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Anatomical Analysis of Medial Branches of Dorsal Rami of Cervical Nerves for Radiofrequency Thermocoagulation
  1. Tae Dong Kweon, MD, PhD*,†,
  2. Ji Young Kim, MD, PhD*,†,
  3. Hye Yeon Lee, MD, PhD‡,
  4. Myung Hwa Kim, MD* and
  5. Youn-Woo Lee, MD, PhD*,†
  1. *Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
  2. †Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
  3. ‡Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea
  1. Address correspondence to: Youn-Woo Lee, MD, PhD, Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-gu, Seoul 120-752, Korea (e-mail: ywleepain{at}yuhs.ac).

Abstract

Background and Objectives Cervical medial branch blocks are used to treat patients with chronic neck pain. The aim of this study was to clarify the anatomical aspects of the cervical medial branches to improve the accuracy and safety of radiofrequency denervation.

Methods Twenty cervical specimens were harvested from 20 adult cadavers. The anatomical parameters of the C4–C7 cervical medial branches were measured. The 3-dimensional computed tomography reconstruction images of the bone were also analyzed.

Results Based on cadaveric analysis, most of the cervical dorsal rami gave off 1 medial branch; however, the cervical dorsal rami gave off 2 medial branches in 27%, 15%, 2%, and 0% at the vertebral level C4, C5, C6, and C7, respectively. The diameters of the medial branches varied from 1.0 to 1.2 mm, and the average distance from the notch of inferior articular process to the medial branches was about 2 mm. Most of the bifurcation sites were located at the medial side of the posterior tubercle of the transverse process. On the analysis of 3-dimensional computed tomography reconstruction images, cervical medial branches (C4 to C6) passed through the upper 49% to 53% of a line between the tips of 2 consecutive superior articular processes (anterior line). Also, cervical medial branches passed through the upper 28% to 35% of a line between the midpoints of 2 consecutive facet joints (midline).

Conclusions The present anatomical study may help improve accuracy and safety during radiofrequency denervation of the cervical medial branches.

https://doi.org/10.1097/AAP.0000000000000175

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    Footnotes

    • Attribution: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea

      No funding was received for this study.

      This study was presented at the 57th Annual Meeting of Korean Pain Society, Seoul, Korea November 16, 2013.

      The authors declare no conflict of interest.