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Qi LN, Sun Y, Shi YT, Yang JH, Yang YR, Qin XZ. Comparison of the Efficacy of Different Radiofrequency Techniques for the Treatment of Lumbar Facet Joint Pain: Combined with Anatomy. Curr Pain Headache Rep 2024; 28:699-708. [PMID: 38526650 DOI: 10.1007/s11916-024-01241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE OF REVIEW Lumbar facet pain is generally considered to be one of the major causes of chronic low back pain. Each lumbar facet joint is innervated by the medial branch of the posterior spinal nerve from its own level and above. Radiofrequency (RF) of the medial branch of the posterior branch of the spinal nerve is an effective method for the treatment of lumbar facet pain. RF technology is diverse, including traditional radiofrequency (TRF), pulsed radiofrequency (PRF), cooled radiofrequency (CRF), low-temperature plasma radiofrequency ablation (CA), and other treatment methods. The purpose of this paper is to compare the efficacy of different radiofrequency techniques and to analyze the reasons for this in the context of anatomy. RECENT FINDINGS There have been studies confirming the differences in efficacy of different RF techniques. However, most of the studies only compared two RF techniques, not four techniques, TRF, CRF, PRF, and CA, and did not analyze the reasons for the differences in efficacy. This article reviews the differences in the efficacy of the above four RF techniques, clarifies that the differences are mainly due to the inability to precisely localize the medial branch of the posterior branch of the spinal nerve, analyzes the reasons for the inability to precisely localize the posterior branch of the spinal nerve in conjunction with anatomy, and proposes that the development of RF technology for lumbar facet pain requires more in-depth anatomical, imaging, and clinical studies.
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Affiliation(s)
- Ling Na Qi
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Ye Sun
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Yu Tong Shi
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Jing Han Yang
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Yi Ran Yang
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Xiang Zheng Qin
- Department of Anatomy, Medical College of Yanbian University, Yanji, Jilin Province, China.
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Liu Z, Chen J, Fang D, Xu Y, Zhou X, Zheng Z, Zhang Z, Fan C, Luo S, Liu Z, Li Q, Zhao Q. Anatomical Observation and Clinical Significance of the Medial Branch of the Lumbar Dorsal Rami. Spine (Phila Pa 1976) 2024; 49:E164-E172. [PMID: 38420729 DOI: 10.1097/brs.0000000000004975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
STUDY DESIGN Anatomical study. OBJECTIVE This study aimed to elaborate on the anatomical characteristics of the medial branch of the lumbar dorsal rami and to discuss its possible clinical significance. SUMMARY OF BACKGROUND DATA Radiofrequency ablation targeting the medial branch of the lumbar dorsal rami has been increasingly used in the clinical management of facetogenic low back pain (FLBP). Nonetheless, attention is also being given to complications such as atrophy of the lumbar soft tissues and muscles. Therefore, a more detailed understanding of the innervation pattern on the facet joint may improve the precision of nerve ablation therapy for FLBP. METHODS An anatomical study of eight human specimens was carried out. The anatomic characteristics of the medial branch were observed and recorded. RESULTS The medial branch originates from the lumbar dorsal rami, running close to the root of the posterolateral side of the superior articular process of the inferior cone. When passed through the mamillo-accessory ligament, it turns direction to the medial and caudal side, running in the multifidus muscle. In our study, each medial branch sent out two to five branches along the way. All the medial branches in L1-L4 gave off one to two small branches when crossing the facet joint and innervated the joint of the lower segment. Nineteen medial branches (23.75%) gave off recurrent branches to innervate the joint at the upper segment. CONCLUSION The anatomical features of the medial branch remain similar in each lumbar segment. There are two types of joint branches, including the articular fibers that emanate from the medial branch as it runs along the medial border of the facet joint and the recurrent branch from the medial branch that innervates the upper facet joint. Moreover, an anastomotic branch was found in the medial branches between different segments.
