Simplicity III SIJ RF

[NJPAIN]

I go really pissed at the KC rep over not covering a SInergy case so I just did my first Neurotherm Simplicity III today. No mater what I did I could not get the probe to stay between the ventral and dorsal "lines" of the sacrum. After a centimeter or two tight to the sacrum I would get caught up on bone. I had to turn the probe > 90 degree and it would head up above the posterior line of the sacrum. I wiggled, I walked, nothing worked. In the end I got as close as I could and had a BBQ. Not very satisfied
Any pearls on how to get this to position correctly???

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[lobelsteve]

I go really pissed at the KC rep over not covering a SInergy case so I just did my first Neurotherm Simplicity III today. No mater what I did I could not get the probe to stay between the ventral and dorsal "lines" of the sacrum. After a centimeter or two tight to the sacrum I would get caught up on bone. I had to turn the probe > 90 degree and it would head up above the posterior line of the sacrum. I wiggled, I walked, nothing worked. In the end I got as close as I could and had a BBQ. Not very satisfied
Any pearls on how to get this to position correctly???

It gets easier by the 5th case..... Cadaver practice when possible. Or practice on your KC rep.

 

[Ligament]

the probe entry point is key. too caudal and it will deflect off the convexity of the dorsal sacrum. too cranial and it will not approximate the dorsal sacrum fully. Its tougher than it sounds. What I do now is under lateral view, stick a 5" 22ga needle in to get the right trajectory. Might take a couple tries. This is probably not the best way to do it but working for me lately.

 

[NJPAIN]

I've done three of these now. One took 5 minutes. The other two 40 min to get placement and even then the most proximal contact not on bone. Results seem good. Looking for other tricks. Manufacturer suggests entry 1 cm lateral and inferior to s4. Is that what others are using? Seems when I start that low I get stuck half way

 

[PainandGain]

I haven't used this in my fellowship. My concerns are probe cost and I understand it to be more painful for the patient. Can anyone comment on using this vs. Bipolar carpet burning.

 

[NJPAIN]

I have done every kind of SI joint denervation in my 23 yrs practicing. Stopped bipolar lesioning 15+ yrs ago because it is tedious and didn't work. Only decent results have been water cooled RF and Simplicity

 

[PainandGain]

Thanks. I've done some cooled RF before on the SIJ. I'll have to look into this. I'd imagine putting in a 22G spinal needle and laying down plenty of local as you pull out would enhance patient comfort and plot out your insertion.

 

[BobBarker]

It still hurts the patient pretty bad.

 

[bedrock]

I haven't used this in my fellowship. My concerns are probe cost and I understand it to be more painful for the patient. Can anyone comment on using this vs. Bipolar carpet burning.

I've found simplicity and cooled RF to work about as well but simplicity RF to be more technique driven. Good simplicity RF technique can equal cooled RF results, when done correctly.

Regarding lining it up, ligaments suggestion of using a 22g 5 in trajectory needle is a good idea. Much of the time you need to start more inferior than the simplicity training would suggest as simplicity was developed in Colorado, the skinniest state in the country, and my patients are usually much thicker.

Regarding pain, this is one of the few procedures that always needs sedation , IMHO, because it's hard to numb everything, even with tract needles.

 

[NJPAIN]

I suspect you are correct about starting lower. My patients are thick especially in the rear. I think I am coming down too steep and not hitting bone tangentially. I find that I am getting caught up about halfway to the sacral ala if I make contact with the sacrum at S4. I guess Brad Vilms guys guidance to enter 1cm below and 1 cm lateral to s4 foramen worker for marathoners and shriveled up cadavers

 

[epidural man]

I have never used Simplicity. Do you also do a lesion at ALA and TP of L5?

Also, why not place the probe next to the joint instead of just lateral to the foramen? It seems like placement would be easier.

 

[lobelsteve]

I've found simplicity and cooled RF to work about as well but simplicity RF to be more technique driven. Good simplicity RF technique can equal cooled RF results, when done correctly.

Regarding lining it up, ligaments suggestion of using a 22g 5 in trajectory needle is a good idea. Much of the time you need to start more inferior than the simplicity training would suggest as simplicity was developed in Colorado, the skinniest state in the country, and my patients are usually much thicker.

Regarding pain, this is one of the few procedures that always needs sedation , IMHO, because it's hard to numb everything, even with tract needles.

I have done one patient without sedation for Simplicity. He rode his bicycle 50 miles the next day. He came back a month later for the opposite side. I would not be able to tolerate Simplicity without sedation on myself.

 

[hyperalgesia]

I agree with the sedation. It is a brutal procedure.

 

[drrosenrosen]

I sedate when I've done Simplicity. But at my current spot I've got a Cosman machine, so I haven't used Simplicity in a couple years. Starting lower than you think is a good way to get the right trajectory. And yes, you do burn L5 dorsal ramus as well.