Medial Branch Research Articles

Cervical facet joint platelet-rich plasma in people with chronic whiplash-associated disorders: A prospective case series of longer term 6- and 12- month outcomes

ObjectiveTo explore the 6- and 12-month effectiveness of a single autologous injection of platelet-rich plasma (PRP) in cervical facet joints of people with chronic WAD and facet-mediated pain. DesignA prospective case series of people with chronic whiplash-associated disorders and cervical facet joint mediated pain in a community setting. InterventionsWe investigated 44 consecutive people who underwent cervical facet joint PRP ( ​± ​adjunct physiotherapy) between 2019 and 2021, selected for PRP based on 80% relief following single diagnostic medial branch blocks or 50% relief and a significant improvement in performing a previously limited activity of daily living. MeasuresMeasures of pain (numerical pain rating scale - NPRS) and disability (Neck Disability Index - NDI) were collected prior to and 3-, 6- and 12- months following cervical facet joint PRP in an electronic registry database. Success was defined as those exceeding the minimal clinically important difference (MCID) for pain (>15%) and disability (>10%). We also calculated the proportion of people with greater than 50% relief of pain. People not reached for follow-up were considered failures for worst-case analysis. ResultsForty-four people (82% female, mean age ​= ​45.2 (range: 25–71) years) underwent cervical facet joint PRP. Nine people received repeat PRP interventions. Thirty-five people provided 12-month data. There was a significant improvement in pain and disability following PRP (and possibly adjunct physiotherapy) received during this time period. At 12-months, 53% of people exceeded MCID for pain, reporting a mean improvement of 66% (95%CI: 55–77%) on the NPRS. For NDI scores, 69% of people exceeded MCID, reporting a mean improvement of 48% (95%CI: 38–58%). Thirty-seven percent of people reported greater than 50% relief of pain 12-months post-cervical facet joint PRP. ConclusionIn people with chronic WAD and facet-mediated pain, our long-term data suggests that PRP (and possibly adjunct physiotherapy) is effective. A controlled study is warranted to evaluate the efficacy of PRP.

Oxytocin mediated excitation of hypoglossal motoneurons: implications for treating obstructive sleep apnea.

Clinical studies have shown that oxytocin administered intranasally (IN) decreased the incidence and duration of obstructive events in patients with obstructive sleep apnea (OSA). Although the mechanisms by which oxytocin promotes these beneficial effects are unknown, one possible target of oxytocin could be the excitation of tongue-projecting hypoglossal motoneurons in the medulla, that exert central control of upper airway patency. This study tested the hypothesis that IN oxytocin enhances tongue muscle activity via the excitation of hypoglossal motoneurons projecting to tongue protrudor muscles (PMNs). To test this hypothesis we performed in vivo and in vitro electrophysiological studies in C57BL6/J mice as well as fluorescent imaging studies in transgenic mice in which neurons that express oxytocin receptors co-express fluorescent protein. IN oxytocin significantly increased the amplitude of inspiratory-related tongue muscle activity. This effect was abolished by severing the medial branch of hypoglossal nerve that innervates PMNs of the tongue. Oxytocin receptor-positive neurons were more prevalent in the population of PMNs than in retractor-projecting hypoglossal motoneurons (RMNs). Oxytocin administration increased action potential firing in PMNs, but had no significant effect on firing activity in RMNs. In conclusion, IN oxytocin stimulates respiratory-relating tongue muscle activity likely acting on central hypoglossal motoneurons that provide tongue protrusion and upper airway opening. This mechanism may play a role in oxytocin-induced reductions in upper airway obstructions in patients with OSA.

Combination mode and optimization strategy of harvest procedure of anterolateral thigh chimeric perforator myocutaneous flap

