343 posters, 5 videos, 2 audios, 18 topics, 33 sessions, 263 authors, 202 institutions

24th Annual Pain Medicine Meeting 2025

November 13-15, 2025| JW Marriott Austin, Austin, Texas

2184964

Safety Considerations for Performing Radiofrequency Ablation in Patients with Deep Brain Stimulators

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Poster Presenter

Gabriel Augustin

Authors

Gabriel Augustin

Affiliations

Henry Ford Hosptial

Part of Topic

Safety/QA/QI Projects

INTRODUCTION

Radiofrequency ablation (RFA) is a widely utilized interventional technique for managing chronic axial pain, particularly in the cervical and lumbar regions. However, limited data exist regarding the safety of RFA in patients with implanted neurostimulators such as deep brain stimulators (DBS) where risks include electromagnetic interference (EMI), thermal injury, and device malfunction.

Furthermore, this presentation aims to provide evidence-based safety strategies regarding the three procedural phases for performing RFA in patients with DBS.

METHODS

As the case report is devoid of patient identifiable information, it is exempt from IRB review requirements as per Henry Ford Hospital's policy

Case Report:

This is a case of a 71-year-old male with the PMHx of lumbosacral spondylosis, Parkinson's disease s/p deep brain stimulator (DBS) placement (04/2024), CAD s/p LAD stent 2024 (currently on DAPT), and type 2 DM.

The patient was referred to our Pain Clinic for a bilateral L3, L4 medial branch and bilateral L5 dorsal root primary ramus radiofrequency ablation under fluoroscopic guidance.

On the day of his procedure, the patient’s DBS device was neither interrogated nor deactivated prior to the intervention. Additionally, the DBS device representative was not contacted.

Prior to starting the procedure, the interventionalist performed a rapid literature review and found that it is recommended to place the grounding pad on the contralateral side of the DBS, however they were unable to find any additional recommendations.

Preprocedural recommendations and

guidelines:

Consult device representative
Multidisciplinary consult with Neurology + Neurosurgery
Preprocedural DBS device interrogation
DBS deactivation for approximately 30 minutes can serve as a clinical trial to assess the patient’s tolerance and anticipated neurologic status during the procedure

Intraprocedural recommendations and guidelines:

Appropriate adjustment of power settings and lesion time
Bipolar RFA preferred over monopolar RFA
Place the RFA cannula more than 6 inches from the internal pulse generator and its leads to avoid EMI interference

If using Monopolar RFA utilize contralateral grounding pad placement

Postprocedural recommendations and guidelines:

Postprocedural device interrogation
Evaluate for pain, warmth, or swelling over the pulse generator + lead tracts (could indicate thermal injury)

DISCUSSION

Key points

RFA should always be performed with the DBS turned off
Grounding pad on the contralateral side + placed far away from the pulse generator and leads
Lowest effective power and lesion time
Evaluate DBS site and lead tracts for signs of thermal injury

REFERENCES

Banik RK, Peng S, Kohan L, Rana P, Darrow DP, Hagedorn JM.
Radiofrequency ablation of lumbar medial branch nerves in a patient with a deep brain stimulator: Our experience and literature review.
Pain Medicine. 2023;24(6):734–737. doi:10.1093/pm/pnac179
Grabie M, Gabriels J, Xiang K, Elayi CS, Makaryus JN, Catanzaro JN.
Feasibility of radiofrequency catheter ablation in a patient with deep brain stimulators.
HeartRhythm Case Reports. 2020;6(5):253–255. doi:10.1016/j.hrcr.2020.01.005

Krishnan S, Pisharady K.
Surgical treatment of levodopa-induced dyskinesia in Parkinson’s disease.
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