cerv facet postioning tips

[specepic]

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Any Pearls for keeping a pt still during lat recumbent for cerv facets/MBB? I prefer this position vs. prone (still use prone for RFA) but find the pts move without realizing it and I have to constantly adjust the fluoro.

What are folks out there doing for pillows/device or other methods to deal with this?

I am very picky about maintaining a true lateral ima to help avoid aiming at the facet/pillar on the other side and ending up in tiger country.

 

[101N]

Prone in an Oakworks frame. If they still move put a bouffant on them and tape it down.

 

[pmrmd]

I tell them to not move so they don't get extra radiation exposure to their brain. This usually scares them into a rigor-type state.

 

[specepic]

Prone in an Oakworks frame. If they still move put a bouffant on them and tape it down.

Even for MBB and upper facet inj's? (prone that is)

 

[101N]

Even for MBB and upper facet inj's? (prone that is)

Yes, prone. ISIS technique recommends side-lying but I don't like that, too much patient and C-arm movement for my tastes. I do all cervical MBB, CRFA, TON, and C1/2 intra-articular prone. I do not perform intra-articular facet - C1/2 isn't a facet- injections in the C-spine.

 

[NOSfan]

i tell them to not move so they don't get extra radiation exposure to their brain. This usually scares them into a rigor-type state.

lol

 

[DOctorJay]

I've seen people rotate the c spine slightly away from the side to be injected while prone to get the jaw out of the fluoro. Worked great for FJI but not sure if it would affect proper placement of RF probes.

 

[Aether2000]

Duct tape

 

[PinchandBurn]

dont do it with patient lateral. Accidental aiming at the contralateral pillar, and you are done.

 

[101N]

How many here are still doing IA cervical facets? This is where paralax is a problem in lateral view.

 

[PMR 4 MSK]

How many here are still doing IA cervical facets? This is where paralax is a problem in lateral view.

I do, but don't use lateral, just AP and obliques

 

[SSdoc33]

How many here are still doing IA cervical facets? This is where paralax is a problem in lateral view.

maybe once or twice a year. young patient, s/p MVA or specific surgeon request. but agreed, very rare.

 

[specepic]

How many here are still doing IA cervical facets? This is where paralax is a problem in lateral view.

I do a lot both lumbar and cerv.; if they wear off quickly, but they get convincing relief for several weeks or a month or 2, I will count as one of the medial branch blocks. In many cases, especially in the cervical spine, it lasts for many months or year or 2.

 

[lovebailey2001]

Yes, prone. ISIS technique recommends side-lying but I don't like that, too much patient and C-arm movement for my tastes. I do all cervical MBB, CRFA, TON, and C1/2 intra-articular prone. I do not perform intra-articular facet - C1/2 isn't a facet- injections in the C-spine.

Dont u feel problem in good visualization of upper MBBs in prone position in lateral view! I know for lower ones you can use swimmer's, lowering down of shoulders etc. Just curius..

 

[101N]

Dont u feel problem in good visualization of upper MBBs in prone position in lateral view! I know for lower ones you can use swimmer's, lowering down of shoulders etc. Just curius..

Well, no. For the lowers it sometimes requires shoulder distraction but I've had good luck with lateral and an Oakworks.