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Affiliation(s)
- Zexian Liu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Junjie Chen
- The Spine Department, Orthopaedic Center, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Duopei Fang
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yejie Xu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xinying Zhou
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Zhiyang Zheng
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Zhenfeng Zhang
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Chaohui Fan
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Shiwen Luo
- Department of Anatomy, School of the Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Zezheng Liu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qingchu Li
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qinghao Zhao
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
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Tran J, Lawson A, Billias N, Loh E. 3D nerve proximity mapping of the medial branch of lumbar dorsal ramus: An anatomical study. INTERVENTIONAL PAIN MEDICINE 2024; 3:100414. [PMID: 39238583 PMCID: PMC11372964 DOI: 10.1016/j.inpm.2024.100414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 09/07/2024]
Abstract
Objective Lumbar medial branch (MB) radiofrequency ablation is a common intervention to treat facetogenic low back pain. Consensus among spine pain interventionalists is that the cannula tip should be placed adjacent to the periosteum of the lateral neck of the superior articular process (SAP) to ensure maximum contact with the MB. The spatial relationship of the nerve to the periosteum of the lateral neck of the SAP has not been quantified in 3D. The objectives of the current study were to: 1) use 3D modelling technology to quantify the location along the lateral neck of the SAP where the MB is in direct contact with the periosteum; and 2) identify target site(s) to optimize lumbar MB denervation. Design Seventy lumbar dorsal rami in 14 formalin-embalmed specimens were dissected, digitized, and modeled in 3D. The 3D positional data of the MB were used to generate a novel nerve proximity map which provided a method to quantify and visualize the 3D course of the MB in relation to the periosteum of the lateral neck of SAP. The percent of the lateral neck of SAP in contact with the MB was quantified and consistent target site(s) identified. Results There was variability in the percentage of the lateral neck of SAP in contact with the MB. The mean percentage of the lateral neck of SAP in contact with the MB for the L1-L5 levels ranged between 57.39 ± 10.72 % (for L1) to 81.54 ± 10.48 % (for L5). The nerve proximity map showed consistent course of the MB along the posterior portion of the lateral neck of SAP and at a novel target site distal to the mamillo-accessory notch (i.e. sub-mammillary landmark). Conclusion The percent of the lateral neck that was in contact with the MB was quantified and visualized using a novel nerve proximity mapping methodology which may be used to inform cannula tip depth placement. Further, the nerve proximity maps were used to identify an alternative landmark to extend the length of the MB captured. The proposed sub-mammillary landmark may be a viable target site pending future anatomical and clinical investigations.
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Affiliation(s)
- John Tran
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, M5S 1A8, Canada
- Department of Physical Medicine and Rehabilitation, Western University, Schulich School of Medicine and Dentistry, London, Ontario, N6C 0A7, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, N6C 2R5, Canada
| | - Arden Lawson
- Department of Physical Medicine and Rehabilitation, Western University, Schulich School of Medicine and Dentistry, London, Ontario, N6C 0A7, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, N6C 2R5, Canada
| | - Nicole Billias
- Department of Physical Medicine and Rehabilitation, Western University, Schulich School of Medicine and Dentistry, London, Ontario, N6C 0A7, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, N6C 2R5, Canada
| | - Eldon Loh
- Department of Physical Medicine and Rehabilitation, Western University, Schulich School of Medicine and Dentistry, London, Ontario, N6C 0A7, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, N6C 2R5, Canada
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Sahar W, Waseem M, Riaz M, Nazeer N, Ahmad M, Haider Z. Effects of prehabilitation resistance training in mild to moderate clinically frail patients awaiting coronary artery bypass graft surgery. J Investig Med 2024; 72:151-158. [PMID: 37804162 DOI: 10.1177/10815589231207795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Coronary artery disease is one of the main causes of mortality and morbidity among chronic heart diseases worldwide. Patients reported chronic chest pain as the primary symptom of coronary artery disease. Due to its progressive nature, it affects the health status and functional capacity of the patients. The current study was planned to compare the effects of prehabilitation resistance training in mild to moderate clinically frail patients awaiting coronary artery bypass graft (CABG). A randomized controlled trial was conducted on 74 patients awaiting CABG at the Faisalabad Institute of Cardiology, Faisalabad, Pakistan. A Modified Healthy Heart Questionnaire was used for screening of the patients. Interventions applied were resistance training by using cuff weights/dumbbells at light intensity (40%-50%) of a maximum of one repetition (10-15 repetitions for one to three times a day) per major muscle groups of upper and lower limbs of the body on weekly basis. The main outcome measures were the 6-minute walk test (6MWT), the New York Heart Association (NYHA) for heart failure, the clinical frailty score, and the essential frailty toolset. Significant differences between group A (resistance training group) and group B (conventional physical therapy group) patients were observed. The mean ranks for 6MWT in group A and group B were 1.70 and 1.55, respectively. The mean ranks of NYHA in group A and group B were 1.68 and 2.84, respectively. Clinical frailty scores in group A and group B were 2.68 and 2.74, respectively, with the essential frailty toolset in group A and group B were 1.14 and 1.11, respectively. There were significant (p < 0.05) differences within and between groups for prehabilitation resistance training after CABG. The study showed that the resistance training group had improved the clinical frailty score, strength, endurance, and functional capacity in patients who underwent elective CABG.
