The peculiarities of location of medial twigs of posterior branches of spinal nerves (topographic-anatomical studies)

Authors

  • Volodymyr Radchenko
  • Olexandr Perfiliev
  • Valery Larichev

DOI:

https://doi.org/10.15674/0030-59872016178-83

Keywords:

medial twigs of posterior branches of spinal nerves, topographic-anatomical studies, facet joints

Abstract

Unsatisfactory results afterthe interventional treatment of pain syndrome associated with lumbar spondyloarthrosis could be explained by underestimation of variants of location of posterior branches (PB) of spinal nerves (SN) and therefor by incomplete denervation of facet joints (FJ).

The goal: to perform topographic-anatomic study of the medial branches PB SN in lumbar spine (LS) of human corpses and determine their size and variation of anatomical location in order to optimize minimally invasive diagnostic and treatment procedures.

The methods: 8 corpses are investigated (6 males and 2 females, age from 45 to 86 years). All the corpses were not claimed for burial, the causes of death were not associated with pathology or trauma of spine. 40 vertebral-motor segments (VMS), i.e. 80 segments on both sides, were isolated from the corpses on the LI–SI levels of spine without blocks removal or violation of corpse shape. The results: it was found out that anatomic variation in LI–LV levels was equal to 15.6 %, in LV–SI — 25 %. Diameter of medial branch was equal to 340–760 microns. «Triangle of medial branches» of PB of SN in LS was determined. Its borders pass in segments LI–LV on the base of transverse process to 2/3 (bottom line), outer surface of superior articular process to 3/3 (medial) and line connecting apex 3/3 of superior articular and 2/3 of transverse process (top). In segments LV–SI inferior border passes on the base of sacrum wing to 2/3, medial — on outer surface of articular process to 3/3 and superior — on the line connecting apex of 3/3 of superior articular process and sacrum wing.

The conclusions: a clear visualization of nerves, planned for the intersection, is required to perform a complete denervation of FJ. Using of specialized endoscopic equipment and taking into consideration the minimum necessary area to determine the bony landmarks VMS make it possible.

