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Research ArticleArticle
Open Access

Endoscopically Guided Foraminal and Dorsal Rhizotomy for Chronic Axial Back Pain Based on Cadaver and Endoscopically Visualized Anatomic Study

Anthony Yeung and Satishchandra Gore
International Journal of Spine Surgery January 2014, 8 23; DOI: https://doi.org/10.14444/1023
Anthony Yeung
1Desert Institute for Spine Care, Phoenix, AZ, USA
MD
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Satishchandra Gore
2Prime Surgical Centre, Pune, India
MD
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Figures

  • Fig. 1
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    Fig. 1

    Surgical setup for ablation of the medial, intermediate and lateral branches of the dorsal ramus.

  • Fig. 2
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    Fig. 2

    Richard Wolf YESS Rhizotomy Set. The cannulas, endoscope, bitip and surgical bipolar RF probes by Elliquence are configured ergonomically to provide excellent focal length imaging to keep image in focus with the endoscope scope resting on cannula. The bitip probe cuts tissue, and the RF probe thermally ablates tissue efficiently.

  • Fig. 3
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    Fig. 3

    Cadaver dissection of the dorsal ramus and its branches out- lining the areas where branches of the dorsal ramus may be visualized and ablated before it reaches the facet joint.

  • Fig. 4
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    Fig. 4

    This H and E slide of the biopsied specimen is consistent with a peripheral nerve fiber.

  • Fig. 5
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    Fig. 5

    This foraminal view of a branch of the dorsal ramus is in the foramen at the level of the SAP. The nerve runs along the ventral lateral aspect of the superior facet to the tip, and can also run in the vicinity of the foraminal ligament. Endoscopic rasps, trephines, kerrisons, and burrs can be used for foraminoplasty. The nerve should be preserved, if possible, but transection of a branch of the dorsal ramus contributes to axial back pain relief. Branches of the dorsal ramus originates in the foramen before exiting to traverse the transverse process. These nerves are difficult to differentiate from furcal nerves arising from the spinal nerves. Palpating the nerve using local anesthesia can sometimes demonstrate a pain response, but not always, depending on the level of sedation and anesthetic use.

  • Fig. 6
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    Fig. 6

    Schematic drawing of Kambin's triangle demonstrating where the medial branch can be visualized at the level of the tip of the SAP and at the transverse process. The medial branch can be visualized endoscopically and transected in the foramen, or more consistently, at the interosseous tunnel crossing the transverse.

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International Journal of Spine Surgery
Vol. 8
1 Jan 2014
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Endoscopically Guided Foraminal and Dorsal Rhizotomy for Chronic Axial Back Pain Based on Cadaver and Endoscopically Visualized Anatomic Study
Anthony Yeung, Satishchandra Gore
International Journal of Spine Surgery Jan 2014, 8 23; DOI: 10.14444/1023

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Endoscopically Guided Foraminal and Dorsal Rhizotomy for Chronic Axial Back Pain Based on Cadaver and Endoscopically Visualized Anatomic Study
Anthony Yeung, Satishchandra Gore
International Journal of Spine Surgery Jan 2014, 8 23; DOI: 10.14444/1023
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  • Article
    • Abstract
    • Introduction
    • Materials and Method and Evolution of Inclusion Criteria
    • Results
    • Discussion
    • Facet innervation
    • Indications and contraindications
    • Complications
    • Postoperative care
    • Outcome of flouroscopic radiofrequency by literature review
    • Conclusion
    • Disclosures
    • References
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  • rhizotomy
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