To summarize the combination methods and optimization strategies of the harvest procedure of anterolateral thigh chimeric perforator myocutaneous flap. A clinical data of 359 cases of oral cancer admitted between June 2015 and December 2021 was retrospectively analyzed. There were 338 males and 21 females with an average age of 35.7 years (range, 28-59 years). There were 161 cases of tongue cancer, 132 cases of gingival cancer, and 66 cases of buccal and oral cancer. According to the Union International Center of Cancer (UICC) TNM staging, there were 137 cases of T 4N 0M 0, 166 cases of T 4N 1M 0, 43 cases of T 3N 1M 0, 13 cases of T 3N 2M 0. The disease duration was 1-12 months (mean, 6.3 months). The soft tissue defects in size of 5.0 cm×4.0 cm to 10.0 cm×7.5 cm remained after radical resection were repaired with the free anterolateral thigh chimeric perforator myocutaneous flaps. The process of harvesting the myocutaneous flap was mainly divided into 4 steps. Step 1: exposing and separating the perforator vessels, which mainly came from the oblique branch and the lateral branch of the descending branch. Step 2: isolating the main trunk of the perforator vessel pedicle and determining the origin of the vascular pedicle of muscle flap, which was came from oblique branch, lateral branch of the descending branch, or medial branch of the descending branch. Step 3: determining the source of muscle flap, including lateral thigh muscle and rectus femoris muscle. Step 4: determining the harvest form of muscle flap, which included muscle branch type, main trunk distal type, and main trunk lateral type. The 359 free anterolateral thigh chimeric perforator myocutaneous flaps were harvested. In all cases, the anterolateral femoral perforator vessels existed. The perforator vascular pedicle of the flap came from the oblique branch in 127 cases and the lateral branch of the descending branch in 232 cases. The vascular pedicle of muscle flap originated from the oblique branch in 94 cases, the lateral branch of the descending branch in 187 cases, and the medial branch of the descending branch in 78 cases. The muscle flaps harvested from the lateral thigh muscle in 308 cases and the rectus femoris muscle in 51 cases. The harvest forms of muscle flaps included 154 cases of muscle branch type, 78 cases of main trunk distal type, and 127 cases of main trunk lateral type. The size of skin flaps ranged from 6.0 cm×4.0 cm to 16.0 cm×8.0 cm, and the size of muscle flaps range from 5.0 cm×4.0 cm to 9.0 cm×6.0 cm. In 316 cases, the perforating artery anastomosed with the superior thyroid artery, and the accompanying vein anastomosed with the superior thyroid vein. In 43 cases, the perforating artery anastomosed with the facial artery, and the accompanying vein anastomosed with the facial vein. After operation, the hematoma occurred in 6 cases and vascular crisis in 4 cases. Among them, 7 cases were successfully saved after emergency exploration, 1 case had partial necrosis of skin flap, which was healed after conservative dressing change, and 2 cases had complete necrosis of skin flap, which was repaired by pectoralis major myocutaneous flap. All patients were followed up 10-56 months (mean, 22.5 months). The appearance of the flap was satisfactory, and the swallowing and language functions were restored satisfactorily. Only linear scar left in the donor site with no significant effect on thigh function. During follow-up, 23 patients had local tumor recurrence and 16 patients had cervical lymph node metastasis. The 3-year survival rate was 38.2% (137/359). The flexible and clear classification of the key points in the harvest process of anterolateral thigh chimeric perforator myocutaneous flap can optimize the protocol to the greatest extent, increase the safety of the operation, and reduce the difficulty of the operation.

Endoscope-Assisted Greater Occipital Nerve Decompression for Migraines, Occipital Neuralgia, and New Daily Persistent Headaches.

In the occipital trigger site for migraine, the greater occipital nerve (GON) is thought to be irritated by surrounding structures, including the semispinalis capitis muscle and occipital artery (OA), producing headaches in the back of the neck. Thus, standard decompression involves removal of surrounding tissue and dissection away from the vessel. The authors noticed a consistent pattern between the GON and OA more distally: the OA approaching laterally and diving under the GON, the OA looping back over the GON and intertwining with the medial branch of the GON, and lastly the OA traveling parallel to the GON. The technique described uses a modified endoscopic approach with a counter incision, endoscopic assistance, and radical artery lysis to address distal sites in addition to the standard release. At the counter incision, distal intertwining between vessel and nerve was released. A high-definition endoscope was used to address dynamic compression points more proximally, including hidden areas where the vessel dives under the GON, as well as to facilitate cautery and removal of the vessel. Without the use of an endoscope and counterincision, it is difficult to achieve complete decompression of the nerve distally without injury to the proximal body of the nerve.

Paraspinal muscles atrophy on both sides and at multiple levels after unilateral lumbar partial discectomy.

