50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Minimally Invasive Interventions for Chronic Neck Pain in
Klippel-Feil Syndrome: A Case Report

Sharima Kanahan-Osman, M.D.1, Sebastian Encalada, M.D. 1, Sohail Bade, M.B.B.S. 1, Sahil Bade, M.B.B.S. 1, Christine Hunt, D.O. 1, Mark Hurdle, M.D.1

1Department of Pain Medicine, Mayo Clinic, Jacksonville, FL, USA

Case Description

Patient 64-year-old woman

Presenting Complaint

•Six-month history of bilateral neck pain, rated 6/10, described as sharp, burning, and aching

•Worsened by cervical spine motion

•Partially relieved by rest

•Physical Examination Findings

•No neurologic deficits reported

•Imaging Findings

•X-ray: Congenital fusion of C4–C6 with rudimentary disc spaces

•MRI:

•Posterior dysraphism at C6–C7

•Large syrinx from C4–C5 to C7–T1

•Moderate foraminal stenosis at C2–C3 and C3–C4

•Disc bulging and uncovertebral hypertrophy

•Degeneration of adjacent segments with mild spinal canal stenosis and anterolisthesis at C3–C4

Results

Initial Management

•Physical therapy

•Oral analgesics

•Conservative therapy failed to provide adequate relief

Interventions

•Two fluoroscopically guided diagnostic medial branch blocks (MBB) at bilateral C2–C3 and C3–C4 facet joints

•First MBB: 3 mL 0.5% bupivacaine + 2 mL iohexol

•Second MBB: 3 mL 0.5% bupivacaine + 1 mL iohexol (Figure 3).

•Cervical RFA at bilateral C2–C3 facet joints

Outcome

•Both procedures were well tolerated

•Significant (90%) post-procedural pain relief was achieved after MBBs

•No complications reported

•Planned Management

•Post-procedure follow-up

Discussion

•Klippel-Feil syndrome (KFS) is a congenital cervical fusion (Figures 1 and 2) often associated with adjacent segment degeneration

•Cervical facet-mediated pain can be difficult to diagnose and manage due to altered anatomy

•Fluoroscopic guidance is critical for safe needle placement during interventions

•Diagnostic MBBs helped identify cervical facet joints as the likely pain source

•RFA demonstrated efficacy for cervical facet-mediated pain

•Potential of personalized, image-guided interventions in anatomically complex patients

References

Palacios Martínez D, Díaz Alonso RA, Gutiérrez López M, Gordillo López FJ. Síndrome de Klippel-Feil, una cervicalgia poco frecuente [Klippel-Feil syndrome, a rare cervicalgia]. Semergen. 2013;39(8):e63-e67. doi:10.1016/j.semerg.2012.09.003

Wessell A, DeRosa P, Cherrick A, et al. Cervical instability in Klippel-Feil syndrome: case report and review of the literature. Chin Neurosurg J. 2015;1(1):6. doi:10.1186/s41016-015-0002-7

Ryu RC, Behrens PH, Burkert BA, Johnson JP, Kim TT. Two-level cervical disc arthroplasty in patients with Klippel-Feil syndrome: A case report and review of the literature. Surg Neurol Int. 2020;11:322. Published 2020 Oct 2. doi:10.25259/SNI_587_2020

Suer M, Wahezi SE, Abd-Elsayed A, Sehgal N. Cervical Facet Joint Pain and Cervicogenic Headache Treated With Radiofrequency Ablation: A Systematic Review. Pain Physician. 2022;25(3):251-263.

Patel K, Evans H, Sommaruga S, et al. Characteristics and management of pain in patients with Klippel-Feil syndrome: analysis of a global patient-reported registry. J Neurosurg Spine.2019;32(4):578-583. Published 2019 Dec 13. doi:10.3171/2019.9.SPINE19820

50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

MINIMALLY INVASIVE INTERVENTIONS FOR CHRONIC NECK PAIN IN KLIPPEL-FEIL SYNDROME: A CASE REPORT

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