The anatomy of the so-called “articular nerves” and their relationship to facet denervation in the treatment of low-back pain

1979 ◽  
Vol 51 (2) ◽  
pp. 172-177 ◽  
Author(s):  
Nikolai Bogduk ◽  
Don M. Long
Keyword(s):  
Medial Branch ◽  
Lumbar Region ◽  
Low Back ◽  
Content Type ◽  
Articular Process ◽  
Zygapophyseal Joints ◽  
Human Cadavers ◽  
Facet Denervation ◽  
Dorsal Rami ◽  
Lateral Branches

✓ Dissections 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. At the caudal edge of the process, the branch turns medially beneath the mammillo-accessory ligament. 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. At the caudal edge of the articular process, the ramus divides into medial and lateral branches, and the medial branch supplies the L5—S1 articulation.

scholarly journals The Anatomy of the Lateral Branches of the Sacral Dorsal Rami: Implications for Radiofrequency Ablation

2014 ◽  
Vol 5;17 (5;9) ◽  
pp. 459-464
Author(s):  
Joseph Fortin
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Radiofrequency Ablation ◽  
Sacroiliac Joint ◽  
Low Back ◽  
Sacral Foramina ◽  
Dorsal Rami ◽  
Lateral Branches ◽  
The Right ◽  
Segmental Innervation

Background: The sacroiliac joint (SIJ) is a major source of pain in patients with chronic low back pain. Radiofrequency ablation (RFA) of the lateral branches of the dorsal sacral rami that supply the joint is a treatment option gaining considerable attention. However, the position of the lateral branches (commonly targeted with RFA) is variable and the segmental innervation to the SIJ is not well understood. Objectives: Our objective was to clarify the lateral branches’ innervation of the SIJ and their specific locations in relation to the dorsal sacral foramina, which are the standard RFA landmark. Methods: Dissections and photography of the L5 to S4 sacral dorsal rami were performed on 12 hemipelves from 9 donated cadaveric specimens. Results: There was a broad range of exit points from the dorsal sacral foramina: ranging from 12:00 – 6:00 position on the right side and 6:00 – 12:00 on the left positions. Nine of 12 of the hemipelves showed anastomosing branches from L5 dorsal rami to the S1 lateral plexus. Limitations: The limitations of this study include the use of a posterior approach to the pelvic dissection only, thus discounting any possible nerve contribution to the anterior aspect of the SIJ, as well as the possible destruction of some L5 or sacral dorsal rami branches with the removal of the ligaments and muscles of the low back. Conclusion: Widespread variability of lateral branch exit points from the dorsal sacral foramen and possible contributions from L5 dorsal rami and superior gluteal nerve were disclosed by the current study. Hence, SIJ RFA treatment approaches need to incorporate techniques which address the diverse SIJ innervation. Key words: Sacroiliac joint pain, radiofrequency ablation, dorsal sacral rami, low back pain

Anatomical study of superior cluneal nerve entrapment

2013 ◽  
Vol 19 (1) ◽  
pp. 76-80 ◽  
Author(s):  
Hiroshi Kuniya ◽  
Yoichi Aota ◽  
Tomoyuki Saito ◽  
Yoshinori Kamiya ◽  
Kengo Funakoshi ◽  
...  
Keyword(s):  
Iliac Crest ◽  
Anatomical Study ◽  
Anatomical Variations ◽  
Lateral Branch ◽  
Medial Branch ◽  
Low Back ◽  
Thoracolumbar Fascia ◽  
Recent Clinical Study ◽  
Lateral Branches ◽  
The Right

