Tran John, Campisi Emma S, Agur Anne M R, Loh Eldon
Department of Physical Medicine and Rehabilitation, Western University, London, ON N6C 0A7, Canada.
Parkwood Institute Research, Lawson Health Research Institute, London, ON N6C 0A7, Canada.
Pain Med. 2024 Jan 4;25(1):13-19. doi: 10.1093/pm/pnad105.
Lumbar medial branch radiofrequency ablation (RFA) is a common intervention to manage chronic axial low back pain originating from the facet joints. A more parasagittal approach targeting the posterior half of the lateral neck of superior articular process (SAP) was previously proposed. However, specific needle angles to achieve parallel placement at this target site have not been investigated.
To quantify and compare the needle angles, on posterior and lateral views, to achieve parallel placement of electrodes along the medial branch at the posterior half of the lateral neck of SAP at each lumbar vertebral level (L1-L5) and sacrum.
Osteological Study.
Twelve disarticulated lumbosacral spines (n = 72 individual bones) were used in this study. Needles were placed along the periosteum of the posterior half of the lateral neck of SAP, bilaterally and photographed. Mean needle angles for each vertebral level (L1-L5) and sacrum were quantified, and statistical differences were analyzed.
The posterior view provided the degrees of lateral displacement from the parasagittal plane (abduction angle), while the lateral view provided the degrees of declination (cranial-to-caudal angle) of the needle. Mean needle angles at each level varied, ranging from 5.63 ± 5.76° to 14.50 ± 14.24° (abduction angle, posterior view) and 40.17 ± 7.32° to 64.10 ± 9.73° (cranial-to-caudal angle, lateral view). In posterior view, a < 10-degree needle angle interval was most frequently identified (57.0% of needle placements). In lateral view, the 40-50-degree (L1-L2), 50-60-degree (L3-L5), and 60-70-degree (sacrum) needle angle intervals occurred most frequently (54.2%, 50.0%, and 41.7% of needle placements, respectively).
Targeting the posterior half of the lateral neck of SAP required <10-degree angulation from parasagittal plane in majority of cases. However, variability of needle angles suggests a standard "one-size-fits-all" approach may not be the optimal technique.
腰椎内侧支射频消融术（RFA）是治疗源自小关节的慢性轴向性下腰痛的常见干预措施。此前有人提出一种更偏向矢状面的方法，针对上关节突（SAP）外侧颈部后半部分。然而，尚未对在此目标部位实现电极平行放置的具体针角度进行研究。
量化并比较在腰椎各椎体水平（L1 - L5）和骶骨处，在前后位和侧位视图上，使电极沿SAP外侧颈部后半部分的内侧支平行放置的针角度。
骨骼学研究。
本研究使用了12个腰椎骶骨脊柱标本（共72块单独骨骼）。将针沿双侧SAP外侧颈部后半部分的骨膜放置并拍照。对每个椎体水平（L1 - L5）和骶骨的平均针角度进行量化，并分析统计差异。
前后位视图提供了针相对于矢状面的侧方移位程度（外展角度），而侧位视图提供了针的倾斜程度（头端至尾端角度）。每个水平的平均针角度各不相同，范围为5.63±5.76°至14.50±14.24°（外展角度，前后位视图）以及40.17±7.32°至64.10±9.73°（头端至尾端角度，侧位视图）。在前后位视图中，最常确定的针角度间隔小于10度（占针放置情况的57.0%）。在侧位视图中，40 - 50度（L1 - L2）、50 - 60度（L3 - L5）和60 - 70度（骶骨）的针角度间隔出现频率最高（分别占针放置情况的54.2%、50.0%和41.7%）。
在大多数情况下，针对SAP外侧颈部后半部分需要针与矢状面的角度小于10度。然而，针角度的变异性表明标准的“一刀切”方法可能不是最佳技术。
