Targeting the lateral neck of superior articular process and sub-mammillary fossa for lumbar medial branch radiofrequency ablation: A case series.

Introduction: Lumbar medial branch (MB) radiofrequency ablation (RFA) is a common image-guided procedure to treat facetogenic low back pain. Recent anatomical literature has proposed a two-lesion RFA approach targeting the posterior portion of the lateral neck of superior articular process (SAP) and the superior aspect of the sub-mammillary fossa. The objectives of this report were to: 1) describe the novel lumbar MB RFA technique, 2) discuss the relevant anatomy, and 3) report pain relief outcomes in four patients who gave informed consent to be treated with the novel two-landmark lumbar MB RFA technique. Methods: Four patients were treated with the novel two-landmark lumbar MB RFA technique targeting the posterior half of the lateral neck of SAP and superior aspect of the sub-mammillary fossa. The quality and duration of pain relief following the treatment are described in this report. Results: All 4 patients, who received the novel technique, self-reported quality of pain relief of ≥80 %. One patient, who self-reported 100 % pain relief, elected not to have repeat RFA treatment at their 15-month follow-up appointment. All 4 patients reported pain relief duration ≥12 months and stated the quality of pain relief following procedure was "excellent" or the "best result" they experienced. Conclusions: This case series reports early evidence of the effectiveness of the two-landmark lumbar MB RFA technique. The novel approach shows promise in a limited number of patient cases and warrants further investigation.