Object Entrapment of the superior cluneal nerve (SCN) in an osteofibrous tunnel in the space surrounded by the iliac crest and the thoracolumbar fascia is a cause of low-back pain (LBP). Several anatomical and surgical reports describe SCN entrapment as a cause of LBP, and a recent clinical study reported that patients with suspected SCN disorder constitute approximately 10% of the patients suffering from LBP and/or leg symptoms. However, a detailed anatomical study of SCN entrapment is rare. The purpose of this study was to investigate the courses of SCN branches and to ascertain the frequency of SCN entrapment. Methods Branches of the SCN were dissected in 109 usable specimens (54 on the right side and 55 on the left side) obtained in 59 formalin-preserved cadavers (average age at death 84.8 years old). All branches were exposed at the points where they perforated the thoracolumbar fascia. The presence or absence of an osteofibrous tunnel was ascertained and, if present, the entrapment of the branches in the tunnel was determined. Results Of 109 specimens, 61 (56%) had at least 1 branch running through an osteofibrous tunnel. Forty-two medial (39%), 30 intermediate (28%), and 14 lateral (13%) SCN branches passed through such a tunnel. Of these, only 2 medial branches had obvious entrapment in an osteofibrous tunnel. There were several patterns for the SCN course through the tunnel: medial branch only (n = 25), intermediate branch only (n = 11), lateral branch only (n = 4), medial and intermediate branches (n = 11), medial and lateral branches (n = 2), intermediate and lateral branches (n = 4), and all branches (n = 4). Conclusions Several anatomical variations of the running patterns of SCN branches were detected. Entrapment was seen only in the medial branches. Although obvious entrapment of the SCN is rare, it may cause LBP.

The Source and the Course of the Articular Branches to the T4-T8 Zygapophysial Joints

Pain Medicine ◽  
2019 ◽  
Vol 20 (12) ◽  
pp. 2371-2376
Author(s):  
Anand Joshi ◽  
Timothy J Amrhein ◽  
Megan A Holmes ◽  
Joel Talsma ◽  
Megan Shonyo ◽  
...  
Keyword(s):  
Gross Anatomy ◽  
Medial Branch ◽  
Needle Placement ◽  
School Of Medicine ◽  
Anatomy Laboratory ◽  
Duke University ◽  
Dorsal Rami ◽  
Lateral Branches ◽  
Osseous Structure ◽  
Side Asymmetry

Abstract Objective To define the source and the course of the articular branches to the midthoracic zygapophysial (“z”) joints. Design Cadaveric dissection. Setting The Gross Anatomy Laboratory of the Duke University School of Medicine. Subjects Ten human cadaveric thoraces. Methods Gross and stereoscopic dissection of dorsal rami T4-T8 was performed bilaterally on 10 adult embalmed cadavers. The medial and lateral branches were traced to their origins from the dorsal rami, and the course of the articular nerves was documented through digital photography. Radio-opaque wire (20 gauge) was applied to the nerves. Fluoroscopic images were obtained to delineate their radiographic course with respect to osseous landmarks. Results Forty-eight inferior articular branches were identified. Three (6.3%) originated from the medial branch and 44 (91.7%) from the dorsal ramus. One was indeterminate. Fifty-one superior articular branches were identified. Eight (15.7%) originated from the medial branch and 43 (84.3%) from the dorsal ramus. In 12% of cases (6/50), there was side-to-side asymmetry in the origins of the articular branches. Nerves were commonly suspended in the intertransverse space. The articular branches contacted an osseous structure in only 39% of cases. As previously reported, a “descending branch” was not identified in any specimen. Conclusions Articular branches to the T4-T8 z-joints have substantial inter- and intraspecimen variability of origin. They typically arise from the dorsal ramus rather than the medial branch and frequently do not contact any osseous structure to allow percutaneous needle placement.

scholarly journals Congenital absence of a lumbosacral facet joint: A case report

2020 ◽  
Vol 11 ◽  
pp. 15
Author(s):  
Nitin Maruti Adsul ◽  
Manoj Kumar ◽  
Shankar Acharya ◽  
K. L. Kalra ◽  
R. S. Chahal
Keyword(s):  
Facet Joint ◽  
Relevant Literature ◽  
Congenital Absence ◽  
Leg Pain ◽  
Low Back ◽  
Lumbar Surgery ◽  
Zygapophyseal Joint ◽  
Resonance Imaging ◽  
Articular Process ◽  
Zygapophyseal Joints

Background: Congenital absence of the lumbosacral facet joint is extremely rare, with only 26 cases reported in the literature. Here, we present a patient with the unilateral absence of the left fifth lumbar inferior articular process and reviewed the relevant literature. Case Description: A 32-year-old gentleman, who had undergone right L4-5 lumbar microdiscectomy 3 months ago now presented with acute low back and left leg pain following a fall. He is now presented with acute low back and left leg pain following a fall. Plain radiographs of the L-S spine revealed an absent left L5–S1 zygapophyseal joint. The magnetic resonance imaging and computed tomography studies additionally confirmed an absent unilateral left L5 lumbar inferior articular process. Conclusion: Patients presenting for lumbar surgery may have unilaterally absent lumbosacral zygapophyseal joints, which may impact the outcome of surgical treatment.

