Cervical Epidurals

[sevoflurane]

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Any one doing them? And I mean those who have not had a pain fellowship. With or without fluoro?

 

[Intubate]

I do probably 3 or 4 cervical interlaminar epidural steroid injections a week. With fluoro. No fluoro equals malpractice.

 

[IN2B8R]

Yes, using fluoroscopy.

 

[Sergio99]

Not only fluoro, but fluoro and contrast.

Unless the patient is allergic to iodine contrast, it is highly desirable to be able to prove that where you injected the steroid is where it was supposed to go. You will be surprised to see how many times you think you are in the right space and you are not. Anybody can stick a needle blindly anywhere and claim that it was an epidural steroid injection, but a nice epidurogram with every steroid injection tells the patient and the referring doctor that you are not a quack. And if the patient is allergic to iodine, still take a plain picture to show at least that the tip of the needle was in a good position, even though you will not be able to prove that the injection went where you wanted it to go.


Greetings

 

[Jeff05]

it's gonna be hard to justify complications (which will occur) if you are not really trained to perform the procedure.

 

[sweetalkr]

my 2 cents. i am in my 3rd month of fellowship. having worked with racz and day who do a lot of legal consultation and hearing what they say, i would not do it without a fellowship.
insurance companies over the next 2-3 years will not reimburse any pain procedures without fellowship
additionally, the cervical epidural space is very tight, and unless you have reviewed the MRI to see if the pressure caused by injecting more fluid into an already tight space (assuming a disc protrusion/bulge), and unless you realize that you could leave them with a permanent deficit if something goes wrong and you will be left to hang in court, i would not do it. i am sure the 300$ you make on that cervical can be made much more safely somewhere else.

again, just my 2 cents. no disrespect. it isn't rocket science, and interlaminar steroid injections are a joke anyways and transforaminals have MUCH better results, but the risk/monetary benefit is not in your favor.

 

[Intubate]

it's gonna be hard to justify complications (which will occur) if you are not really trained to perform the procedure.

I was trained. In residency. This procedure is a chip shot. A very careful chip shot. And as to the next comment about not getting reimbursed without fellowship training-- thats crap. Most interventional pain procedures in this country are done by people without fellowships. That would leave a lot of people hurting.

 

[sevoflurane]

Agree with fluoro and contrast. 50% false positives with LOR w/o contrast.

Wasn't sure if people were doing them like this:


[YOUTUBE]http://www.youtube.com/watch?v=bW4KEunLfuU[/YOUTUBE]

Anyone using LOR anymore? The incidence of pneumocephalus is higher.

Hanging drop is pretty darn reliable in the cervical region.

 

[sevoflurane]

We get $500 a pop (negotiated with the hospital).

We mop up all the stuff our pain specialist doesn't take (due to insurance reasons).

 

[doctor712]

At Clev. Clinic Florida, only Anesthesiologists are allowed to do Cervical Epidurals. That is, when I observed Pain Service for a week a year ago, they had one (Pain Fellowed) Anesthesiologist, and one ("Interventional Spine Technique" and Pain fellowed) Physiatrist who did all Pain cases.

The Spine Fellowed Physiatrist, was not ALLOWED to do cervical epidurals. Even though he did an Interventional Spinal and Pain Fellowship. Insurance issues with CCFL wouldn't permit it.

He wasn't very happy about that, that he was trained to do them through fellowship, but had to pass them off to partner because of Anesthesia rules at CCFL. I mean, that's what he trained for and did "thousands" of cervicals but couldn't do that as part of his current practice.

Just tossing this out there for discussion, seems highly dependent on Institution. Anesthesiologist did backs all day long, and used LOR (air) with at varying squirts of contrast - and always fluoro - for anything and everything (epidurals) I ever saw him do.

D712

 

[IlDestriero]

When I was a resident I did 20 or 30 with the hanging drop technique. We did transforaminal with fluoro and contrast. I would never do them now.
2nd calling BS re not getting reimbursed for pain procedures without fellowship training. Insurance companies/m'caid are not in the business of determining who is qualified to do certain specific procedures.