Introduction: Radiofrequency (RF) ablation of medial branches of dorsal rami has been successfully utilized for long term pain relief of zygapophyseal joint pain. This procedure uses uni-polar radiofrequency RF heat to produce a neurolytic lesion. Radiofrequency waves may interfere with implanted devices, such as pacemakers or stimulators and safety of radiofrequency ablation has not been established during the presence of such devices. Methods: 49-year-old female patient, diagnosed with postlaminectomy pain syndrome, was scheduled for radiofrequency ablation of right L4 to S1 medial branches after a successful diagnostic medial branch block. After informed consent, the patient was brought to the procedure room and placed on the fluoroscope table in prone position. After sterile prep and drape, landmarks were identified under fluoroscopy. A 21-G, 10cm radiofrequency cannula with 10mm active tip was placed into position. A second radiofrequency cannula of same size was placed approximately 4-5 mm adjacent to the previously placed cannula. Similar procedure was performed at all levels. Results: Sensory and motor simulation was performed at each level. There was no alteration of EKG monitoring and no clinical signs of arrhythmia or hemodynamic compromise. There was no abnormal discharge from the sacral nerve stimulator. Radiofrequency ablation was performed at each level with at a temperature of 65-70 degree Celsius for 3 minutes. There were no problems with the pacemaker or sacral nerve stimulator afterwards. Conclusion: This is the first report of use of bipolar radiofrequency ablation in the presence of a sacral nerve stimulator and pacemaker without any complications. Increasing number of patients requiring advanced neuromodulation, may also require radiofrequency ablation for facet related pain. This report provides grounds for further investigations to elucidate the safety of radiofrequency ablation in the presence of central or peripheral nerve stimulators and pacemakers.