The role of HLA B27 in the diagnosis and management of low-back pain and sciatica

1977 ◽  
Vol 47 (4) ◽  
pp. 561-566 ◽  
Author(s):  
William F. Bingham
Keyword(s):  
Histocompatibility Antigen ◽  
Low Back ◽  
Hla B27 ◽  
Content Type ◽  
Seronegative Spondyloarthropathy ◽  
X Ray ◽  
Facet Denervation ◽  
Fine Print ◽  
Better Than

✓ Present diagnostic criteria for ankylosing spondylitis (AS) lean heavily on the x-ray examination, but there is much dispute as to its efficacy, especially in mild or early cases. Determinations of the HLA B27 histocompatibility antigen appear to define the population at risk far better than any other means. Of 31 patients who had the HLA B27 antigen, all had negative latex fixation tests and axial polyarthritic complaints (seronegative spondyloarthropathy or rheumatoid variant). Three had Reiter's syndrome and one had ulcerative colitis. Of the remaining 27 patients, nine had definite AS, 11 had probable AS, and seven had possible AS. Eleven of the 27 underwent at least one invasive spinal procedure (myelogram, laminectomy, fusion, facet denervation) before a diagnosis of AS was made.

scholarly journals Prolongation of Lumbar Facet Joint Nerve Block Duration with 10% Lidocaine Neurolysis: A Retrospective Cohort Study

2018 ◽  
pp. 81-88
Author(s):  
David D. Kim
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Relief ◽  
Facet Joint ◽  
Medial Branch ◽  
Low Back ◽  
Significant Difference ◽  
Dorsal Rami

Background: Neural blockade of the facet medial branch/L5 dorsal rami with local anesthetic with or without corticosteroid has been used to both diagnose and treat low back pain. Higher concentration lidocaine has been shown to be neurolytic in multiple in vivo, in vitro, and some clinical studies. This may make 10% lidocaine a possible neurolytic agent to prolong pain relief from facet blocks. Objective: Compare neurolytic effects of 10% lidocaine to prolong pain relief compared to bupivacaine/ methylprednisolone (BM) in facet medial branch/L5 dorsal rami blocks (MBB). Methods: Retrospective review of 77 patients who received a 10% lidocaine MBB from after short term relief from MBB with BM. Comparison was made in visual analog scale (VAS) and duration of relief using Wilcoxon signed rank matched pairs test. Results: There was no significant difference between baseline median VAS prior to MBB with BM and 10% lidocaine and median days VAS recorded post each MBB ((P = 0.477). Median VAS immediately after BM MBB (17.5 mm) was not significantly different than after 10% Lidocaine MBB) of 18 mm (P = 0.341). Median duration of relief with 10% lidocaine was greater at 14 days versus BM at 3.5 days (P = 0.001). There was no significant correlation between the volume of 10% lidocaine at each level and performance measures: % change VAS post lidocaine MBB (P= 0.529), duration lidocaine MBB (P = 935), VAS pre-RFTC (P = 0.683). Limitation: Retrospective, small study. Conclusion: Ten percent lidocaine was moderately effective neurolytic agent with longer duration than BM. Key words: Lidocaine, facet joint, neurolysis, low back pain

Chondroblastoma of the lumbar spine

2005 ◽  
Vol 2 (5) ◽  
pp. 596-600 ◽  
Author(s):  
Raphaël Vialle ◽  
Antoine Feydy ◽  
Ludovic Rillardon ◽  
Carla Tohme-Noun ◽  
Philippe Anract ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Local Recurrence ◽  
Osteolytic Lesion ◽  
Radicular Pain ◽  
Appendicular Skeleton ◽  
Lumbar Region ◽  
Content Type ◽  
Anterior Posterior ◽  
Fine Print

