Ablation one side works this other doesnt

[schmee90]

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Curious, what are people’s thoughts on patients who have ablation procedures in the spine? One side works great the other side no relief.

Do you think these are from technical issues from bad placement. I’ve had a few of these patients one side worked great the other with no benefit needle placement look the same and fine to me on both sides.

I know obviously not all patients have good results to ablations especially if you’re only doing one mbb however, however Curious if others have had similar situations and their thoughts.

 

[BobBarker]

This is a clear indication for medial branch PNS.








😂

 

[SSdoc33]

yeah, it happens. probably just worse disease on one side vs. the other, i doubt its technical. do an SIJ on the bad side and give it some time.

 

[Taus]

I’d query patient again on mbb response and original pain. I’d bet this side that didn’t respond was the worst side chronically and response to mbb was marginal on that side… ie overall it ain’t facet pain

 

[clubdeac]

Obviously no one on here can tell you without seeing pictures

 

[MitchLevi]

Many reasons to have back pain, facets are but one.

 

[Kissmyabjj]

Have had this happen twice. Very annoying.

 

[SpineandWine]

Maybe osteophyte blocking needle on one side compared to other.
I’d retry on side that didn’t work in 6 months

 

[Agast]

Try some trigger point injections on that side

 

[Orin]

Curious, what are people’s thoughts on patients who have ablation procedures in the spine? One side works great the other side no relief.

Do you think these are from technical issues from bad placement. I’ve had a few of these patients one side worked great the other with no benefit needle placement look the same and fine to me on both sides.

I know obviously not all patients have good results to ablations especially if you’re only doing one mbb however, however Curious if others have had similar situations and their thoughts.

I see quite a few patients with bilateral axial pain where one side is clearly myofascial while the other is facet loading driven, but in some scenarios, the bad side is more an anatomic issue where maybe you think about internally cooled electrodes or endoscopic neurectomy.

 

[SSdoc33]

I see quite a few patients with bilateral axial pain where one side is clearly myofascial while the other is facet loading driven, but in some scenarios, the bad side is more an anatomic issue where maybe you think about internally cooled electrodes or endoscopic neurectomy.

how is back pain "clearly myofascial" when the other side is facet?

 

[Orin]

how is back pain "clearly myofascial" when the other side is facet?

For example: A patient complains of pain in their back
Loading the facet joints on the right causes pain on the left side, but no worsening and perhaps some improvement of the right sided pain.
Loading the facet joints on the left causes pain on both sides but more on the left

The left side is then consistent with facetogenic pain while the right side is more myofascial pain

 

[clubdeac]

For example: A patient complains of pain in their back
Loading the facet joints on the right causes pain on the left side, but no worsening and perhaps some improvement of the right sided pain.
Loading the facet joints on the left causes pain on both sides but more on the left

The left side is then consistent with facetogenic pain while the right side is more myofascial pain

Are you using Helbig or Revels criteria?