Radiofrequency ablation is a well-established therapy to treat axial spine, facet-mediated pain. The targets are the medical branches which can be found at all levels of the spine. The thoracic spine, though not as a common source of pain, responds as well to medial branch therapies including radiofrequency ablation. Given the variable anatomy of the medial branches from T1 to T12, it is important to understand the location and technique of this procedure to maximize its efficacy. Herein we describe the background, indications, techniques, as well as pearls and pitfalls that will allow practitioners to provide safe and effective treatment for those suffering from mid back pain.
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Atluri S, et al. Systematic review of diagnostic utility and therapeutic effectiveness of thoracic facet joint interventions. Pain Physician. 2008;11(5):611–29.PubMedGoogle Scholar
Boswell MV, et al. A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician. 2007;10(1):229–53.PubMedGoogle Scholar
Chua WH, Bogduk N. The surgical anatomy of thoracic facet denervation. Acta Neurochir [Wien]. 1995;136:140–4.CrossRefGoogle Scholar
Dreyfuss P, Tibiletti C, Dreyer SJ. Thoracic zygapophyseal joint pain patterns. A study in normal volunteers. Spine (Phila Pa 1976). 1994;19(7):807–11.CrossRefGoogle Scholar
Fukui S, Ohseto K, Shiotani M. Patterns of pain induced by distending the thoracic zygapophyseal joints. Reg Anesth. 1997;22(4):332–6.CrossRefGoogle Scholar
Manchikanti L, et al. Comparative effectiveness of a one-year follow-up of thoracic medial branch blocks in management of chronic thoracic pain: a randomized, double-blind active controlled trial. Pain Physician. 2010;13(6):535–48.PubMedGoogle Scholar
Manchikanti KN, et al. An update of evaluation of therapeutic thoracic facet joint interventions. Pain Physician. 2012;15(4):E463–81.PubMedGoogle Scholar
Manchikanti L, et al. Assessment of the escalating growth of facet joint interventions in the medicare population in the United States from 2000 to 2011. Pain Physician. 2013;16(4):E365–78.PubMedGoogle Scholar
Manchikanti L, et al. A systematic review and best evidence synthesis of the effectiveness of therapeutic facet joint interventions in managing chronic spinal pain. Pain Physician. 2015;18(4):E535–82.PubMedGoogle Scholar
Provenzano DA, Lassila HC, Somers D. The effect of fluid injection on lesion size during radiofrequency treatment. Reg Anesth Pain Med. 2010;35(4):338–42.CrossRefGoogle Scholar
Provenzano DA, Liebert MA, Somers DL. Increasing the NaCl concentration of the preinjected solution enhances monopolar radiofrequency lesion size. Reg Anesth Pain Med. 2013;38(2):112–23.CrossRefGoogle Scholar
Speldewinde G. Outcomes of percutaneous zygapophysial and sacroiliac joint neurotomy in a community setting. Pain Med. 2011;12(2):209–18.CrossRefGoogle Scholar