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Bertolotti Syndrome interventional options?
Started by specepic
Inject at the pseudoarthrosis
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RF that joint
RF the joint and the medial branch L4 and dorsal ramus L5.
When you all say RF the joint how exactly are you doing that?
my question as well
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.
Block the L5-S1 facet and walk laterally into pseudojoint.
I do trigger point and 77003. Not sure if i get paid for 77003.
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.
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
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
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What do you think…?
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 - PMC
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 in ...
www.ncbi.nlm.nih.gov
this is usually an answer given when you don't know.
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 belowView 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.
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 - PMC
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 in ...
"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.
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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.
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.
