From the *Department of Anesthesiology and Pain Medicine, †Anesthesia and Pain Research Institute, and ‡Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea.
Reg Anesth Pain Med. 2014 Nov-Dec;39(6):465-71. doi: 10.1097/AAP.0000000000000175.
Cervical medial branch blocks are used to treat patients with chronic neck pain. The aim of this study was to clarify the anatomical aspects of the cervical medial branches to improve the accuracy and safety of radiofrequency denervation.
Twenty cervical specimens were harvested from 20 adult cadavers. The anatomical parameters of the C4-C7 cervical medial branches were measured. The 3-dimensional computed tomography reconstruction images of the bone were also analyzed.
Based on cadaveric analysis, most of the cervical dorsal rami gave off 1 medial branch; however, the cervical dorsal rami gave off 2 medial branches in 27%, 15%, 2%, and 0% at the vertebral level C4, C5, C6, and C7, respectively. The diameters of the medial branches varied from 1.0 to 1.2 mm, and the average distance from the notch of inferior articular process to the medial branches was about 2 mm. Most of the bifurcation sites were located at the medial side of the posterior tubercle of the transverse process. On the analysis of 3-dimensional computed tomography reconstruction images, cervical medial branches (C4 to C6) passed through the upper 49% to 53% of a line between the tips of 2 consecutive superior articular processes (anterior line). Also, cervical medial branches passed through the upper 28% to 35% of a line between the midpoints of 2 consecutive facet joints (midline).
The present anatomical study may help improve accuracy and safety during radiofrequency denervation of the cervical medial branches.
颈椎内侧支阻滞用于治疗慢性颈痛患者。本研究旨在阐明颈椎内侧支的解剖学特征，以提高射频去神经支配的准确性和安全性。
从 20 具成人尸体中采集了 20 个颈椎标本。测量了 C4-C7 颈椎内侧支的解剖参数。还对骨骼的三维 CT 重建图像进行了分析。
根据尸体分析，大多数颈椎背侧支发出 1 个内侧支；然而，颈椎背侧支在 C4、C5、C6 和 C7 椎体水平分别有 27%、15%、2%和 0%发出 2 个内侧支。内侧支的直径从 1.0 到 1.2 毫米不等，从下关节突切迹到内侧支的平均距离约为 2 毫米。大多数分支部位位于横突后结节的内侧。在三维 CT 重建图像分析中，颈椎内侧支（C4 至 C6）穿过连续两个上关节突尖端之间的线的上 49%至 53%（前线）。此外，颈椎内侧支穿过连续两个关节突关节中点之间的线的上 28%至 35%（中线）。
本解剖学研究可能有助于提高射频去神经支配颈椎内侧支的准确性和安全性。
