Radiofrequency ablation (RFA) is a widely used procedure for managing axial low back pain, offering prolonged relief by targeting the lumbar medial branch.

Steroid injections post RFA reduce inflammation and the incidence of neuritis and are a common practice.

This case report describes an elderly female who developed sepsis secondary to a urinary infection following steroiduse after RFA procedure.

An 80-year-old female with a past medical history of lumbar spondylosis, scoliosis, pacemaker implantation, and hypertension presented to the clinic with progressively worsening chronic low back pain lasting several years. Physical examination revealed tenderness along the bilateral lower lumbar facet joints and positive bilateral facet loading. Lumbar computed tomography scan demonstrated bilateral facet hypertrophy from L3-4 to L5-S1 and multiple broad-based disc bulges with bilateral foraminal stenosis L1-2 to L5-S1.

Following unsuccessful conservative management the patient received two bilateral L4-S1 medial branch blocks spaced two weeks apart which resulted in substantial pain improvement. Based on this positive response, a bilateral L4-S1 RFA procedure was performed.

Two days post-procedure, family reported nausea, fever, chills, and dizziness and evaluation in the emergency department showed hypotension, fever, and sepsis due to a urinary tract infection (UTI) following which patient was managed in the critical care unit. The patient improved and was discharged to a rehabilitation facility due to critical illness myopathy.

While steroid injections post RFA is effective for managing low back pain. It reduces the risk of developing post-ablation neuritis, a condition characterized by nerve irritation and pain following procedure. Howeversteroids can suppress the immune system, increasing therisks forcomplications such as infections. Carefulconsideration of the patient's overall health and risk factors is essential to balance the benefits and potential harms.