Feigl G C, Mattersberger C, Rosmarin W, Likar R, Avila González C
Institut für makroskopische und klinische Anatomie, Medizinische Universität Graz, Harrachgasse 21, 8010, Graz, Österreich.
Abteilung für Anästhesie und Intensivmedizin, LKH Klagenfurt, Klagenfurt, Österreich.
Schmerz. 2018 Apr;32(2):99-104. doi: 10.1007/s00482-018-0283-9.
The success of radiofrequency ablation (RF) of the medial branch of the dorsal ramus in patients with facet joint pain depends on the effective coagulation distance. To date, computed tomography(CT)-guided techniques do not reach the nerve in parallel but rather than punctually. We report a new CT-guided technique to enhance parallelism and proximity of the RF needle to the nerve.
Two examiners with different experience with CT-guided procedures in corpses performed all punctures at the lumbar spine on 10 corpses. A RF needle was inserted 1 cm lateral to the spinous process of the vertebra located caudal to the target nerve. The needle was advanced under CT guidance at a flat angle between the superior articular process and the base of the costal or transverse process of the cranial vertebra. The position was verified by dissection. Needle position was judged successful provided the needle could be positioned in the first attempt with no more than one angle correction.
In 86 out of 100 possible cases (50 per side) at the 5 lumbar segments, the RF needle could be depicted by CT in the target area with no more than one correction of the needle position. Anatomical dissections revealed that 47 out of 86 needles (54.6%) fulfilled the requirements of parallelism and proximity to the nerve. The dorsal ramus was never reached by the RF needle. Higher success rates were obtained in the middle segments compared to the border segments of L1-L2 and L5-S1.
We could demonstrate that the principle of parallelism and proximity of the needle to the nerve could be fulfilled with this new technique; however, needle positioning requires practice due to the oblique puncture direction.
在小关节疼痛患者中，射频消融背侧支内侧支的成功取决于有效的凝固距离。迄今为止，计算机断层扫描（CT）引导技术并非与神经平行到达，而是点状到达。我们报告一种新的CT引导技术，以增强射频针与神经的平行度和接近度。
两名在尸体CT引导操作方面经验不同的检查者，对10具尸体的腰椎进行了所有穿刺操作。将射频针插入目标神经尾侧椎体棘突外侧1厘米处。在CT引导下，针以与上位关节突和颅侧椎体肋突或横突基部之间的平角推进。通过解剖验证位置。如果针能在首次尝试时定位，且角度校正不超过一次，则判定针的位置成功。
在5个腰椎节段的100个可能病例中（每侧50个），86例中射频针可通过CT在目标区域显示，且针位置校正不超过一次。解剖显示，86根针中有47根（54.6%）满足与神经平行和接近的要求。射频针从未触及背侧支。与L1-L2和L5-S1的边缘节段相比，中间节段的成功率更高。
我们可以证明，这种新技术可以实现针与神经平行和接近的原则；然而，由于穿刺方向倾斜，针的定位需要练习。
