C8 medial branch location.....

[Taus]

Have a pt with C4-7 fusion, apparent adjacent segment pain below at C7-T1 facet..... C8 medial branch location is not well documented in the literature. Do you just target like a typical thoracic mbb at superolateral corner of transverse process??

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[clubdeac]

I see this a lot and that's where I block. Taus I'm curious, where is the patient's pain? I usually only target this joint if they are having peri or interscapular pain. You?

 

[Taus]

I see this a lot and that's where I block. Taus I'm curious, where is the patient's pain? I usually only target this joint if they are having peri or interscapular pain. You?

Thanks.

Tender over this exact location (C7-T1 paramidline) and has referred pain exactly as you describe- medial periscapular, ie classic C6-7 facet referral, though that level is fused.

 

[lobelsteve]

It's not fused posteriorly.

 

[onewithpain]

Didn't someone like Bogduk show that patients with anterior fusion can still have pain at facet joints?
I had a patient drive up from CA to see me with CA WC. He has fusion C5-C7. He seemed to have pain above and below the fusion so I applied for MBB C4,5,7,8 ( I would have done C6 for free just to make sure) but was denied because C5,C6 and C7 are fused and humans don't have a C8 vertebrae so there could be no C8 medial branch nerve. I guess C4 is still a possibility.

 

[bedrock]

Didn't someone like Bogduk show that patients with anterior fusion can still have pain at facet joints?
I had a patient drive up from CA to see me with CA WC. He has fusion C5-C7. He seemed to have pain above and below the fusion so I applied for MBB C4,5,7,8 ( I would have done C6 for free just to make sure) but was denied because C5,C6 and C7 are fused and humans don't have a C8 vertebrae so there could be no C8 medial branch nerve. I guess C4 is still a possibility.

These days your best bet is to describe facet joints by level for auth and for procedure payment. We only get paid by joint , not nerve now anyway.

Work comp also struggles to mentally process you saying that anything but one spot is the problem. Sometimes best to pick the worst spot and get the one worst spot treated instead of being denied for 2-3 spots, and the patient getting no treatment at all.

 

[pmrrulez]

I block the C8 medial branch at the location that Centeno described it. Screenshot of the image below. You can find it here:

Radiofrequency lesioning of the cervical medial branches (PDF Download Available)

 

[Aether2000]

C8 mb may lie more medial and c7 mb is certainly more variable than shown in the xray above.

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