The mamillary process is a small tubercle on the posterior surface of each lumbar superior articular process, providing attachment for the multifidus and the medial branch of the posterior rami. It lies immediately lateral to the superior articular process and is a critical landmark for lumbar medial branch block and radiofrequency ablation targeting the facet joint nerves.
The mamillary process is the definitive anatomical target for lumbar medial branch nerve block and radiofrequency neurotomy, the standard treatment for facet-mediated low back pain. The medial branch nerve runs in the groove between the mamillary and accessory processes and is reliably located at this bony landmark under fluoroscopic or CT guidance. Accuracy of needle placement at the mamillary process predicts diagnostic block reliability.
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