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Mitigating Factors in L4 and L5 Medial Branch Motor Stimulation During Radiofrequency Ablation

  • Neuropathic Pain (A Kaye, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Radiofrequency ablation (RFA) is a minimally invasive procedure for facet joint pain. The targets for the procedure are the medial branches of the dorsal spinal nerves which innervate the facet joints. Before RFA, patients undergo diagnostic meal branch blocks to ensure appropriate pain relief and confirm the utility of proceeding to RFA. The success of RFA relies heavily on procedural technique and accurate placement near the medial branch.

Recent Findings

Motor testing is utilized in the lumbar region to assess the response of the multifidus and ensure proper placement of the RFA probe to prevent inadvertent damage to surrounding spinal anatomy. However, relying on motor responses in this area presents challenges given the frequency of lack of muscle twitching. Factors contributing to limited muscle twitch responses include muscle atrophy, excessive lordosis, facet arthropathy, local anesthetic use before ablation, and previous surgical neurotomy. These complexities highlight the challenges in ensuring precise motor stimulation during RFA. Despite these obstacles, accurate anatomical placement remains crucial. For RFA cases that prove challenging, relying on anatomical placement can be adequate to proceed with the procedure.

Summary

Bridging knowledge gaps is vital for standardized practices and safer procedures. Further research is necessary to refine techniques, understand patient-specific factors, and enhance the efficacy of RFA in managing chronic lumbar facet joint pain.

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Data Availability

No datasets were generated or analyzed during the current study.

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Authors and Affiliations

  1. Department of Pain Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Mihir Jani, Nimesha Mehta, Sandra Yu, Ugur Yener & Sayed Emal Wahezi

  2. Department of Rehabilitation, Burke Rehabilitation Hospital, White Plains, NY, USA

    Ricky Ju

  3. Department of Anesthesiology, University of Wisconsin, Madison, WI, USA

    Alaa Abd-Elsayed

  4. Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA

    Lynn Kohan

  5. Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, 1250 Waters Place, Tower #2 8Th Floor, Bronx, NY, 10461, USA

    Sayed Emal Wahezi

Authors
  1. Mihir Jani
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  2. Nimesha Mehta
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  3. Sandra Yu
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  4. Ricky Ju
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  5. Ugur Yener
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  6. Alaa Abd-Elsayed
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  7. Lynn Kohan
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  8. Sayed Emal Wahezi
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Contributions

Mihir Jani: Formal analysis and investigation, Writing - original draft preparation. Nimesha Mehta: Formal analysis and investigation, Writing - original draft preparation. Ricky Ju: Writing, Editing, Methodology. Sandra Yu: Formal analysis and investigation, Writing - original draft preparation. Ugur Yener: Writing - review and editing. Alaa Abd-Elsayed: Conceptualization, Writing, Editing, Methodology. Lynn Kohan: Conceptualization, Editing. Sayed E. Wahezi: Conceptualization, Writing, Editing, Supervision.

Corresponding author

Correspondence to Sayed Emal Wahezi.

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Jani, M., Mehta, N., Yu, S. et al. Mitigating Factors in L4 and L5 Medial Branch Motor Stimulation During Radiofrequency Ablation. Curr Pain Headache Rep (2024). https://doi.org/10.1007/s11916-024-01232-8

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  • DOI: https://doi.org/10.1007/s11916-024-01232-8

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