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Back and central nervous system
Published in Aida Lai, Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
Intervertebral foramen– ant. relationships: vertebral bodies– post. relationships: zygapophyseal joints– sup. and inf. relationships: vertebral pedicles
Facet (zygapophyseal) joint injections and medial branch blocks
Published in Harald Breivik, William I Campbell, Michael K Nicholas, Clinical Pain Management, 2008
Posterolaterally, a firm fibrous capsule covers the joint, while anteriorly the softer ligament flavum contacts the synovium. Fatty tissue around the exiting spinal nerve is continuous with that in the superior recess of the joint providing a direct route to the epidural space. Zagopophyseal joint volume in the lumbar spine is in the order of 1–2 mL. If larger volumes are injected, this can produce capsular distension and spread directly into the epidural space, confounding any observed results from diagnostic blocks. Drugs injected on one side can spread contralaterally at that level, or to an adjacent level on the same side.12 The zygapophyseal joints help to resist the associated shearing movements with forward flexion and the compressive forces with rotational spinal movements.
Diagnostic procedures in chronic pain
Published in Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen, Clinical Pain Management, 2008
A similar process applies to the investigation of zygapophysial joint pain. It is inefficient to investigate one joint at a time. The prevalence of zygapophysial joint pain is low, and the chances of negative responses are high. If joints are investigated one at a time, the chances are that multiple blocks will prove negative. This constitutes a waste of resources. It is more efficient to conduct a screening block, targeting multiple levels, in the first instance. If a screening block of multiple levels proves negative, further investigations are not warranted. Thereby, patients who do not have zygapophysial joint pain are identified with one test, and resources are not wasted performing multiple tests with negative results.
An incoherent HIFU transducer for treatment of the medial branch nerve: Numerical study and in vivo validation
Published in International Journal of Hyperthermia, 2020
J. Chen, S. LeBlang, A. Hananel, R. Aginsky, J. Perez, M. Gofeld, Y. Shir, J. F. Aubry
The first line treatment of chronic low back pain includes oral non-opioid medication, physiotherapy and lifestyle changes. If these fail, targeted injections of steroids into the joint and sensory nerve ablations are therapeutic alternatives [3–8]. Zygapophyseal joint denervation is achieved by ablation of the medial branch nerves (MBN) supplying the joint. The MBN can be targeted and treated in a controlled manner with various methods. The most common procedure is thermal radiofrequency ablation (RFA), where an operator uses X-ray fluoroscopy to correctly position a cannula where the lumbar medial branch of the targeted vertebra is located [3–8]. The cannula causes the tissue temperature near the tip to increase and cause an oval-shaped tissue coagulation at the target site. Despite its effectiveness, this procedure has side effects and complications. The most common side effects are pain and discomfort associated with percutaneous insertion of the radiofrequency cannula [3–8]. More serious complications include bleeding and infections. Thus, a noninvasive alternative with the same efficacy is desirable.
After-effects of neck muscle vibration on sensorimotor function and pain in neck pain patients and healthy controls – a case-control study
Published in Disability and Rehabilitation, 2019
Konstantin Beinert, Volker Englert, Wolfgang Taube
However, a significant group effect (F3,24 = 5.291, p = 0.03) was detected at the zygapophyseal joint C2/C3. Assessing immediate effects, time and time x group interactions were calculated (time pre/post: F1,24 = 8.08; p < 0.01; time pre/post × groupneck pain/healthy control: F1,24 = 3.28; p = 0.08). Calculation of potential effects after 15 min of neck muscle vibration showed significant time effects (timepre/post15: F1,24 = 6.85; p = 0.01), but no time × group interaction (timepre/post15 × groupneck pain/healthy control: F1,24 = 1.94; p = 0.17). The results for pressure pain threshold at the zygapophyseal joint of C2/C3 are presented in Figure 4.
Use of lasers in minimally invasive spine surgery
Published in Expert Review of Medical Devices, 2018
Facet syndrome or facet joint arthritis is one of the major etiologies of low back pain for which surgical intervention might be applied [55,56]. Lumbar facets or zygapophyseal joints are synovial arthroses richly innervated with nerve endings from the medial branch of the posterior primary ramus [57]. Current treatment options include facet joint block or medial branch block for short-term pain relief and facet joint denervation for long-term pain relief by radiofrequency or cryotherapy. The results of facet joint denervation or rhizotomy have been variable, with many patients requiring repeated procedures or experiencing inadequate pain relief. Some authors have reported laser facet denervation techniques [56,58,59]. The patient is placed prone on the radiolucent table. Under fluoroscopic guidance or endoscopic visualization, the Ho:YAG straight-firing laser probe is directed at the medial branch or the dorsal ramus, the nerve that gives rise to the articular branches at each level. Each facet joint is innervated from above and below the segments. The laser probe can be also directed to the facet joint itself. The target points are the lower, middle, and upper portions of the facet joint. The total irradiation energy at one facet is about 500–600 J. Laser has the advantage of coagulating a relatively larger area in the vicinity of the probe tip compared with a radiofrequency probe. Laser facet denervation can be applicable and efficient for patients who failed to be relieved by block or radiofrequency facet rhizotomy.