Anatomic basis: The posterior branches of the spinal nerves are smaller than the anterior branches, and after exiting the intervertebral foramen, they divide into medial and lateral branches between adjacent transverse processes to innervate the skin and muscles of the region. Most posterior spinal nerve branches are more clearly segmental in distribution. In particular, the posterior medial branch runs laterally and obliquely posterior to the root of the superior articular process in the inferior vertebrae, and turns downward through the fibrous canal to the back of the arch plate; it distributes to the deep dorsal muscles and spinal column. The posterior branch is surrounded by only a little adipose tissue and abuts the intertransverse ligament; its relative fixation is the anatomical basis of the posterior branch causing low back pain and the biomechanical basis of nerve strain injury. It is also often a cause of pain, and the posterior medial branch in particular is very important.
It is noteworthy that the medial branches are more closely connected to each other, and each small joint is doubly innervated, for example, the L45 small joint receives innervation from both the L3 and L4 medial branches.
Diagnostic criteria: 1. paravertebral pain, aggravated in the resting position, without improvement after rest 2. restricted movement, aggravated by changing position 3. no radicular symptoms, may be accompanied by head, face, shoulder and back pain or lumbar back pain 4. normal neurological physical examination 5. auxiliary examination is mainly spinal degeneration, with or without intraspinal lesions Operation: 1. patient in prone position with a pillow under the abdomen, palpate the spinous process and mark it well. The spinous process is opened about 2 cm laterally as the puncture point, and the towel is routinely disinfected.
2, use the lumbar puncture needle or radiofrequency puncture needle from the entry point vertical skin slowly into the needle, straight to the transverse process bone surface, and then slowly adjust the position of the needle tip until as close as possible to the root of the transverse process.
3, If the needle is positioned under X-ray, the orthogonal oblique position and lateral position confirm that the needle tip is at the root of the transverse process and anatomically positioned.
4.For more precise localization, it is also possible to connect radiofrequency electrodes and use motor and sensory tests. If the patient has obvious muscle throbbing or pain in the area innervated by the posterior spinal nerve branch within 0.5 V, it is proved that the needle tip is close to the posterior spinal nerve branch here, and there is no blood or cerebrospinal fluid in the retraction, it is possible to inject 3-5 ml of local anesthetic. 5.The block of the posterior spinal nerve branch should be about 2-3 up and down at the same time because the posterior spinal nerve branch The branches of the posterior spinal nerve have the characteristic of cross distribution.