Cx MB RF ?Preferred Tech

[lovebailey2001]

I am doing Cx RF using the ISIS tech, but it takes a lot of time and exposure to burn a single nerve (3 oblique and 2-3 sag passes)! Results are good, but is there any way to reduce the the exposure and time without reducing the effectiveness? Is there any new ISIS technique of 'Single Needle Pass with comparative results'. Please chime in....

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[specepic]

I am doing Cx RF using the ISIS tech, but it takes a lot of time and exposure to burn a single nerve (3 oblique and 2-3 sag passes)! Results are good, but is there any way to reduce the the exposure and time without reducing the effectiveness? Is there any new ISIS technique of 'Single Needle Pass with comparative results'. Please chime in....

I did ISIS Cerv RF course last year and they did not teach us mutliple passes except for C2-3 and esp 3ONB. o/w we were taught a well placed needle in a sagittal pass, optional for multiple pass. emphasis on knowinbg the MBB anatomy in the neck which as you know is much more complex and variable than LS. I usually just spin the bevel for a double burn as I use curved tip and that makes a nice wide lesion. Been working great.

 

[lovebailey2001]

You mean no oblique pass for Cx MB except for TON! But in book, ISIS supports both oblique and parasagital needle placements with 2-3 burns at one electrode width for effective and sure burn of MB.
Do you stimulate also before burn or just the anatomical landmarks and AP and lat views do the job!

 

[specepic]

no oblique for TON either, just mult parellel sagittal passes.

They were teaching fluoro AP, then tilt caudal (Image intenifier towards the feet) so the grooves in the pillars are crisp. Mark skin overlying lat edge of facet joint immediately below that pillar (at base of that pillar) and drive needle AP, hit os, then walk along pillar getting more and more anterior. They also pointed out that most people do not go anterior enough and advised AP, lat, and foramenal views prior to burn. I do motor stim too.

Prob goes without saying but also necessary to conisider unique MB anatomy of each level rather than just landing mid pillar.

 

[painstop]

Do you have a picture with a needle in place using this approach that you could post?

 

[lovebailey2001]

Thank you Specific for the info! That practically means that ISIS no longer supports the technique given in their book. But I wonder that are their any comparative study of Cx MBRF with obl. & Para-sag pass and Para-sag pass only in terms of duration of relief etc.

I know that some of the ISIS instructers are there on this board, please contribute on this issue!

 

[PinchandBurn]

Thank you Specific for the info! That practically means that ISIS no longer supports the technique given in their book. But I wonder that are their any comparative study of Cx MBRF with obl. & Para-sag pass and Para-sag pass only in terms of duration of relief etc.

I know that some of the ISIS instructers are there on this board, please contribute on this issue!

their silence probably means they've abandonned what's in the book. It's pragmatically way too cumbersome.

 

[bedrock]

I was told the book description of Cervical RF will be updated to what's taught at the courses with the next edition of the ISIS guidelines, but there have been delays writing the new book.

 

[Aether2000]

It is far too cumbersome, painful, and not logical. The book was written when straight needles were being used and in the lumbar section Tew needles (16 ga straight non-injectable) needles were being used. The book is way outdated but after the untimely death of the standards committee director a few years back during the book's revision, the task passed on to others that have not moved nearly as fast. There are no comparative studies of the techniques.

 

[Ligament]

agree with Algos, the key is that straight 16ga RF spears were being used, thus one could not curve around the articular pillar. With the advent of curved tip RF cannulae, this changed and the articular pillar curvature could be approximated in full. Thats my understanding at least.

 

[specepic]

Do you have a picture with a needle in place using this approach that you could post?

I will try to post when I get back to the office next week. I'm sure others here also have pics of this technique as I think it is now the more common method?

 

[lovebailey2001]

But the ISIS book I have, has a comparison of Curved RF needle with Straight RF needle (in the appendix of Cx RF chapter) and it says that with curved RF needle & sag pass you get only 66% of the nerve and with obl & sag pass, you get some 80% of the nerve- resulting in longer term relief!

Well, thankyou all for the inputs!

 

[Aether2000]

The book was made when the only hollow needles available were 20ga. With 18ga needles the burn size is much larger and if one wants to obtain an even larger radius burn, you simply rotate the needle 180 degrees at its final placement point and make another lesion.

 

[nvrsumr]

The book was made when the only hollow needles available were 20ga. With 18ga needles the burn size is much larger and if one wants to obtain an even larger radius burn, you simply rotate the needle 180 degrees at its final placement point and make another lesion.

Algos

I had some unpublished bench work sent to me that showed a 5.5 mm diameter burn with 20g and a 6mm burn with 18g. This was not done in egg white but I believe chicken breast or beef liver. Cant remember. Supposedly the medium the burn is done in makes quite a difference in size and egg white is not very comparable. What numbers do you have for lesion diameter?

 

[PMR 4 MSK]

The book was made when the only hollow needles available were 20ga. With 18ga needles the burn size is much larger and if one wants to obtain an even larger radius burn, you simply rotate the needle 180 degrees at its final placement point and make another lesion.

How does turning a cylindrical object 180 degrees give a larger burn radius?

 

[Pain_doc]

They are referring to RF needles with the curved distal tips.

 

[Aether2000]

Correct...rotating the curve 180 extends the lesion. As for lesion size...I don't have the numbers in front of me but think the 18ga gave around 4.5mm while the 20ga gave around 3mm diameter burns...

 

[PMR 4 MSK]

OK, I can see that, then. We only have an old Radionics Machine built around 1738, and cannot get curved tips any longer, for a at least a couple years.