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Introduction Percutaneous radiofrequency facet denervation (PRFD) by thermocoagulation is a useful treatment for nonspecific thoracic pain syndrome. To guarantee that maximal thermal lesion is applied to the nerve, it is essential to have precise knowledge of the topography of the thoracic dorsal branches of the spinal nerves. This special anatomy was investigated, and the results were compared with the existing technique for PRFD, where the active needle tip is placed in the junction of the superior articular process and the transverse process. Methods Twenty thoracic spines of cadavers (10 females and 10 males) embalmed according to Thiel's method were bilaterally dissected. After careful removal of skin and subcutaneous fat tissue, the lateral and medial branches were traced centrally. In addition, the articular branch to the thoracic facet joint was traced peripherally. The distance of the medial branch to the inferior articular process at the level of the nerve passing the superior costotransverse ligament was measured. Results The dorsal branch bifurcates into lateral and medial branches medial to the superior costotransverse ligament. The medial branch runs laterally first to pass in between two parts of the intertransverse ligament running dorsally and to turn medially superficial to this ligament. The zygapophysial branch always originated from the medial branch passing the inferior articular process laterally by running caudally to turn medially and send branches to the capsule of the zygapophyseal joint. The distance of the medial branch lateral to the inferior articular process was constantly 3 mm. Conclusions The current technique of PRFD at the thoracic spine targets the medial branch distal to the separation of the articular branch, rendering the lesion ineffective at denervating the zygapophyseal joint. For selective thermocoagulation of the articular branches of the thoracic zygapophyseal joint, a new technique should be developed. We propose an anatomically informed needle position that can now be confirmed clinically. [ABSTRACT FROM AUTHOR]

Introduction The zygapophyseal joints represent one possible cause for back pain. Therefore, many interventions are targeting the denervation of the facet joints. The aim of this study is to describe the course of the medial branch of the dorsal branch of the spinal nerve and its articular branches to the zygapophyseal joints in the segments T10–T12. Methods The medial branches in the thoracic segments T10–T12 were dissected in 20 Thiel embalmed cadavers. An Eschenbach magnifying glass (4.0× magnification) was used during dissection preserving the articular branches. The topography and the branching pattern of the medial branches was observed. Results The course of the nerves in the segments T10–T12 differed from each other because of the different osseous anatomy of each segment. The medial branch at the segment T10 crossed the tip of the transverse process in 28 of the 40 hemivertebral specimens. In the remaining cases it passed superior to the transverse process. At T11 the medial branch ran constantly through an osteofibrous canal. At the segment T12 the medial branches showed a similar course to the medial branches in the lumbar region. In many cases two articular branches, which arose from the medial branch were identified. Conclusions The results of this study show a considerable anatomic variety at the segment T10. It also demonstrates that the transverse process is an important landmark to encounter the medial branch. Furthermore, the possibility of a double innervation of the facet joints should always be considered. [ABSTRACT FROM AUTHOR]

Background Context: Percutaneous vertebroplasty (PVP) is an effective procedure for treatment of osteoporotic vertebral compression fractures (OVCFs). Recollapse of the cemented vertebrae is not unusual and the thoracolumbar junction is the most common region. Nevertheless, not all patients suffering from OVCFs in this region develop recollapse after PVP., Purpose: The aim of this study was to investigate possible risk factors related to recollapse of the cemented vertebrae in the thoracolumbar region., Study Design/setting: Retrospective study., Patient Sample: A total of 161 patients undergoing PVP., Outcome Measures: Clinical outcomes were assessed using Visual Analog Scale (VAS) scores. Radiographic parameters included pelvic incidence (PI), thoracolumbar kyphosis (TLK), kyphotic angle, compression rate, reduction rate, and occurrence of intravertebral cleft (IVC)., Methods: Patients were divided into the recollapse group and control group. Patient characteristics, clinical and radiographic parameters were compared between the two groups. Univariate and multivariate logistic regression were used to evaluate the potential risk factors for recollapse. The correlations between the variables were examined. A receiver operating characteristic curve of PI was constructed to discriminate between patients with and without recollapse., Results: There were no significant differences in patient characteristics between the two groups except for bone mineral density (BMD). Occurrence rate of IVC was significantly higher in the recollapse group. VAS scores were significantly decreased after PVP. At last follow-up, they were increased in the recollapse group and maintained in the control group. PI was significantly lower in the recollapse group than in the control group. The univariate logistic regression found four possible risk factors for recollapse, including low PI, IVC, low BMD, and high TLK. Further multivariate logistic regression eliminated high TLK from them. The collinear analysis showed low tolerance and high variance inflation factor for preoperative and postoperative TLK, but not for PI, IVC and BMD. PI was a good predictor of recollapse, and the optimal cut-off value was 43°. The magnitude of preoperative and postoperative TLK was significantly correlated with the value of PI., Conclusions: Recollapse of the cemented vertebrae in the thoracolumbar region was related to low PI, IVC and low BMD. PI less than 43° was a good predictor of recollapse. TLK was dependent on PI and not a risk factor for recollapse. In addition to PVP, patients with low PI, IVC and low BMD may require personalized interventions such as combined internal fixation and trunk orthoses., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)