Bertolotti Syndrome interventional options?

[specepic]

Bertolotti Syndrome interventional options?

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[Baron Samedi]

Sacroiliac joint injection

 

[TIVAndy]

Inject at the pseudoarthrosis

 

[paindoc007]

RF that joint

 

[Ducttape]

RF the joint and the medial branch L4 and dorsal ramus L5.

 

[RoloTomassi]

When you all say RF the joint how exactly are you doing that?

 

[specepic]

When you all say RF the joint how exactly are you doing that?

my question as well

 

[schmee90]

Inject at the pseudoarthrosis

I have seen an attending do this in residency...was wondering how do you bill as a joint injection with fluoro?

 

[RoloTomassi]

I have seen an attending do this in residency...was wondering how do you bill as a joint injection with fluoro?

Inject it and SIJ, bill the SIJ.

 

[cowboydoc]

I have seen an attending do this in residency...was wondering how do you bill as a joint injection with fluoro?

Block the L5-S1 facet and walk laterally into pseudojoint.

 

[TIVAndy]

I have seen an attending do this in residency...was wondering how do you bill as a joint injection with fluoro?

I do trigger point and 77003. Not sure if i get paid for 77003.

 

[Ducttape]

RF the L4 median branch, the L5 dorsal ramus.

look at the pseudoarticulation itself. the couple of cases i did, i put a 3rd needle at the superior aspect of the pseudoarticulation (which admittedly is probably is coming from L4 median branch).

i billed for the single level RFA.

 

[Taus]

RF the L4 median branch, the L5 dorsal ramus.

look at the pseudoarticulation itself. the couple of cases i did, i put a 3rd needle at the superior aspect of the pseudoarticulation (which admittedly is probably is coming from L4 median branch).

i billed for the single level RFA.

I have done same and then essentially a bipolar lesion for what looks most like a normal S1 lateral branch target directly below the transitional segment.

Documented and billed as 2 level facets

Results have been mixed, unpredictable, but small n

Most typically the pseudo articulation is a red herring in my experience

 

[BloodySurgeon]

RF the L4 median branch, the L5 dorsal ramus.

look at the pseudoarticulation itself. the couple of cases i did, i put a 3rd needle at the superior aspect of the pseudoarticulation (which admittedly is probably is coming from L4 median branch).

i billed for the single level RFA.

This above. I’ve had really good success for both steroid injections and RFAs.

 

[TIVAndy]

This above. I’ve had really good success for both steroid injections and RFAs.

why are we putting a RF needle at the pseudoarticulation and what's the rationale for L4 and L5 MB/dorsal ramus

 

[paindoc007]

why are we putting a RF needle at the pseudoarticulation and what's the rationale for L4 and L5 MB/dorsal ramus

What do you think…?

 

[Orin]

Radiofrequency sensory ablation as a treatment for symptomatic unilateral lumbosacral junction pseudarticulation (Bertolotti's syndrome): a case report - PubMed

This case report describes a novel radiofrequency technique for treating symptomatic lumbosacral junction pseudarticulation that warrants further evaluation.

pubmed.ncbi.nlm.nih.gov

Case report of it.

Recent review without much better to suggest

A Comprehensive Update of the Treatment and Management of Bertolotti’s Syndrome: A Best Practices Review

Bertolotti’s Syndrome is defined as chronic back pain caused by transitional lumbosacral vertebra. The transitional vertebra may present with numerous clinical manifestations leading to a myriad of associated pain types. The most common is pain ...

www.ncbi.nlm.nih.gov

 

[TIVAndy]

What do you think…?

this is usually an answer given when you don't know.

 

[TIVAndy]

View attachment 381015

Radiofrequency sensory ablation as a treatment for symptomatic unilateral lumbosacral junction pseudarticulation (Bertolotti's syndrome): a case report - PubMed

This case report describes a novel radiofrequency technique for treating symptomatic lumbosacral junction pseudarticulation that warrants further evaluation.

pubmed.ncbi.nlm.nih.gov

Case report of it.

Recent review without much better to suggest

A Comprehensive Update of the Treatment and Management of Bertolotti’s Syndrome: A Best Practices Review

Bertolotti’s Syndrome is defined as chronic back pain caused by transitional lumbosacral vertebra. The transitional vertebra may present with numerous clinical manifestations leading to a myriad of associated pain types. The most common is pain ...

www.ncbi.nlm.nih.gov

thank you for the articles. I was trying to come up with a rationale for ablating around the pseudoarticulation. there's not much explanation in the case report except below

"This case suggests that: lumbosacral junction pseudarticulation can contribute to low back pain syndromes; thepseudarticulation may be posteriorly innervated; RFsensory ablation may be a successful minimally invasivepain management option in refractory cases; and furtherinvestigation of this technique is warranted."

it was more of a speculative attempt. maybe we are ablating the terminal nerve endings.

 

[Ducttape]

i ablate the area around the pseudoarticulation with the thought that ablating those small branches would reduce pain transmission.

i dont have time to find the post, but i remember a forum member posting about ablating up and down a lumbar facet joint (sounded like a field block) as way to treat facet arthropathy.