3D nerve proximity mapping of the medial branch of lumbar dorsal ramus: An anatomical study
Bibliographic record
Abstract
Objective: Lumbar medial branch (MB) radiofrequency ablation is a common intervention to treat facetogenic low back pain. Consensus among spine pain interventionalists is that the cannula tip should be placed adjacent to the periosteum of the lateral neck of the superior articular process (SAP) to ensure maximum contact with the MB. The spatial relationship of the nerve to the periosteum of the lateral neck of the SAP has not been quantified in 3D. The objectives of the current study were to: 1) use 3D modelling technology to quantify the location along the lateral neck of the SAP where the MB is in direct contact with the periosteum; and 2) identify target site(s) to optimize lumbar MB denervation. Design: Seventy lumbar dorsal rami in 14 formalin-embalmed specimens were dissected, digitized, and modeled in 3D. The 3D positional data of the MB were used to generate a novel nerve proximity map which provided a method to quantify and visualize the 3D course of the MB in relation to the periosteum of the lateral neck of SAP. The percent of the lateral neck of SAP in contact with the MB was quantified and consistent target site(s) identified. Results: There was variability in the percentage of the lateral neck of SAP in contact with the MB. The mean percentage of the lateral neck of SAP in contact with the MB for the L1-L5 levels ranged between 57.39 ± 10.72 % (for L1) to 81.54 ± 10.48 % (for L5). The nerve proximity map showed consistent course of the MB along the posterior portion of the lateral neck of SAP and at a novel target site distal to the mamillo-accessory notch (i.e. sub-mammillary landmark). Conclusion: The percent of the lateral neck that was in contact with the MB was quantified and visualized using a novel nerve proximity mapping methodology which may be used to inform cannula tip depth placement. Further, the nerve proximity maps were used to identify an alternative landmark to extend the length of the MB captured. The proposed sub-mammillary landmark may be a viable target site pending future anatomical and clinical investigations.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".