Considerations for Cervical Medial Branch Nerve Radiofrequency at Spinal Motion Segments Adjacent to Cervical Fusion Constructs: A Technical Note
Heili Truumees, Robert M Amick, Joel Turtle, Nicholas T Spina, Robert W Hurley, Zachary L McCormick, Brian A KaramianAbstract
Background
Cervical fusion alters regional biomechanics and increases load transmission through adjacent facet joints, which may produce facet-mediated pain. Cervical medial branch blocks (MBBs) and radiofrequency ablation (RFA) remain highly useful diagnostic and therapeutic interventions, yet surgical approaches used in cervical fusion frequently disrupt the cervical medial branch nerves (MBNs) at treated levels. Identifying which MBNs remain anatomically intact is essential for accurate diagnostic and therapeutic targeting of relevant nerves (and sensate facet joints), and for avoiding unnecessary procedure levels or procedures altogether.
Objective
To present an approach to determining which cervical medial branches require management after fusion, drawing upon surgical approach, anatomic landmarks, implant trajectory, and cross-sectional imaging.
Design
Technical Note
Setting
Cervical radiofrequency ablation following spinal fusion surgery.
Conclusions
A systematic, anatomy-based method improves diagnostic precision, reduces unnecessary procedures, and helps identify patients most likely to benefit from interventions. Posterior cervical fusion using modern screw and rod instrumentation will essentially always result in denervation of the MBN at the operated level(s). Anterior surgical approaches reliably preserve the MBNs, making them viable targets for cervical RFA.