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Neuroablation can be performed with chemical neurolysis or radiofrequency ablation. These techniques are often used on the medial branch nerves to treat low back pain and have been applied to the superior cluneal nerves. The use of phenol has been noted to relieve pain for up to 9 months but may not completely resolve symptoms. [5]
Radiofrequency ablation or lesioning, also known as rhizolysis, can be used to give longer lasting relief by destroying the nerves that supply the facet joint (medial branch nerves). [9] Current guidelines as per the International Spine Intervention Society require two successful medial branch blocks before progressing to a radiofrequency ablation.
Radiofrequency waves are used to produce heat on specifically identified nerves surrounding the facet joints called the lumbar medial branches of the dorsal ramus of the spinal nerves. [33] By generating heat around the nerve, the nerve is ablated, thus destroying its ability to transmit signals to the brain.
Lumbar sympathetic neurolysis is performed by using absolute alcohol, but other chemicals such as phenol, or other techniques such as radiofrequency or laser ablation have been studied. To aid in the procedure, fluoroscopy or CT guidance is used. Fluoroscopic guidance is the most frequent, giving better real-time monitoring of the needle.
The dorsal ramus then turns to course posterior-ward before splitting into a medial branch and a lateral branch. Both these branches provide motor innervation to deep back muscles. In the neck and upper back, the medial branch is also responsible for providing sensory innervation of the skin; in the lower back, the lateral branch does so.
The medial clunial nerves innervate the skin of the buttocks closest to the midline of the body. Those nerves arise from the posterior rami of spinal sacral nerves (S1, S2, and S3). Additional images
The medial branches run close to the articular processes of the vertebræ and end in the Multifidus.; The lateral branches supply the Sacrospinalis.The upper three give off cutaneous nerves which pierce the aponeurosis of the Latissimus dorsi at the lateral border of the Sacrospinalis and descend across the posterior part of the iliac crest to the skin of the buttock, some of their twigs ...
Nikolai Bogduk AM is a retired Australian anatomist, and emeritus professor of the University of Newcastle Bone & Joint Institute, Australia. [1] His research and publications were primarily on the anatomical sources and causes of chronic spinal pain and headache, as well as the development of new diagnostic techniques and treatments for these conditions.