12" needle?

[Algiatrist]

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Hi gang,

Spine surgeon requested a disco on a big 'ol gal pushing 400lbs. My longest needle is 9" and buried to the hub I was still 2 inches from the disc at 4-5.

Retried by starting out more medial. No dice. Still about 1 inch from the tip of the disc.

Either I am going to need a 12 inch needle or tell the surgeon to use his clinical judgement (oxymoron?-ha ha, just kidding)

And, for L5-S1, I may need something even longer if I use two needle technique.

Anybody know where I can get a 12" harpoon?

As always, thanks in advance.

 

[bedrock]

Hi gang,

Spine surgeon requested a disco on a big 'ol gal pushing 400lbs. My longest needle is 9" and buried to the hub I was still 2 inches from the disc at 4-5.

Retried by starting out more medial. No dice. Still about 1 inch from the tip of the disc.

Either I am going to need a 12 inch needle or tell the surgeon to use his clinical judgement (oxymoron?-ha ha, just kidding)

And, for L5-S1, I may need something even longer if I use two needle technique.

Anybody know where I can get a 12" harpoon?

As always, thanks in advance.

Just tell the surgeon the disco can't be performed as no needle is long enough to do the procedure.

Even if a 12 in needle exists, I don't want to know about it. You don't want all the radiation from doing a discogram on a 400lb patient, and the surgeon is out of his mind if he thinks its a good idea to fuse a 400lb patient.

Someone needs to man up and level with her that she is too fat for a procedure or for surgery and the best treatment for her pain is to lose 250 lbs.

 

[lobelsteve]

Just tell the surgeon the disco can't be performed as no needle is long enough to do the procedure.

Even if a 12 in needle exists, I don't want to know about it. You don't want all the radiation from doing a discogram on a 400lb patient, and the surgeon is out of his mind if he thinks its a good idea to fuse a 400lb patient.

Someone needs to man up and level with her that she is too fat for a procedure or for surgery and the best treatment for her pain is to lose 250 lbs.

I want to like twice....

 

[Ducttape]

I want to like twice....

i liked it too.. hope that helped.

fyi does this violate the House of God rule?
ie

1. THERE IS NO BODY CAVITY THAT CANNOT BE REACHED WITH A #14G NEEDLE AND A GOOD STRONG ARM.

 

[Tenesma]

Any surgeon even suggesting a disco on a patient who is 400lbs is a fool because it implies that he would fuse a 400lbs patient based on a positive disco (because why else get the disco).

By the way, I measure all of my obese patients' MRIs based on my anticipated needle trajectory so that i know what needle length to use - and if I can even reach the space w/ my longest needle - i have a 7 inch --- that is my longest - where did you get a 9 inch?

 

[Taus]

I had to use a 9" today on an SI joint!! 350+ pounder sp multilevel fusion. Buried needle to hub. Was unreal.

 

[Aether2000]

Try the local metal tubing factory. They can make you a 2' long pipe

 

[Algiatrist]

An update,

We are referring this patient for Bariatric surgery consultation. She does not want spine surgery (smart move) and figures the weight loss will help her even more in the long run (smarter move).

In the meantime, she'll stick to her Butrans, aquatherapy, and venlafaxine.

Thanks for all the responses.

-L

 

[ziggyziggy]

Any surgeon even suggesting a disco on a patient who is 400lbs is a fool because it implies that he would fuse a 400lbs patient based on a positive disco (because why else get the disco).

By the way, I measure all of my obese patients' MRIs based on my anticipated needle trajectory so that i know what needle length to use - and if I can even reach the space w/ my longest needle - i have a 7 inch --- that is my longest - where did you get a 9 inch?

How do you do that?

 

[lobelsteve]

How do you do that?

MRI comes on CD and most every software to view has measurement tools.
Could not do kypho very well without measuring and picking trajectory.

 

[nvrsumr]

could have done trans thecal

 

[Ligament]

I used 12" needles on occasion in Detroit. I don't remember who made them.

 

[emd123]

I used 12" needles on occasion in Detroit. I don't remember who made them.

I did too, but it was not for spine injections. It's was for self defense. Lol

 

[Ligament]

Detroit butts. Thats all i need say

 

[Dr Manhattan]

we had a 5" needle buried to the hub on a 600 lb patient for a lower cervical facet injection (posterior). still wasnt long enough to reach bone so procedure aborted. not sticking a 7" in anyone's neck

 

[lobelsteve]

we had a 5" needle buried to the hub on a 600 lb patient for a lower cervical facet injection (posterior). still wasnt long enough to reach bone so procedure aborted. not sticking a 7" in anyone's neck

Why not? you have imaging at your disposal. Needle size is nothing. But I'd like to know what table you had Orca on to even try.