Evaluation of a novel nerve ablation technique to relieve lower back pain: a cadaveric feasibility pilot study

Radiofrequency ablation is a treatment for facetogenic low back pain that targets medial branches of lumbar dorsal rami to denervate facet joints. Clinical outcomes vary; optimizing cannula placement to better capture the medial branch could improve clinical outcomes. A novel parasagittal technique was proposed from an anatomic model; this technique was proposed to optimize capture of the medial branch. The anatomic feasibility of the novel technique has not been evaluated.

To simulate and evaluate the proposed parasagittal technique in its ability to achieve proper cannula placement and proximity of uninsulated cannula tips to the medial branches of the dorsal rami in cadaveric specimens.

Under fluoroscopic guidance, the parasagittal technique was used to place 14 cannulae targeting the lumbar medial branches of 2 cadavers. Meticulous dissection was undertaken to assess cannula alignment and measure proximities to target nerves with a digital caliper.

The novel parasagittal technique was successfully performed in a cadaveric model in 12 of 14 attempts. The technique achieved close proximity of cannula tips to medial branches (0.8 ± 1.1 mm). In 2 instances, cannulae were placed unsuccessfully; in one instance, the cannula was too far anterior, and in the other, it was too far retracted.

In this cadaveric simulation study, the feasibility of performing the parasagittal technique for lumbar radiofrequency ablation was evaluated. This study suggests that the parasagittal technique is a feasible option for lumbar medial branch radiofrequency ablation.