Development and Description of a New Multifidus‐Sparing Radiofrequency Neurotomy Technique for Facet Joint Pain

Russo, Marc; Santarelli, Danielle M.

doi:10.1111/papr.13010

Cited by 9 publications

(6 citation statements)

References 55 publications

(58 reference statements)

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“…Multifidus denervation leading to disuse atrophy may cause a vicious cycle of dysfunction among the three spinal stabilizing systems (spinal column, spinal muscles, and neural control unit) causing repetitive tissue injury, suboptimal stabilization of forces, improper tissue overloading, intersegmental spinal instability, impaired sensorimotor control, and chronic nociceptive and neuroplastic changes. Thus, a proposed more conservative multifidus sparing RFA would be preferred targeting the terminal end branches of the medial branch of the dorsal root, directly over the facet joint capsule ( 44 ). Targeting the LMBN has long proven to have therapeutic value.…”

Section: Discussionmentioning

confidence: 99%

Non-Spinal Neuromodulation of the Lumbar Medial Branch Nerve for Chronic Axial Low Back Pain: A Narrative Review

et al. 2022

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Chronic low back pain remains highly prevalent, costly, and the leading cause of disability worldwide. Symptoms are complex and treatment involves an interdisciplinary approach. Due to diverse anatomical etiologies, treatment outcomes with interventional options are highly variable. A novel approach to treating chronic axial low back pain entails the use of peripheral nerve stimulation to the lumbar medial branch nerve, and this review examines the clinical data of the two different, commercially available, non-spinal neuromodulation systems. This review provides the clinician a succinct narrative that presents up-to-date data objectively. Our review found ten clinical studies, including one report of two cases, six prospective studies, and three randomized clinical trials published to date. Currently, there are different proposed mechanisms of action to address chronic axial low back pain with different implantation techniques. Evidence suggests that peripheral nerve stimulation of the lumbar medial branch nerve may be effective in improving pain and function in patients with chronic axial low back pain symptoms at short and long term follow up, with good safety profiles. Further long-term data is needed to consider this intervention earlier in the pain treatment algorithm, but initial data are promising.

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Section: Discussionmentioning

confidence: 99%

Non-Spinal Neuromodulation of the Lumbar Medial Branch Nerve for Chronic Axial Low Back Pain: A Narrative Review

et al. 2022

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“…Based on our anatomical finding, it might be a strategy involving targeted nerve ablation surrounding the facet joint capsule to mitigate potential injury to the medial branch. 32 Previous studies have attributed the low effectiveness of medial branch ablation for LBP to unsuitable patient groups and improper surgical methods. 30 However, our study revealed the presence of an anastomotic branch between two medial branches of different segments.…”

Section: Clinical Relevancementioning

confidence: 99%

Anatomical Observation and Clinical Significance of the Medial Branch of the Lumbar Dorsal Rami

Liu,

Chen,

Fang

et al. 2024

Spine

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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 8 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 2-5 branches along the way. All the medial branches in L1-L4 gave off 1-2 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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“…94 New application forms of radiofrequency are currently under investigation (eg, cooled RF and multi-tined electrodes). 95,96 Other treatment options…”

Section: Alternative Radiofrequency Administration Possibilitiesmentioning

confidence: 99%

3. Pain originating from the lumbar facet joints

Van den Heuvel,

Cohen,

de Andrès Ares

et al. 2023

Pain Practice

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IntroductionPain originating from the lumbar facets can be defined as pain that arises from the innervated structures comprising the joint: the subchondral bone, synovium, synovial folds, and joint capsule. Reported prevalence rates range from 4.8% to over 50% among patients with mechanical low back pain, with diagnosis heavily dependent on the criteria employed. In well‐designed studies, the prevalence is generally between 10% and 20%, increasing with age.MethodsThe literature on the diagnosis and treatment of lumbar facet joint pain was retrieved and summarized.ResultsThere are no pathognomic signs or symptoms of pain originating from the lumbar facet joints. The most common reported symptom is uni‐ or bilateral (in more advanced cases) axial low back pain, which often radiates into the upper legs in a non‐dermatomal distribution. Most patients report an aching type of pain exacerbated by activity, sometimes with morning stiffness. The diagnostic value of abnormal radiologic findings is poor owing to the low specificity. SPECT can accurately identify joint inflammation and has a predictive value for diagnostic lumbar facet injections. After “red flags” are ruled out, conservatives should be considered. In those unresponsive to conservative therapy with symptoms and physical examination suggesting lumbar facet joint pain, a diagnostic/prognostic medial branch block can be performed which remains the most reliable way to select patients for radiofrequency ablation.ConclusionsWell‐selected individuals with chronic low back originating from the facet joints may benefit from lumbar medial branch radiofrequency ablation.

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Development and Description of a New Multifidus‐Sparing Radiofrequency Neurotomy Technique for Facet Joint Pain

Cited by 9 publications

References 55 publications

Non-Spinal Neuromodulation of the Lumbar Medial Branch Nerve for Chronic Axial Low Back Pain: A Narrative Review

Non-Spinal Neuromodulation of the Lumbar Medial Branch Nerve for Chronic Axial Low Back Pain: A Narrative Review

Anatomical Observation and Clinical Significance of the Medial Branch of the Lumbar Dorsal Rami

3. Pain originating from the lumbar facet joints

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