facet joint denervation with radiofrequency to four medial branches L4-L5 AND L5-S1

PROCEDURE: Informed consent was obtained. A time-out was performed to assure the correct patient and the proper procedure. The patient was placed in a prone position with a pillow under his abdomen. The anatomy was analyzed with fluoroscopy. The four medial branches to the L4-5 and L5-S1 facet joints were identified by appropriate bony landmarks and labeled as the S1 branch, the sacral alar branch, the L5 branch and the L4 branch. Next, 22-gauge 10-cm radiofrequency lesioning needles with 10-mm active curved tips were advanced into the appropriate positions after anesthetizing the skin and deep tissues. They were placed at the superolateral edge of the S1 neural foramen, the junction of the sacral ala and the superior articulating process of the L5-S1 facet joint, the L5 branch at the transverse process of L5 at the junction of the superior articulating process of the L4-5 facet joint, and the L4 branch at the junction of the L4 transverse process and the superior articulating process of the L3-4 facet joint. The appropriate position was verified with sensory stimulation as well as motor stimulation, noting no sensory or motor stimulation to the lower extremities. Next, 1 mL of 1% Lidocaine was injected prior to the denervation, which was performed for 90 seconds at 80 degrees centigrade. After the denervations, 1 mL of 0.25% Bupivacaine and 20 mg of Kenalog was injected at each level. The patient tolerated the procedure well.
confused on the four branches only seeing three. Need help!!!!