The mamillo-accessory ligament is a fibrous band connecting the mamillary process to the accessory process of each lumbar vertebra, converting the groove between them into a fibro-osseous tunnel through which the medial branch of the posterior ramus passes.
Creates the fibro-osseous tunnel enclosing the medial branch of the lumbar dorsal ramus — the nerve supply to the facet joint. When ossified, this tunnel becomes a bony channel.
The mamillo-accessory ligament is the structure that can trap the medial branch of the dorsal ramus, producing facetogenic pain that is resistant to conventional medial branch block if the nerve is entrapped proximal to the injection site. Surgical release or ablation at the ossified foramen addresses this variant.
Ossified mamillo-accessory ligament trapping the medial branch of the dorsal ramus producing facetogenic pain resistant to standard medial branch block injection.
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