MBB and RFA for lumbarized/sacralized levels

[MD87]

I found only a couple case reports/case series about this. I see tons of these in my clinic. I haven't had to MBB or RFA any of them yet, but I wonder how to even go about doing it. Does anyone have experience with this? Do you feel like RFA is less successful in these patients or have you found good locations to put your needles and still get good relief? Do you have to do a ton of lesions? Thanks

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[Ducttape]

if it is sacralized, there is no movement across the nonexistent joint.



think... would it still be a causative agent of pain then?

 

[thecentral09]

I would say that I do this at least weekly. And baby and RFA the meteor branches around the facets that do exist and see. Do what you know you can help with. Also look for L4 for L5 disc issues and sacroiliac Pain. I believe that pain from this often becomes multifactorial

 

[emd123]

I found only a couple case reports/case series about this. I see tons of these in my clinic. I haven't had to MBB or RFA any of them yet, but I wonder how to even go about doing it. Does anyone have experience with this? Do you feel like RFA is less successful in these patients or have you found good locations to put your needles and still get good relief? Do you have to do a ton of lesions? Thanks

Since these are anatomic variants that are different in each patient, there is no blanket answer that says you can apply to all people. Transitional anatomy is different in every patient. Some are totally fused. Some are partially fused. Some involved a sacralized L5. Some involve a lumbarized S1. Some are one thing on one side and something different on the other. Some T12's have a micro rib or none at all and therefore it's an extra lumbar body. You have to take them on a patient by patient basis, depending on how the anatomy looks. But since the anatomy in these patients is by definition, different than the norm, nobody can tell you where the medial branches are, or are not, in any of these.

That being said, transitional anatomy is not by itself, alone, an absolute contraindication to lesioning the nerves to the joints at a given level. But it might be in a given patient based on what you're seeing. Just do what you think is best.