In vivo measurements of medial branch nerve depth and adjacent osseous structures for ablation of facet-related back pain: Predictors for patient candidacy.
Facetogenic back pain
Medial branch nerve
RF ablation
Thermal ablation
Journal
North American Spine Society journal
ISSN: 2666-5484
Titre abrégé: N Am Spine Soc J
Pays: United States
ID NLM: 9918335076906676
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
24
05
2020
revised:
15
07
2020
accepted:
02
08
2020
entrez:
10
2
2022
pubmed:
7
8
2020
medline:
7
8
2020
Statut:
epublish
Résumé
Medial branch (MB) targeting during RF ablation for facetogenic back pain is usually performed with flouroscopic guidance yet no specific measurements on the target depth have been published. In order to understand candidacy for other potential ablation methods, we sought to determine the actual MB depth and measurements of adjacent osseous structures. CT scans without contrast of the lumbar spine performed in the supine position were retrospectively analyzed in 100 patients. Axial slices less than or equal to 2.5 mm with sagittal and coronal reformations were evaluated. The following distances were measured bilaterally at the L2-L5 levels: The depth from the skin to the MB nerve (anatomic target for RF ablation) at a 15° angulation, the smallest width of the pedicle, and the length, height and width of the transverse process. Age, gender, weight, height, and BMI were correlated with the above measurements. The average distance and 95% CI from skin-to-MB in mm at a 15°angle to the skin increased as the lumbar level increased measuring 64.4 (62.4-66.5) at L2, 72.0 (69.7-74.3) at L3, 79.2 (76.9-81.6) at L4, and 79.1 (76.7-81.5) at L5. The average thickness of the pedicles also increased as the lumbar level increased measuring 9.2 mm at L2 and 16.1 mm at L5. Body weight, lumbar level, and female gender were associated with increased MB depth. Taller stature was associated with more superficial MB depth. We eliminated mild interaction effects between height, weight, and gender by substituting BMI for height and weight without affecting r Our results demonstrate that the MB resides 107 mm or less in depth when measured at a 15° angulation from the skin in > 95% of patients and the distance increases as the lumbar level increases.
Sections du résumé
BACKGROUND
BACKGROUND
Medial branch (MB) targeting during RF ablation for facetogenic back pain is usually performed with flouroscopic guidance yet no specific measurements on the target depth have been published. In order to understand candidacy for other potential ablation methods, we sought to determine the actual MB depth and measurements of adjacent osseous structures.
METHODS
METHODS
CT scans without contrast of the lumbar spine performed in the supine position were retrospectively analyzed in 100 patients. Axial slices less than or equal to 2.5 mm with sagittal and coronal reformations were evaluated. The following distances were measured bilaterally at the L2-L5 levels: The depth from the skin to the MB nerve (anatomic target for RF ablation) at a 15° angulation, the smallest width of the pedicle, and the length, height and width of the transverse process. Age, gender, weight, height, and BMI were correlated with the above measurements.
RESULTS
RESULTS
The average distance and 95% CI from skin-to-MB in mm at a 15°angle to the skin increased as the lumbar level increased measuring 64.4 (62.4-66.5) at L2, 72.0 (69.7-74.3) at L3, 79.2 (76.9-81.6) at L4, and 79.1 (76.7-81.5) at L5. The average thickness of the pedicles also increased as the lumbar level increased measuring 9.2 mm at L2 and 16.1 mm at L5. Body weight, lumbar level, and female gender were associated with increased MB depth. Taller stature was associated with more superficial MB depth. We eliminated mild interaction effects between height, weight, and gender by substituting BMI for height and weight without affecting r
CONCLUSIONS
CONCLUSIONS
Our results demonstrate that the MB resides 107 mm or less in depth when measured at a 15° angulation from the skin in > 95% of patients and the distance increases as the lumbar level increases.
Identifiants
pubmed: 35141588
doi: 10.1016/j.xnsj.2020.100018
pii: S2666-5484(20)30018-4
pmc: PMC8820050
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100018Informations de copyright
© 2020 The Authors. Published by Elsevier Ltd on behalf of North American Spine Society.
Déclaration de conflit d'intérêts
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Références
Radiology. 2015 Feb;274(2):387-94
pubmed: 25302829
Pain Med. 2016 Sep;17(9):1634-7
pubmed: 26764338
Pain Physician. 2007 Jan;10(1):229-53
pubmed: 17256032
Curr Rev Musculoskelet Med. 2009 Mar;2(1):15-24
pubmed: 19468914
Spine (Phila Pa 1976). 2008 May 20;33(12):1291-7; discussion 1298
pubmed: 18496338
Reg Anesth Pain Med. 2008 Jan-Feb;33(1):24-9
pubmed: 18155053
Bone. 2013 Nov;57(1):92-7
pubmed: 23867220
Reg Anesth Pain Med. 2009 Mar-Apr;34(2):100-5
pubmed: 19282707
Reg Anesth Pain Med. 2018 Apr;43(3):225-262
pubmed: 29278603
Spine (Phila Pa 1976). 1987 Apr;12(3):264-8
pubmed: 2954221
Mol Cell Endocrinol. 2015 Feb 15;402:113-9
pubmed: 25578600
Int J Hyperthermia. 2016 Nov;32(7):786-94
pubmed: 27443328
J Spinal Disord Tech. 2007 Oct;20(7):539-45
pubmed: 17912133
Eur Spine J. 2007 Aug;16(8):1215-22
pubmed: 17180401
Anaesthesia. 2011 Oct;66(10):907-12
pubmed: 21883121
J Neurosurg. 1979 Aug;51(2):172-7
pubmed: 156249
J Ther Ultrasound. 2016 Apr 06;4:14
pubmed: 27054038
Arch Phys Med Rehabil. 2009 Feb;90(2):201-5
pubmed: 19236974
Anesthesiology. 2010 Aug;113(2):395-405
pubmed: 20613471
Medicine (Baltimore). 2015 Dec;94(52):e2367
pubmed: 26717379
Pain Med. 2012 Apr;13(4):498-506
pubmed: 22390231
Insights Imaging. 2018 Oct;9(5):773-789
pubmed: 30090998
Anesthesiology. 2007 Mar;106(3):591-614
pubmed: 17325518
Korean J Pain. 2011 Dec;24(4):216-20
pubmed: 22220243
J Ther Ultrasound. 2015 Aug 11;3:13
pubmed: 26261720
J Pain Res. 2017 Jan 13;10:183-190
pubmed: 28144161
Br J Radiol. 2016;89(1057):20150358
pubmed: 26607640