Articles: back-pain.
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Percutaneous lumbar medial branch neurotomy is a technique for facet denervation in which the target is specifically the medial branch of the dorsal ramus. The radiology of the technique is illustrated, and the technical aspects of the procedure are described. The accuracy of previous techniques for facet denervation as compared with medial branch neurotomy is reviewed in a comparative analysis of radiographs illustrating the various techniques. It is suggested that the greater accuracy of medial branch neurotomy will permit a more adequate trial of the rationale and efficacy of facet denervation.
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Structures innervated by the dorsal primary ramus play a significant part in the genesis of chronic backache and associated leg pain. The features of this syndrome are described and compared with those in the more familiar clinical picture following intervertebral disc degeneration. ⋯ A technique of percutaneous facet denervation with a radiofrequency probe, although by no means successful in every case, is entirely safe and a very wothwhile procedure. It has helped many patients, who would otherwise have been disabled by pain and restricted in their activities.
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Journal of neurosurgery · Aug 1979
The anatomy of the so-called "articular nerves" and their relationship to facet denervation in the treatment of low-back pain.
Disections of the dorsal rami of L1--5 were performed in human cadavers, and the course of the dorsal rami, their branches, and the innervation of the zygapophyseal joints in the lumbar region were specifically studied. At the L-1 through L-4 levels, the dorsal rami divide into medial and lateral branches within the intertransverse ligaments. Each medial branch runs across the root of the adjacent superior articular process. ⋯ Beneath the mammillo-accessory ligament, medial branches occur that innervate the adjacent zygapophyseal joint, and distal zygapophyseal branches arise at the laminar level to innervate the next lower joint. The L-5 dorsal ramus runs along a groove between the ala of the sacrum and its superior articular process. A the caudal edge of the articular process, the ramus divides into medial and lateral branches, and the medial branch supplies the L5--S1 articulation.