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Selected Publication:
Skias, C.
Anatomical topographical investigation of the dorsal thoracic branch of the spinal nerve
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2017. pp. 86
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- Authors Med Uni Graz:
- Advisor:
- Feigl Georg
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- Abstract:
- Introduction Percutaneus radiofrequencyfacetdenervation (PRFD) by thermocoagulation is a useful treatment for unspecific thoracic pain syndrome. To guarantee maximal parallelism and proximity to the nerve, it is essential to have precise knowledge of the topography of the thoracic dorsal branches of spinal nerves. This special anatomy was investigated and the results were compared to the existing technique for PRFD, where the active needle tip is placed in the junction of the superior articular process and the transverse process. Materials and Methods 20 thoracic spines of cadavers embalmed with 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 zygapophysial branch to the thoracic facet joint was traced peripherally. The distance of the medial branch to the inferior articular process at level of the nerve passing the superior costotransversal ligament was measured. Results: The dorsal branch bifurcates into lateral and medial branches medial to the superior costotransversal ligament. The lateral branch passes the entire intertransversal ligament ventrally and laterally to change course caudally. The medial branch runs laterally first to pass in between two parts of the intertransversal 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 sent branches to the capsule of the facet joint. The distance of the medial branch lateral to the inferior articular process was constantly 3mm. Conclusions The current technique of PRFD at the thoracic spine reaches the medial branch only. For selective thermocoagulation of the facet joint, a new technique should be developed.