To identify the changes in cross-sectional areas (CSAs) and fatty infiltration of both sides of the paravertebral muscles and their associations with prognostic factors in patients who underwent unilateral lumbar discectomy. We retrospectively reviewed 27 patients who underwent magnetic resonance imaging before and after 1- or 2-level lumbar discectomy. The CSAs and functional cross-sectional areas of the paraspinal muscles were bilaterally measured from L1 to L2 to L5 to S1 based on T2-weighted axial images. These parameters were compared pre-and postoperatively. CSAs and functional cross-sectional areas decreased also in non-operative, non-surgical levels, not only in operated levels after discectomy. In the correlation analysis, the CSA of psoas major muscle at L1 to L2 was significantly decreased in patients with lower preoperative lordosis (r = 0.598, P = .040). The postoperative CSA of psoas major muscle at L4 to L5 was lower in those with the higher Pfirrmann grade (r = -0.590, P = .002); however, the CSA of quadratus lumborum muscle at L1 to L2 showed the opposite result (r = 0.526, P = .036). Similar results were also observed in the partial correlation adjusted for age and postoperative duration. Patients who underwent discectomy experienced overall paraspinal muscle atrophy in the lumbar region, including surgical and non-surgical sites. Such atrophic changes emphasized the need for core strengthening and lumbar rehabilitation from the early period after partial discectomy.

Finite Element Simulation of Proportional, Integral, and Derivative-Controlled Bipolar Radiofrequency Ablation of Porcine Spinal Muscle

Abstract Radio frequency ablation (RFA) of the medial branch nerve is a widely used therapeutic intervention for back pain originating from the facet joint. However, multifidus denervation is a well-known adverse effect of this RFA procedure. Computational simulations of RFA can be used to design a new multifidus-sparing RFA procedure for facet joint pain. Unfortunately, there is not a computational model available for RFA of porcine spines (a common animal model for the translation of spinal treatments). The objective of this study is to develop and verify a computational model for bipolar radio frequency ablation of porcine spine muscle. To do this, the electrical and thermal conductivity properties were measured over a temperature range of 20–90 °C in ex vivo porcine spinal. A proportional, integral, and derivative (PID) controlled finite element (FE) model was developed and tuned to simulate the ablation process. Finally, tissue temperatures from simulations and experimental ablations were compared. Thermal conductivity values of spinal muscle ranged from 0.33 W/mK to 0.57 W/mK. Similarly, electrical conductivity varied from 0.36 S/m to 1.28 S/m. The tuned PID parameters for temperature-controlled model were KP=40, Ki=0.01, and Kd=0. A close agreement between experimental measurements of tissue temperature and simulations were observed in the uncertainty range with R-squared values between 0.88 and 0.98. The model developed in this study is a valuable tool for preclinical studies exploring new RFA methods of spinal nerves.

Electromyoneurography in the diagnostics of rare causes of carpal tunnel syndrome

Introduction. The paper points to the problem of electromyoneurography of the bifid median nerve as a rare cause of carpal tunnel syndrome. Carpal tunnel syndrome represents a set of symptoms caused by compression of the distal portion of the median nerve. It is important in clinical practice as it significantly effects the functionality and the quality of daily activities. One of the predisposing factors for the carpal tunnel syndrome is the bifid median nerve. Electromyoneurography is still the gold standard for the verification of the carpal tunnel syndrome. Case Report. A 48-year-old patient, after a clinical suspicion of carpal tunnel syndrome, has been confirm by ultrasonography to be suffering from moderate carpal tunnel syndrome, with a detection of ?incomplete? bifid median nerve in the carpal tunnel. Electromyoneurography also confirmed a mild level of carpal tunnel syndrome. However, as difficulties were exclusively present in the innervation area of the median nerve internal branch, and there was a possibility of incomplete correlation of electromyoneurography results, the lumbrical muscles and dorsal interossei muscles were examined, and confirmed a moderate degree of carpal tunnel syndrome. Discussion. The bifid median nerve can be the cause of the above insufficient sensitivity of this method, which is why it is necessary to apply optional electromyoneurographic techniques. Conclusion. The final practical significance lies in the fact that the presence of the diagnosed bifid median nerve could affect the choice and efficiency of certain therapeutical options.

