I need cervical medial branch block and radiofrequency ablation pearls

[MitchLevi]

Just do a free needle. That's what I do.

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[callmeanesthesia]

Just do a free needle. That's what I do.

Document medical necessity of the third level in your procedure note (e.g. patient has extensive degenerative changes by imaging and pain that correlates with the referral pattern of >2 joints, as well as tenderness to palpation of those joints. Patient is not likely to get adequate relief from 2 levels, necessitating additional procedures or denying access to RF (or got inadequate relief from 2 level MBB). Therefore, 3 level facet procedure is medically necessary for this patient.)
Your billers will have to keep track and appeal when denied, but you can get them paid. I don’t use it regularly - mainly for degenerative lumbar scoliosis patients. Sometimes for the 3 level unilateral cervical RF.

 

[SSdoc33]

Once on call, I had the worst canker of all cankers - at the base of the tongue at the corner of the floor of my mouth, so every motion hurt. It was MISARABLE. It was so bad, that I injected myself (lido with epi) and the relief was the most beautiful experience I've ever had in my life. I would have taken that over an orgasm with Catherine Zeta-Jones right after she filmed the scene with her sliding under the lasers in the movie Entrapement (holy crap..if you haven't seen it...I suggest watch). Anyway, it lasted 5 MINUTES!!! I was pissed.

So I tried bupivicaine with epi. That lasted a whopping 40 minutes.

It was extremely difficult to inject myself by the way.

weird reference, but im pretty sure that was a body double

 

[geauxg8rs]

Once on call, I had the worst canker of all cankers - at the base of the tongue at the corner of the floor of my mouth, so every motion hurt. It was MISARABLE. It was so bad, that I injected myself (lido with epi) and the relief was the most beautiful experience I've ever had in my life. I would have taken that over an orgasm with Catherine Zeta-Jones right after she filmed the scene with her sliding under the lasers in the movie Entrapement (holy crap..if you haven't seen it...I suggest watch). Anyway, it lasted 5 MINUTES!!! I was pissed.

So I tried bupivicaine with epi. That lasted a whopping 40 minutes.

It was extremely difficult to inject myself by the way.

+1 for laser scene

 

[MitchLevi]

+1 for laser scene

Desperado scene IMO

 

[oreosandsake]

Something I learned from Paul Dreyfuss.

I learned to palpate each specific facet joint level, both posteriorly and laterally. I can distinguish C4-C5 from C5-C6 and C3-C4 from C4-C5, C2-C3 from C3-C4, etc.

Very useful skill to further clarify pain generators when imaging and/or or pain referral patterns don't give you the answer.

The lateral joint line palpation is also more accurate in many patients who have overlapping myofascial pain, and they can give more concrete answers during your exam.

you can also do positive provocation under ultrasound. I can usually poke at 3 facet joints from one entry point c3-4, 4-5, 5-6 with a 25G 1.5 needle under US. injecting the capsule with a little hypertonic dextrose (very inflammatory) will also help you nail the diagnosis and treat at the same time. can bill 76942 and 20550 x3 . not sure what you actully get paid for

 

[oreosandsake]

Q for motor testing in TON, C3, 4, etc

what are you guys looking for?

also, what do you make of someone who says they feel the motor sensation down to the wrist when you are testing at C4 or even 5 and the cannula tips on a true lateral are not close to the foramen?

lady recently had this. sensation, not true motor twitch. i kept pulling back until i wasn't even on the articular pillar anymore before she said it went away. I think it was referred

 

[lobelsteve]

Q for motor testing in TON, C3, 4, etc

what are you guys looking for?

also, what do you make of someone who says they feel the motor sensation down to the wrist when you are testing at C4 or even 5 and the cannula tips on a true lateral are not close to the foramen?

lady recently had this. sensation, not true motor twitch. i kept pulling back until i wasn't even on the articular pillar anymore before she said it went away. I think it was referred

C4 prefixed plexus in 10%, worth motor testing. No twitch, who cares. Burn away.
C3/TON- no motor testing. T-spine, no motor testing.

 

[deleted875186]

C4 prefixed plexus in 10%, worth motor testing. No twitch, who cares. Burn away.
C3/TON- no motor testing. T-spine, no motor testing.

What do you mean C4 prefixed plexus?

 

[lobelsteve]

What do you mean C4 prefixed plexus?

Brachial plexus is C5-T1.
Except when it is not:

Abstract: Prefixed and Postfixed Brachial Plexus: Is It Clinically Relevant? (2014 AAP National Conference and Exhibition)

 

[SSdoc33]

Desperado scene IMO

NOT a body double in that scene

 

[bedrock]

NOT a body double in that scene

You guys are confusing Catherine zeta Jones with Salma Hayek.

Jones did entrapment and Hayek did desperado.

Antonio banderas starred with Jones in zorro and Hayek in desperado, which is likely how you all got confused.

 

[SSdoc33]

You guys are confusing Catherine zeta Jones with Salma Hayek.

Jones did entrapment and Hayek did desperado.

Antonio banderas starred with Jones in zorro and Hayek in desperado, which is likely how you all got confused.

cant speak for mitch, but im aware they are different actresses and different movies

 

[lobelsteve]

Valeria Golino in Hot Shots.

 

[MitchLevi]

You guys are confusing Catherine zeta Jones with Salma Hayek.

Jones did entrapment and Hayek did desperado.

Antonio banderas starred with Jones in zorro and Hayek in desperado, which is likely how you all got confused.

Desperado and From Dusk Til Dawn.

Grace Kelly in Rear Window.

 

[MitchLevi]

Did yall know 27% of ppl have two C4 medial branch nerves, 15% have two C5 MBN and 2% have two C6 MBN?

 

[SC Tian]

How often and how you do C7 mb rf, by sis guideline? Thanks.

 

[MD87]

For patients with adjacent level disease, which MBBs do you do? For example, let’s say someone has c4-5 fusion and develops C3-4 facet arthropathy, would you just block c3 or would you block c3 and c4? I typically do both but not sure if it makes sense.

 

[Taus]

For patients with adjacent level disease, which MBBs do you do? For example, let’s say someone has c4-5 fusion and develops C3-4 facet arthropathy, would you just block c3 or would you block c3 and c4? I typically do both but not sure if it makes sense.

Depends if anterior or posterior fusion. ACDF (or TDR)? Both. Posterior? generally just the one without a pedicle screw. Same with lumbar.

 

[MD87]

Depends if anterior or posterior fusion. ACDF (or TDR)? Both. Posterior? generally just the one without a pedicle screw. Same with lumbar.

Sorry. Should have said this. Was thinking of patients with ACDF.

 

[MD87]

Sorry. Should have said this. Was thinking of patients with ACDF.

Thanks!

 

[RoloTomassi]

Sorry. Should have said this. Was thinking of patients with ACDF.

Both MBs

 

[callmeanesthesia]

Sorry. Should have said this. Was thinking of patients with ACDF.

Definitely both.