✓ Chondroblastoma is a benign cartilaginous neoplasm that generally affects the appendicular skeleton. Twenty-six cases of spinal chondroblastoma have been reported in the past 50 years, only six of which were located in the lumbar region. The authors report two cases involving this exceptional location. In both patients, low-back pain, in the absence of radicular pain, was the presenting symptom. In both cases, plain radiography and computerized tomography scanning revealed an osteolytic lesion surrounded by marginal sclerosis. Magnetic resonance imaging allowed the authors to study the tumor's local extension. Examination of a percutaneous fluoroscopy-guided biopsy sample revealed the following typical histological features of chondroblastoma: chondroid tissue, focally alternating with cellular areas, and no nuclear atypia or pleomorphism. To reduce the risk of local recurrence, vertebrectomy and anterior—posterior fusion were performed in both cases. In one case, a structural lumbar scoliosis was corrected during the posterior procedure. There was no postoperative complication. No recurrence was observed during the 3- to 6-year follow-up period. The surgery-related results were deemed successful. Although exceptional, the diagnosis of chondroblastoma is possible in lesions involving the lumbar spine. Other spinal locations are described in the literature, and frequency of recurrence is stressed. A vertebrectomy is advised to reduce the risk of local recurrence.

Surgical management of giant sacral schwannomas

1986 ◽  
Vol 65 (3) ◽  
pp. 286-295 ◽  
Author(s):  
Chad D. Abernathey ◽  
Burton M. Onofrio ◽  
Bernd Scheithauer ◽  
Peter C. Pairolero ◽  
Thomas C. Shives
Keyword(s):  
Preoperative Assessment ◽  
Daily Activities ◽  
Joint Involvement ◽  
Complete Relief ◽  
Minimal Risk ◽  
Low Back ◽  
Content Type ◽  
Benign Schwannoma ◽  
Anterior Aspect

✓ Thirteen cases of giant sacral schwannomas with erosion of the anterior aspect of the sacrum and associated intrapelvic extension are reviewed. These tumors showed no sex predilection; the patients' mean age was 38.6 years at the time of diagnosis, and their symptoms predated the diagnosis by an average of 5.2 years. The most common symptoms were low-back pain and lower-extremity dysesthesiae. Plain roentgenograms, myelography, and computerized tomography constituted essential and complementary studies in the preoperative assessment. Choice of surgical approach (anterior transabdominal vs. posterior transsacral) was dependent upon the amount of sacral destruction, intrapelvic extension, and sacroiliac joint involvement. Microscopic examination revealed classic features of benign schwannoma in all but three cases, which were classified as cellular schwannomas. Patients who presented with pain and dysesthesiae reported immediate and complete relief of symptoms following surgery. In addition, all 13 patients were ambulatory and able to resume their routine daily activities postoperatively. At the last reported follow-up examination, which ranged from 5 months to 33 years and 3 months (mean 9 years) after surgery, two patients had died of unrelated causes, two reported return of preoperative symptoms, and the remainder were asymptomatic. This experience suggests that these histologically benign but neurologically devastating tumors should be aggressively resected with the intent of complete extirpation, and that this goal may be accomplished with minimal risk and an excellent prognosis.

Intervertebral disc space cyst simulating a recurrent herniated nucleus pulposus

1988 ◽  
Vol 69 (1) ◽  
pp. 137-139 ◽  
Author(s):  
Jordan C. Grabel ◽  
Raphael Davis ◽  
Rosario Zappulla
Keyword(s):  
Intervertebral Disc ◽  
Preoperative Diagnosis ◽  
Relevant Literature ◽  
Radicular Pain ◽  
Lumbar Region ◽  
Intervertebral Disc Space ◽  
Disc Space ◽  
Content Type ◽  
Herniated Nucleus Pulposus ◽  
Fine Print

✓ The case presented is of a patient with an intervertebral disc space cyst producing recurrent radicular pain following microdiscectomy in the lumbar region. Difficulties with the preoperative diagnosis of this and other recurrent radicular syndromes are discussed, and a review of the relevant literature is presented.

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