procedure in management of patients with back pain. The benefits of the procedure are related to denervation of facet joints. In patients with truncal dystonia, where spine degenerative processes are accelerated the procedure may be introduced to these patients in early stages of the disease since RFA may not only decrease the pain secondary to facet denervation but also slow down degenerative cascade by eliminating muscle spasm in multifidus muscles.

Presented American Association of Physicians of Indian Origin National Research Competition, June 20^th 2015, Orlando, FL

References: A Brotier et al. Extensor Truncal dystonia with spondylosis: Interest of Botulinum Toxin in the spinal muscles for pain relief. Spasticity 55S (2012) e225-e341.

Dreyfuss P, Stout A, Aprill C, et al. The significance of multifidus atrophy after successful radiofrequency neurotomy for low back pain. PM R 2009;1:719–22.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/treatment-of-back-pain-in-patient-with-extensor-truncal-dystonia-with-lumbar-radiofrequency-ablation-rfa/