![]() This is a recognised landmark for medial branch denervation performed using fluoroscopy ( Figure 1B). Innervation of the upper and lower cervical facet joints differs slightly from the mid-cervical spine (discussed below): C3 to C6 levelsĪnatomic studies have demonstrated that the course of the C3–6 medial branches pass through the midpoint of the trapezoidal shape formed by the articular pillar on lateral neck imaging. Note the C7 medial branch (open arrow) courses high along the superior articular process as it is elevated by the large C7 transverse process (asterisk). The traditional fluoroscopic landmark is the intersection of bisecting lines created by the trapezoidal shape of the articular pillar on sagittal imaging (red dotted lines). The dorsal ramus subsequently divides into medial and lateral branches, with the medial branch coursing around the lateral margin of the articular pillar to its dorsal aspect ( Figure 1A,B).įigure 1 (A) Axial and (B) sagittal images demonstrating the course of the medial branch (yellow). ![]() For instance, the C5/6 facet joint is innervated by the medial branches of both C5 and C6.Īfter exiting the neural foramina, each cervical spinal nerve divides into ventral and dorsal rami. This article describes the technique for CT guided radiofrequency denervation of the cervical medial branch using a lateral approach in a supine patient.Įach facet joint is innervated by the medial branch of the dorsal ramus of the cervical spinal nerve from above and below. To our knowledge the technique and anatomical landmarks used for CT guided medial branch denervation have not previously been described. Traditionally medial branch denervation has been performed under fluoroscopic guidance, however the advent of CT fluoroscopy has provided an alternative modality for image guided intervention. and has been further validated in several observational and prospective studies ( 6- 9). The efficacy of the procedure was initially evaluated in a double blind controlled trial by Lord et al. Therapeutic techniques for the management of chronic facet joint pain include facet joint denervation via radiofrequency ablation of the medial branch of the spinal dorsal ramus. The facet joints are a common source of cervicalgia, implicated in up to 55% of patients with chronic neck pain, including following whiplash injury and cervical spine surgery ( 1- 5). Department of Medical Imaging, St Andrews Hospital, 350 South Terrace, Adelaide, South Australia, 5000, Australia. Policy of Dealing with Allegations of Research MisconductĬorrespondence to: Dr.Policy of Screening for Plagiarism Process.
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