Case 1: Cervical facet joint pain treated with RF ablation
34-year-old female presented with severe headache for five years. Pain started at the upper neck, spread over the back of the head, and slowly involved the frontal region. Pain lasted many hours unless she took strong analgesics; frequency and severity worsened over the last six months.
She had been treated as migraine (still on anti-migraine drugs), had psychological assessment, and physiotherapy — without benefit.
At our centre, examination showed significant tenderness over paraspinal muscles along the facet column; neck range of motion to the right was limited due to pain and spasm.
Diagnostic medial branch block under X-ray guidance was strongly positive (about 80–90% pain relief). She proceeded to RF ablation and improved approximately 80%, able to manage daily activities without assistance.
Case 2: Failed back surgery syndrome — Racz adhesiolysis and ozone discectomy
A Pakistani national with multi-level thoracic disc prolapses (T3–4, T8–9, T9–10, T10–11) had undergone laminectomy in Karachi. Pre-operatively he had motor weakness, severe electric pain in the lower limbs (left greater than right), and numbness. He could walk but fell if unsupported. Post-operatively pain reduced for one month without improvement in leg power.
Extensive physiotherapy was limited by burning and spastic pain in the left leg. Repeat MRI showed similar disc findings with bands of adhesions around nerves from post-surgical fibrosis (a common cause of persistent pain after spine surgery).
Dr. Kailash Kothari advised percutaneous Racz adhesiolysis, followed by ozone discectomy at the major prolapse (T10–11). A catheter was passed via the sacral hiatus; under live X-ray the tip was placed at the adhesion site and medications (including hyaluronidase and steroid) were used per protocol over three days. He then had intensive physiotherapy for three weeks with marked improvement in pain, spasticity, and standing ability.
Three weeks later, X-ray–guided percutaneous ozone discectomy was performed under local anaesthesia. Six weeks after ozone discectomy he could walk short distances (e.g. to the bathroom and balcony) without support and was virtually free of pain and spasticity in the lower limbs — an example of advanced pain management for difficult failed back surgery syndrome.
Case 3: Atypical back and foot pain — SI joint source
Female patient with burning over the feet and gluteal pain; toe tips affected daily life. MRI, EMG, and other tests were non-specific. Orthopaedic colleagues referred her to Pain Clinic of India.
Presentation was vague; gabapentin, amitriptyline, and lidocaine patch did not help. Bilateral L4–L5 medial branch blocks did not relieve pain within 30 minutes. Palpation over the gluteal region was tender above the SI joint.
Diagnostic SI joint block with local anaesthetic under live X-ray abolished pain immediately — including foot pain on examination. She was about 80% better. Conclusion: precision diagnosis matters; SI joint inflammation can refer pain in unexpected patterns. Further options include physiotherapy, steroid injection, and radiofrequency ablation.