PMC3903800_01
Illustration of medial branch (MB) and lateral branch (LB) thoracic spine. Bogduk N (ed). Practice Guidelines for Spinal Diagnostics and Treatment Procedures. International Spine Injection Society (ISIS) 2004. Reproduced with permission of the publishers. PD: pedicle, VB: body of vertebra, SAP: superior articular process, LCL: lateral costovertebral ligament, LC: levator costorum, TP: transverse process, RB: rib, EI: external intercostal muscle, ZJ: zygaphophysial joint, VR: ventral root, SP: spinous process.
kjpain-27-43-g001.jpg
PMC3903800_01_kjpain-27-43-g001.jpg
F1
Unlike the lumbar medial branches, the course of the medial branch in the thoracic tends to be variable depending on the thoracic level (Fig. 1, 2). T4-T8 level, the medial branch is located in the soft tissue between the transverse process and therefore does not have as consistent skeletal landmark to place a radiofrequency cannula for ablation as other vertebral body levels (Fig. 1, 2). Two studies have used radiofrequency thermocoagulation (RFTC) of the medial branch for thoracic pain with moderate benefit.
Illustration of variation of position of medial branch in thoracic spine. Bogduk N (ed). Practice Guidelines for Spinal Diagnostics and Treatment Procedures,. International Spine Injection Society (ISIS) 2004. Reproduced with permission of the publishers.
kjpain-27-43-g002.jpg
PMC3903800_01_kjpain-27-43-g002.jpg
F2
Unlike the lumbar medial branches, the course of the medial branch in the thoracic tends to be variable depending on the thoracic level (Fig. 1, 2). T4-T8 level, the medial branch is located in the soft tissue between the transverse process and therefore does not have as consistent skeletal landmark to place a radiofrequency cannula for ablation as other vertebral body levels (Fig. 1, 2). Two studies have used radiofrequency thermocoagulation (RFTC) of the medial branch for thoracic pain with moderate benefit.