References

  1. Manchikanti L, Helm S, Singh V, Benyamin RM, Datta S, Hayek SM, Fellows B, Boswell MV; ASIPP. An algorithmic approach for clinical management of chronic spinal pain. Pain Physician. 2009;12(4):E225–64.
  2. Sirenko AA. Diagnostika, profilaktika i lechenie retsidivov spondiloartralgii posle denervatsii poyasnichnykh dugootrostchatykh sustavov: abstract dis. the candidate of medical sciences. Kharkov, 2010. 20 p.
  3. Manchikanti L, Pampati V, Singh V, Falco FJ. Assessment of the escalating growth of facet joint interventions in the medicare population in the United States from 2000–2011. Pain Physician. 2013;16(4):E365–78.
  4. Manchikanti L, Kaye AD, Boswell MV, Bakshi S, Gharibo CG, Grami V, Grider JS, Gupta S, Jha SS, Mann DP, Nampiaparampil DE, Sharma ML, Shroyer LN, Singh V, Soin A, Vallejo R, Wargo BW, Hirsch JA. A systematic review and best evidence synthesis of the effectiveness of therapeutic facet joint interventions in managing chronic spinal pain. Pain Physician. 2015;184:E535–82.
  5. Civelek E, Cansever T, Kabatas S, et al. Comparison of effectiveness of facet joint injection and radiofrequency denervation in chronic low back pain. Turk Neurosurg. 2012;22(2):200–6. doi: 10.5137/1019-5149.JTN.5207-11.1.
  6. Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine. 2009;34(10):1078–93. doi: 10.1097/BRS.0b013e3181a103b1.
  7. Bogduk NA, Dreyfuss P, Govind J. Narrative review of lumbar medial branch neurotomy for the treatment of back pain. Pain Medicine. 2009;10(6):1035–45. doi: 10.1111/j.1526-4637.2009.00692.x.
  8. Moon JY, Lee PB, Kim YC, Choi SP, Sim WS. An alternative distal approach for the lumbar medial branch radiofrequency denervation: a prospective randomized comparative study. Anesth. Analg. 2013;116(5):1133–40. doi: 10.1213/ANE.0b013e31828b35fe.
  9. Jeong SY, Kim JS, Choi WS, Hur JW, Ryu KS. The effectiveness of endoscopic radiofrequency denervation of medial branch for treatment of chronic low back pain. J Korean Neurosurg. Soc. 2014;56(4):338–43. doi: 10.3340/jkns.2014.56.4.338.
  10. Pedersen HE, Blunck CF, Gardner E. The anatomy of lumbosacral posterior rami and meningeal branches of spinal nerves (sinu-vertebral nerves). J Bone Joint Surg. 1956;38-A:377–91.
  11. Lazorthes G, Juskiewenski S. Etude comparative des branches posterieures des nerfs dorsaux et lombaires et de leurs rapports avec les articulations interapophysiares vertebrales. Bulletin de l’Association des anatomists. 1964;49e:1025–33.
  12. Bogduk N, Wilson AS, Tynan WT. The human lumbar dorsal rami. J Anat. 1982:134(2):383–97.
  13. Loh JT, Nicol AL, Elashoff D, Ferrante FM. Efficacy of needle-placement technique in radiofrequency ablation for treatment of lumbar facet arthropathy. J Pain Res. 2015;8:687–94. doi: 10.2147/JPR.S84913.
  14. Leggett LE, Soril LJ, Lorenzetti DL, Noseworthy T, Steadman R, Tiwana S, Clement F. Radiofrequency ablation for chronic low back pain: a systematic review of randomized controlled trials. Pain Res. Manag. 2014;19(5):e146–53.
  15. Boswell MV, Manchikanti L, Kaye AD, Bakshi S, Gharibo CG, Gupta S, Jha SS, Nampiaparampil DE, Simopoulos TT, Hirsch JA. A best-evidence systematic appraisal of the diagnostic accuracy and utility of facet (zygapophysial) joint injections in chronic spinal pain. Pain Physician. 2015;18(4):E497–533.
  16. Lau P, Mercer S, Govind J, Bogduk N. The surgical anatomy of lumbar medial branch neurotomy (facet denervation). Pain Med. 2004:5(3):289–98.
  17. Chen JD, Hou SX, Peng BG, Shi YM, Wu WW, Li L. Anatomical study of human lumbar spine innervation. Zhonghua Yi Xue Za Zhi. 2007;87(9):602–5.
  18. Steinke H, Saito T, Miyaki T, Oi Y, Itoh M, Spanel-Borowski K. Anatomy of the human thoracolumbar Rami dorsales nervi spinalis. Ann. Anat. 2009:191(4):408–16. doi: 10.1016/j.aanat.2009.04.002.
  19. Zhou L, Schneck CD, Shao Z. The anatomy of dorsal ramus nerves and its implications in lower back pain. Neuroscience Medicine. 2012;3:192–201.
  20. Saito T1, Steinke H, Miyaki T, Nawa S, Umemoto K, Miyakawa K, Wakao N, Asamoto K, Nakano T. Analysis of the posterior ramus of the lumbar spinal nerve the structure of the posterior ramus of the spinal nerve. Anesthesiology. 2013;118(1):88–94. doi: 10.1097/ALN.0b013e318272f40a.
  21. Yeung A, Gore S. Endoscopically guided foraminal and dorsal rhizotomy for chronic axial back pain based on cadaver and endoscopically visualized anatomic study. Int. J Spine Surg. 2014;8:1–16. doi: 10.14444/1023.
  22. Cohen SP, Williams KA, Kurihara C, Nguyen C, Shields C, Kim P, Griffith SR, Larkin TM, Crooks M, Williams N, Morlando B, Strassels SA. Multicenter, randomized, comparative cost-effectiveness study comparing 0.1 and 2 diagnostic medial branch (facet joint nerve) block treatment paradigms before lumbar facet radiofrequency denervation. Anesthesiology. 2010;113(2):395–405. doi: 10.1097/ALN.0b013e3181e33ae5.
  23. Tome-Bermejo F, Barriga-Martin A, Martin JL. Identifying patients with chronic low back pain likely to benefit from lumbar facet radiofrequency denervation: a prospective study. J Spinal Disord Tech. 2011;24(2):69–75. doi: 10.1097/BSD.0b013e3181dc9969.
  24. Wiltse LL, Bateman JG, Hutchinson RH, Nelson W. The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg Am. 1968;50-A(5):919–26.
  25. Mahato NK. Mamillo-accessory notch and foramen: distribution patterns and correlation with superior lumbar facet structure. Morphologie. 2014;98(323):176–81. doi: 10.1016/j.morpho.2014.03.002.
  26. Giles LG, Taylor JR. Innervation of lumbar zygapophyseal joint synovial folds. Acta Orthop. Scand. 1987;58(1):43–6.
  27. Jackson R. The facet syndrome. Myth or reality? Clin. Orthop. 1992;279(1):110–21.

Downloads

How to Cite

Radchenko, V., Perfiliev, O., & Larichev, V. (2016). The peculiarities of location of medial twigs of posterior branches of spinal nerves (topographic-anatomical studies). ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (1), 78–83. https://doi.org/10.15674/0030-59872016178-83

Issue

No. 1 (2016)

Section

ORIGINAL ARTICLES

License

Copyright (c) 2016 Volodymyr Radchenko, Olexandr Perfiliev, Valery Larichev

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

The authors retain the right of authorship of their manuscript and pass the journal the right of the first publication of this article, which automatically become available from the date of publication under the terms of Creative Commons Attribution License, which allows others to freely distribute the published manuscript with mandatory linking to authors of the original research and the first publication of this one in this journal.

Authors have the right to enter into a separate supplemental agreement on the additional non-exclusive distribution of manuscript in the form in which it was published by the journal (i.e. to put work in electronic storage of an institution or publish as a part of the book) while maintaining the reference to the first publication of the manuscript in this journal.

The editorial policy of the journal allows authors and encourages manuscript accommodation online (i.e. in storage of an institution or on the personal websites) as before submission of the manuscript to the editorial office, and during its editorial processing because it contributes to productive scientific discussion and positively affects the efficiency and dynamics of the published manuscript citation (see The Effect of Open Access).