Medial Branch Block and Radiofrequency Lesioning

Published on 10/03/2015 by admin

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Last modified 10/03/2015

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Chapter 8 Medial Branch Block and Radiofrequency Lesioning

Medial branch block (MBB) and radiofrequency lesioning yield good results both after failure of conservative treatment in patients with mechanical back pain and in patients with failed back surgery syndrome. The complications of these procedures are usually minor and transient, and the complication rates are low.

Preoperative preparation

History Taking and Physical Examination

The symptoms and signs that should be sought during history taking and on physical examination include the following:

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Figure 8–6 Patterns of pain (shaded areas) evoked by stimulation of the facet joints at segments C2-C3 to C6-C7.

(Adapted from Dwyer A, Aprill C, Bogduk N: Cervical zygapophyseal joint pain patterns: I: A study in normal volunteers. Spine 1990;15:453-457.)

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Figure 8–7 A composite map shows pain referral patterns from the T3-T4 to the T10-T11 thoracic facet joints.

(Modified from Dreyfuss P, Tibiletti C, Dreyer S: Thoracic zygapophyseal joint pain patterns. Spine 1994:19;807-811.)

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Figure 8–8 A composite map shows pain referral patterns at the C7-T1, T1-T2, T2-T3, and T11-T12 thoracic facet joints.

(Modified from Fukui S, Ohseto K, Shiotani M: Patterns of pain induced by distending the thoracic zygapophyseal joints. Reg Anesth 1997:22;332-336.)

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Figure 8–9 A schematic drawing shows the referred pain pattern for the lumbar facet joints.

(Modified from Bous RA: Facet joint injections. In Stanton-Hicks M, Bous RA [eds]: Chronic Low Back Pain. New York, Raven, 1982, pp 199-211.)

Indications

Anatomy

At each level, facet joint innervation is derived from the medial branch of the adjacent spinal nerve, as well as the medial branches located one level above and perhaps one level below. Figures 8-10 through 8-12 show facet joint innervation of the three regions of the spine.