O-Arm CT–Guided Intercostal Nerve Radiofrequency Ablation for Refractory Tietze’s Syndrome: A Case Report

Tamerlan Shokanov, Talgat Anashev, Ibragim Sakhanov, Yerdar Shaukhin Department of Orthopedic Trauma and Pain Management, National Scientific Center of Traumatology and Orthopedics named after N.D. Batpenov, Astana, KazakhstanCorrespondence: Talgat Anashev, National Scientific Center of Traumatology and Orthopedics (NSCTO), Astana, Kazakhstan, Email [email protected]: Tietze’s syndrome is a rare inflammatory condition of the anterior chest wall that may cause chronic localized pain resistant to conservative treatment. Surgical cartilage resection often provides only temporary relief, and recurrence of pain presents a significant therapeutic challenge.Case Presentation: We report the case of a 49-year-old female with recurrent anterior chest wall pain due to refractory Tietze’s syndrome following two costal cartilage resections. Despite corticosteroid injections and physiotherapy, pain persisted with a VAS score of 7– 8/10. Considering multiple treatment failures, O-arm CT-guided radiofrequency ablation (RFA) of the intercostal nerves at the 2nd– 3rd ribs was performed. The procedure allowed precise cannula placement under 3D visualization and correction of intrathoracic misplacement detected on intraoperative O-arm CT (not evident on conventional fluoroscopy). After final lesioning at 80 °C for 90s, the patient experienced complete pain relief (VAS 0– 1/10), restored respiratory comfort, and full functional recovery without complications.Conclusion: O-arm CT guidance enables accurate targeting and improved safety during intercostal nerve RFA in anatomically complex anterior chest wall regions. This technique represents a promising minimally invasive option for refractory Tietze’s syndrome when surgery and conservative therapy fail.Keywords: Tietze’s syndrome, radiofrequency ablation, intercostal nerves, O-arm CT, chest wall pain