title: A Modified Posterolateral Approach for Radiofrequency Denervation of the Medial Branch of the Cervical Segmental Nerve in Cervical Facet Joint Pain Based on Anatomical Considerations.
abstract: The cervical facet joints, also called the zygapophyseal joints, are a potential source of neck pain (cervical facet joint pain). The cervical facet joints are innervated by the cervical medial branches (CMBs) of the cervical segmental nerves. Cervical facet joint pain has been shown to respond to multisegmental radiofrequency denervation of the cervical medial branches. This procedure is performed under fluoroscopic guidance. Currently, three approaches are described and used. Those three techniques of radiofrequency treatment of the CMBs, classified on the base of the needle trajectory toward the anatomical planes, are as follows: the posterolateral technique, the posterior technique, and the lateral technique. We describe the three techniques with their advantages and disadvantages. Anatomical studies providing a topographic anatomy of the course of the CMBs are reviewed. We developed a novel approach based on the observed strengths and weaknesses of the three currently used approaches and based on recent anatomical findings. With this fluoroscopic-guided approach, there is always bone (the facet column) in front of the needle, which makes it safer, and the insertion point is easier to determine without the risk of positioning the radiofrequency needle too dorsally.
authors.affiliation: Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands.|Department of Anesthesiology and Pain Management, Amphia Ziekenhuis, Breda, The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: van Eerd
authors.affiliation: Department of Anatomy and Embryology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Arno
authors.initials: A
authors.lastname: Lataster
authors.affiliation: Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands.
authors.forename: Micha
authors.initials: M
authors.lastname: Sommer
authors.affiliation: Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands.
authors.forename: Jacob
authors.initials: J
authors.lastname: Patijn
authors.affiliation: Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: van Kleef
mesh_terms: D003714:Denervation / Q000379:methods*; D006801:Humans; D019547:Neck Pain / Q000601:surgery*; D021801:Zygapophyseal Joint / Q000294:innervation / Q000601:surgery*
keywords: cervical pain; facet joint; neck pain; radiofrequency ablation