The Negative Screening Rate of Second Cervical Medial Branch Blocks in Patients With Positive First Blocks: A Retrospective Chart Review

The Negative Screening Rate of Second Cervical Medial Branch Blocks in Patients With Positive First Blocks: A Retrospective Chart Review

The Effect of Medial Branch Radiofrequency Ablation on the Progression of Lumbar Spondylolisthesis Compared to Natural History: A Retrospective Observational Cohort Study

The Effect of Medial Branch Radiofrequency Ablation on the Progression of Lumbar Spondylolisthesis Compared to Natural History: A Retrospective Observational Cohort Study

The Negative Screening Rate of a Second Lumbar Medial Branch Block in Patients With a Positive First Block: A Retrospective Cohort Study

The Negative Screening Rate of a Second Lumbar Medial Branch Block in Patients With a Positive First Block: A Retrospective Cohort Study

The Effect of Lumbar Medial Branch Radiofrequency Ablation on Cobb Angle Progression in Individuals with Degenerative Scoliosis compared to Natural History: A Retrospective Observational Cohort Study

The Effect of Lumbar Medial Branch Radiofrequency Ablation on Cobb Angle Progression in Individuals with Degenerative Scoliosis compared to Natural History: A Retrospective Observational Cohort Study

A Pragmatic Randomized Prospective Trial of Cooled Radiofrequency Neurotomy of the Medial Branch Nerves Versus Facet Joint Injection of Corticosteroid for the Treatment of Lumbar Facet Syndrome: 12 Month Results

A Pragmatic Randomized Prospective Trial of Cooled Radiofrequency Neurotomy of the Medial Branch Nerves Versus Facet Joint Injection of Corticosteroid for the Treatment of Lumbar Facet Syndrome: 12 Month Results

Are There Optimal Prognostic Block Selection Criteria for Predicting Treatment Success Following Cervical Medial Branch Radiofrequency Neurotomy? A Real-world Cohort Study

Are There Optimal Prognostic Block Selection Criteria for Predicting Treatment Success Following Cervical Medial Branch Radiofrequency Neurotomy? A Real-world Cohort Study

Success Rate of Advancing from Medial Branch Blocks to Radiofrequency Ablation in Patients with Modic Endplate Changes

Success Rate of Advancing from Medial Branch Blocks to Radiofrequency Ablation in Patients with Modic Endplate Changes

Success Rate of Advancing from Medial Branch Blocks to Radiofrequency Ablation in the Setting of Moderate-Severe Central Spinal Stenosis.

Success Rate of Advancing from Medial Branch Blocks to Radiofrequency Ablation in the Setting of Moderate-Severe Central Spinal Stenosis.

Two-arm observational study to assess the efficacy of cooled versus conventional radiofrequency ablation of medial branch nerves in patients with lumbar facet joint arthropathy

Two-arm observational study to assess the efficacy of cooled versus conventional radiofrequency ablation of medial branch nerves in patients with lumbar facet joint arthropathy

The Effectiveness of Cervical Medial Branch Radiofrequency Neurotomy Using a Perpendicular Approach with a Multi-tined Probe: A Single-Arm, Retrospective Cohort Study

The Effectiveness of Cervical Medial Branch Radiofrequency Neurotomy Using a Perpendicular Approach with a Multi-tined Probe: A Single-Arm, Retrospective Cohort Study

Investigating the Use of Kinematic Motion Data to Measure Outcomes of Patients Treated With Medial Branch Block

Investigating the Use of Kinematic Motion Data to Measure Outcomes of Patients Treated With Medial Branch Block

Anatomical Topographical Investigation of the Medial Branch of the Dorsal Thoracic Branch of the Spinal Nerve in the Segments T10 – T12

Anatomical Topographical Investigation of the Medial Branch of the Dorsal Thoracic Branch of the Spinal Nerve in the Segments T10 – T12

Are There Optimal Prognostic Block Selection Criteria for Predicting Treatment Success Following Lumbar Medial Branch Radiofrequency Neurotomy? A Cohort Study

Are There Optimal Prognostic Block Selection Criteria for Predicting Treatment Success Following Lumbar Medial Branch Radiofrequency Neurotomy? A Cohort Study