Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China.
The Spine Department, Orthopaedic Center, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, China.
Spine (Phila Pa 1976). 2024 Jun 1;49(11):E164-E172. doi: 10.1097/BRS.0000000000004975. Epub 2024 Feb 29.
Anatomical study.
This study aimed to elaborate on the anatomical characteristics of the medial branch of the lumbar dorsal rami and to discuss its possible clinical significance.
Radiofrequency ablation targeting the medial branch of the lumbar dorsal rami has been increasingly used in the clinical management of facetogenic low back pain (FLBP). Nonetheless, attention is also being given to complications such as atrophy of the lumbar soft tissues and muscles. Therefore, a more detailed understanding of the innervation pattern on the facet joint may improve the precision of nerve ablation therapy for FLBP.
An anatomical study of eight human specimens was carried out. The anatomic characteristics of the medial branch were observed and recorded.
The medial branch originates from the lumbar dorsal rami, running close to the root of the posterolateral side of the superior articular process of the inferior cone. When passed through the mamillo-accessory ligament, it turns direction to the medial and caudal side, running in the multifidus muscle. In our study, each medial branch sent out two to five branches along the way. All the medial branches in L1-L4 gave off one to two small branches when crossing the facet joint and innervated the joint of the lower segment. Nineteen medial branches (23.75%) gave off recurrent branches to innervate the joint at the upper segment.
The anatomical features of the medial branch remain similar in each lumbar segment. There are two types of joint branches, including the articular fibers that emanate from the medial branch as it runs along the medial border of the facet joint and the recurrent branch from the medial branch that innervates the upper facet joint. Moreover, an anastomotic branch was found in the medial branches between different segments.
解剖学研究。
本研究旨在详细阐述腰椎背侧支内侧支的解剖学特征，并探讨其可能的临床意义。
针对腰椎背侧支内侧支的射频消融术已越来越多地应用于小关节源性腰痛（FLBP）的临床治疗。然而，人们也开始关注腰椎软组织和肌肉萎缩等并发症。因此，更详细地了解关节突关节的神经支配模式可能会提高 FLBP 神经消融治疗的精确性。
对 8 个人体标本进行解剖学研究。观察并记录内侧支的解剖学特征。
内侧支起源于腰椎背侧支，靠近下锥体后外侧角根的上方。当穿过乳突辅助韧带时，它向内侧和尾侧方向转弯，在多裂肌中运行。在我们的研究中，每个内侧支在沿途发出 2 至 5 个分支。L1-L4 的所有内侧支在穿过关节突关节时发出 1 至 2 个小分支，支配下位节段的关节。19 个内侧支（23.75%）发出复发性分支，支配上位节段的关节。
每个腰椎节段的内侧支解剖学特征都相似。有两种类型的关节分支，包括从内侧支发出的沿关节突关节内侧走行的关节纤维和支配上位关节的内侧支的复发性分支。此外，在不同节段的内侧支之间发现了吻合支。
