Advertisement

Ablation of Medial Bundle Branch Under Spinal Endoscopy

  • Kutbuddin Akbary
  • Jin-Sung Kim
Chapter

Abstract

This chapter identifies the advantages and techniques of radiofrequency ablation of the medial bundle branch (MBB) under spinal endoscopy in patients suffering from chronic low back pain. Although the intra-articular injection and MBB block with steroids are easy-to-perform, non-surgical procedures with additional diagnostic values, patients may experience symptom recurrence due to shorter duration of relief, and there are always risks of possible local and systemic complications associated with repeated steroid injections. Continuous radiofrequency and pulsed radiofrequency lesioning of the medial branch of the dorsal ramus, an interventional surgical technique to treat facet-mediated axial back pain, is a current method utilised in pain management for the treatment of chronic lumbar back pain. First described by Shealy in 1975, it involves using energy in the radiofrequency range to perform necrosis of specific nerves (medial branches of the dorsal rami in patients with lumbar facetogenic pain), avoiding the neural transmission of pain. Although steroid infiltrations do provide good long-term relief, the occasional variation in anatomy due to the individual changes or advanced degenerative process can be overcome by direct visualisation under the endoscope. This focussed endoscopic lesioning also avoids extensive scar formation which may occasionally lead to recurrence of low back pain.

Keywords

Medial bundle branch ablation Endoscopic medial branch ablation Radiofrequency medial branch ablation Chronic low back pain 

Supplementary material

Video 24.1

(MP4 81789 kb)

Video 24.2

(MP4 76749 kb)

References

  1. 1.
    Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, et al. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician. 2007;10:7–111.PubMedGoogle Scholar
  2. 2.
    Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, et al. The rising prevalence of chronic low back pain. Arch Intern Med. 2009;169:251–8.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am. 2006;88:21–4.PubMedGoogle Scholar
  4. 4.
    Manchikanti L, Pampati V, Fellows B, et al. Prevalence of lumbar facet joint pain in chronic low back pain. Pain Physician. 1999;2:59–64.PubMedGoogle Scholar
  5. 5.
    Ghormley RK. Low back pain: with special reference to the articular facets, with presentation of an operative procedure. JAMA. 1933;101:1773–7.CrossRefGoogle Scholar
  6. 6.
    McLain RF, Pickar JG. Mechanoreceptor endings in human thoracic and lumbar facet joints. Spine. 1998;23:168–73.PubMedCrossRefGoogle Scholar
  7. 7.
    Bogduk N. International spinal injection society guidelines for the performance of spinal injection procedures. Part 1: zygapophysial joint blocks. Clin J Pain. 1997;13:285–302.PubMedCrossRefGoogle Scholar
  8. 8.
    Yeung A, Gore S. Endoscopically guided foraminal and dorsal rhizotomy for chronic axial back pain based on cadaver and endoscopically visualized anatomic study. Int J Spine Surg. 2014;8:23.PubMedCentralCrossRefGoogle Scholar
  9. 9.
    Jeong SY, Kim JS, Choi WS, et al. The effectiveness of endoscopic radiofrequency denervation of medial branch for treatment of chronic low back pain. J Korean Neurosurg Soc. 2014;56(4):338–43.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Jo H, Kim JS. Minimally invasive treatment for back pain. J Minimally Invasive Spine Surg Tech. 2017;2(1):7–14.CrossRefGoogle Scholar
  11. 11.
    Shealy CN. Percutaneous radiofrequency denervation of spinal facets. Treatment for chronic back pain and sciatica. J Neurosurg. 1975;43:448–51.PubMedCrossRefGoogle Scholar
  12. 12.
    Bogduk N. The lumbar mamillo-accessory ligament. Its anatomical and neurosurgical significance. Spine (Phila Pa 1976). 1981;6(2):162–7.CrossRefGoogle Scholar
  13. 13.
    Shuang F, Hou SX, Zhu JL, et al. Clinical anatomy and measurement of the medial branch of the spinal dorsal ramus. Medicine (Baltimore). 2015;94(52):e2367.CrossRefGoogle Scholar
  14. 14.
    Vialle R, Court C, Khouri N, Olivier E, Miladi L, Tassin JL, et al. Anatomical study of the paraspinal approach to the lumbar spine. Eur Spine J. 2005;14:366–71.PubMedCrossRefGoogle Scholar
  15. 15.
    Carragee EJ, Don AS, Hurwitz EL, Cuellar JM, Carrino JA, Herzog R. 2009 ISSLS prize winner: does discography cause accelerated progression of degeneration changes in the lumbar disc: a ten-year matched cohort study. Spine (Phila Pa 1976). 2009;34:2338–45.CrossRefGoogle Scholar
  16. 16.
    Lakemeier S, Lind M, Schultz W, et al. A comparison of intra-articular lumbar facet joint steroid injections and lumbar facet joint radiofrequency denervation in the treatment of low back pain: a randomized, controlled, double-blind trial. Anesth Analg. 2013;117:228–35.PubMedCrossRefGoogle Scholar
  17. 17.
    Civelek E, Cansever T, Kabatas S, et al. Comparison of effectiveness of facet joint injection and radiofrequency denervation in chronic low back pain. Turk Neurosurg. 2012;22:200–6.PubMedGoogle Scholar
  18. 18.
    Bogduk N. A narrative review of intra-articular corticosteroid injections for low back pain. Pain Med. 2005;6:287–96.PubMedCrossRefGoogle Scholar
  19. 19.
    Boswell MV, Colson JD, Sehgal N, Dunbar EE, Epter R. A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician. 2007;10:229–53.PubMedGoogle Scholar
  20. 20.
    Boswell MV, Colson JD, Spillane WF. Therapeutic facet joint interventions in chronic spinal pain: a systematic review of effectiveness and complications. Pain Physician. 2005;8:101–14.PubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • Kutbuddin Akbary
    • 1
    • 2
  • Jin-Sung Kim
    • 1
  1. 1.Department of NeurosurgerySeoul St. Mary’s Hospital, Spine Centre, College of Medicine, The Catholic University of KoreaSeoulSouth Korea
  2. 2.The Spine ClinicLilavati HospitalMumbaiIndia

Personalised recommendations