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Affiliation(s)
- Wajeeha Sahar
- Department of Physiotherapy, The University of Lahore, Lahore, Pakistan
| | - Mehwish Waseem
- Faculty of Rehabilitation & Allied Health Sciences, Riphah International University, Islamabad, Pakistan
| | - Muhammad Riaz
- Department of Allied Health Sciences, University of Sargodha, Sargodha, Pakistan
| | - Nouman Nazeer
- Post Graduate Resident Cardiology Department, Bahawal Victoria Hospital Bahawalpur, Quaid-e-Azam Medical College, Bahawalpur, Pakistan
| | - Muhammad Ahmad
- Department of Physiotherapy, The University of Lahore, Lahore, Pakistan
| | - Zulfiqar Haider
- Department of Cardiac Surgery, Quaid-e-Azam Medical College, Bahawalpur, Pakistan
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Zhang Z, Liu J, Xu Y, Chen Z, Luo S, Zhang X, Wang G, Cheng L. Anatomical study and clinical significance of the posterior ramus of the spinal nerve of the lumbar spine. Front Cell Dev Biol 2022; 10:1019309. [PMID: 36263013 PMCID: PMC9573941 DOI: 10.3389/fcell.2022.1019309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/16/2022] [Indexed: 11/27/2022] Open
Abstract
Background and objectives: Chronic nonspecific back pain is a common clinical disease typically treated by ultrasound-guided spinal injection. This minimally invasive treatment targets the posterior ramus of the spinal nerve (PRSN). The target of the medial branch is clear, but there is unclear target for the intermediate and lateral branches. This study attempted to observe the distribution of PRSN in the dorsal region of transverse process to provide a more detailed anatomical basis for treating spinal pain. Methods: The present study was conducted on 16 transverse processes of six adult male embalmed corpses. The dorsal area of the transverse process was divided into three equal zones, which are zone I, zone II and zone III from inside to outside. The origin, distribution, quantity, transverse diameter, and relationship with the bone structure of the PRSN on the transverse process were observed. Results: Sixty PRSNs were found in the lumbar of six cadavers, of which 48 were divided into three branches, and 12 PRSNs were divided into two branches. The intermediate branch is mainly distributed in zone I, and the lateral branch is mainly distributed in zone II. Twenty-nine communicating branches were found in 48 adjacent segments of six specimens, all of which originated from the intermediate branch of the previous segment and connected with the lateral branch of the next segment. Conclusion: This anatomical study describing the PRSN may have important clinical significance for spinal surgeons. Understanding the bony localization targets of the PRSN and the links between the PRSNs may benefit patients with low back pain who receive spinal injections.
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Affiliation(s)
- Zhenfeng Zhang
- Department of Orthopedics, Guangzhou Development District Hospital, Guangzhou, China
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Jing Liu
- Department of Orthopedics, Guangzhou Development District Hospital, Guangzhou, China
| | - Yejie Xu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Zeyan Chen
- Department of Orthopedics, Guangzhou Development District Hospital, Guangzhou, China
| | - Shiwen Luo
- Department of Anatomy, School of the Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Xin Zhang
- Department of Orthopaedics and Traumatology, Wuyi Hospital of Traditional Chinese Medicine, Jiangmen, China
| | - Guoliang Wang
- Department of Orthopedics, Guangzhou Development District Hospital, Guangzhou, China
- *Correspondence: Guoliang Wang, ; Liang Cheng,
| | - Liang Cheng
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
- *Correspondence: Guoliang Wang, ; Liang Cheng,
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Tran J, Peng P, Loh E. Anatomical study of the medial branches of the lumbar dorsal rami: implications for image-guided intervention. Reg Anesth Pain Med 2022; 47:rapm-2022-103653. [PMID: 35589133 DOI: 10.1136/rapm-2022-103653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/04/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Fluoroscopic-guided radiofrequency ablation of the lumbar medial branches is commonly performed to manage chronic low back pain originating from the facet joints. A detailed understanding of the course of medial branches in relation to bony and soft tissue landmarks is paramount to optimizing lumbar denervation procedures, particularly parallel placement of the radiofrequency electrode. The objectives of this study were to investigate the relationship of medial branches to anatomical landmarks and discuss the implications for lumbar denervation. METHODS Ten cadaveric specimens were meticulously dissected. The origin, course, and relationship of lumbar medial branches to bony and soft tissue landmarks were documented. RESULTS The medial branches followed the lateral neck of superior articular process deep to the intertransversarii mediales muscle at each lumbar vertebral level. In all specimens, the medial branches coursed laterally on the anterior half of the neck and transitioned from parasagittal-to-medial on the posterior half to reach the mamillo-accessory notch. The mamillo-accessory ligament was found to not occlude the nerve on the posterior quarter of the lateral neck but rather at the mamillo-accessory notch located at the posterior margin of the superior articular process. DISCUSSION A detailed understanding of the relationship of medial branches to anatomical landmarks is essential to optimizing needle placement for lumbar denervation procedures. The current study suggests that a parasagittal placement, with increased cranial-to-caudal angulation of the electrode, may improve parallel tip alignment with the targeted medial branch and represent a potential alternative to the traditional technique.
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Affiliation(s)
- John Tran
- Physical Medicine and Rehabilitation, Western University, London, Ontario, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, Canada
| | - Philip Peng
- Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eldon Loh
- Physical Medicine and Rehabilitation, Western University, London, Ontario, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, Canada
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OUP accepted manuscript. PAIN MEDICINE 2022; 23:1863-1868. [DOI: 10.1093/pm/pnac073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/20/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022]
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A Study on the Anatomical Relationship of the Lumbar Extrapedicular Puncture Approach with the Spinal Nerve and its Branches. Spine (Phila Pa 1976) 2021; 46:E611-E617. [PMID: 33428360 DOI: 10.1097/brs.0000000000003947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The anatomical relationship of the extrapedicular approach with the spinal nerve and its branches was researched in cadavers. Three types of extrapedicular paths were simulated: puncture inside the medial branch (MB), puncture outside the MB, and puncture outside the lateral branch (LB). At L1-L3, puncture outside the LB could avoid damage to these nerves.
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