The posterior rami of lumbar spinal nerves divide into medial branches (supplying the facet joints and multifidus) and lateral branches (supplying the iliocostalis and longissimus), with cutaneous branches extending to the skin of the back and gluteal region. The medial branch at each level is the target for facet joint denervation.
The lumbar medial branch nerves are the specific target of radiofrequency ablation (RFA) for lumbar facet joint pain. The standard technique targets each medial branch at two points — the transverse process-superior articular process junction at each facet level. Three medial branch blocks (L3, L4, L5 medial branches) are required to denervate the L4-L5 and L5-S1 facet joints because each facet receives dual-level innervation.
Radiofrequency ablation of the L3, L4, and L5 medial branch nerves for chronic lumbar facet pain providing 6-18 months of relief in appropriately selected patients with confirmed facetogenic pain pattern and positive diagnostic blocks.
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