Cervical MBB

[deleted875186]

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I typically do cervical MBBs lateral, and usually only do one side.

Do other folks do bilateral cervical MBBs? How do you position patients, do it prone with a posterior approach, prone and still come in lateral?

 

[afob100]

I do lateral mbb bilateral. I just flip them after the first side.

 

[callmeanesthesia]

From posterior to anterior. Not as precise but easier to do bilateral, much easier to get a good fluoro view especially for the lower facets, and lower risk if you stick it too far in.

 

[Taus]

I do lateral mbb bilateral. I just flip them after the first side.

In general I prefer lateral recumbent positioning. . However, it’s it bilateral and they’re super old and/or difficult to get on the table and positioned, I’ll just do prone posterior approach. Also, for the rate c mbb who gets sedation, if bilateral will do prone so don’t have to flip and re position a sedated patient.

 

[NJPAIN]

In general I prefer lateral recumbent positioning. . However, it’s it bilateral and they’re super old and/or difficult to get on the table and positioned, I’ll just do prone posterior approach. Also, for the rate c mbb who gets sedation, if bilateral will do prone so don’t have to flip and re position a sedated patient.

I do lateral approach unilateral. Modified swimmers based on that brilliant author at ROTHMAN institute who’s name escapes me. I never sedate any longer because then they flop around as they doze off and I lose my view. I only use posterior for c7-T1. 2” 25 gauge needle. Anything in the neck I use the shortest needle I can get away with. I do hold my breath a bit at c6 and c7 if needle goes deep and I haven’t landed on bone. Quick to get cross table AP when that happens.

 

[Dr. Ice]

Jeremy Simon, Furman fellow..

 

[RoloTomassi]

Prone, posterior, bilateral

 

[fathead88]

Prone, posterior, bilateral unless super old.

 

[IAmTheOne1]

MBB: Prone, posterior, bilateral.
RFA: Lateral position, one side per visit.

 

[bedrock]

I do all cervical procedures on a prone patient. Bilateral MBB are done posteriorly on lower levels C5-C7, and I do bilateral lateral MBB for upper levels TON-C4.
(C5 can go either way depending on whether it is part of a lower or upper cervical MBB)
Cervical RFA is always done prone with posterior approach. SIS technique

 

[Taus]

Jeremy Simon, Furman fellow..

I think it’s the balding guy in the articles pictures

 

[Dr. Ice]

Oh right that guy..although Simon is the head of the department there isn’t he? Oh Rothman..your jersey docs are really not much of a competition for me

 

[deleted875186]

I do all cervical procedures on a prone patient. Bilateral MBB are done posteriorly on lower levels C5-C7, and I do bilateral lateral MBB for upper levels TON-C4.
(C5 can go either way depending on whether it is part of a lower or upper cervical MBB)
Cervical RFA is always done prone with posterior approach. SIS technique

This is what I was thinking, have a bilateral upper cervical MBB I booked, going to try prone with lateral approach on each side.

 

[deleted875186]

Does anyone do cervical facets or just MBB/RFA?

 

[Taus]

Oh right that guy..although Simon is the head of the department there isn’t he? Oh Rothman..your jersey docs are really not much of a competition for me

Yes.

 

[bedrock]

Does anyone do cervical facets or just MBB/RFA?

I do for younger patients, particularly post trauma as one IA facet injection works as well as MBB X 2 and RFA X 2 for young patients. Most get sustained relief, and if they don't then these young patients are now more mentally prepared for RFA at this point.

I also start with IA facets in patients that have psych issues, because if they come up with a list of BS side affects after IA facets then you can just cut them off from procedures and never do RFA/ESI after that. Much easier to deal with such imagined complaints after IA facets compared to someone convinced that their "nerve burning" caused damage to other nerves, or the epidural injection "damaged their spinal cord/nerves", BS.

 

[Orin]

Prone, lateral approach for MBBs
Prone, posterolateral approach for RFAs, regardless of unilateral or bilateral

Will do lateral or supine depending on patient factors, but prefer prone as less head movement

 

[painfree23]

I do for younger patients, particularly post trauma as one IA facet injection works as well as MBB X 2 and RFA X 2 for young patients. Most get sustained relief, and if they don't then these young patients are now more mentally prepared for RFA at this point.

I also start with IA facets in patients that have psych issues, because if they come up with a list of BS side affects after IA facets then you can just cut them off from procedures and never do RFA/ESI after that. Much easier to deal with such imagined complaints after IA facets compared to someone convinced that their "nerve burning" caused damage to other nerves, or the epidural injection "damaged their spinal cord/nerves", BS.

What do u mean trauma? What do u see on the facets that tell you to inject that particular joint?

 

[Pain_doc]

supine if visualization adequate, prone otherwise

 

[bedrock]

What do u mean trauma? What do u see on the facets that tell you to inject that particular joint?

MVA most commonly. But a major falls also can do this to you. Or rodeo accidents out here in the West, Lol.

which joint is based on a careful physical exam as MRI/X-rays rarely localize facet levels in a young patient.

 

[DODOCSS]

I do for younger patients, particularly post trauma as one IA facet injection works as well as MBB X 2 and RFA X 2 for young patients. Most get sustained relief, and if they don't then these young patients are now more mentally prepared for RFA at this point.

I also start with IA facets in patients that have psych issues, because if they come up with a list of BS side affects after IA facets then you can just cut them off from procedures and never do RFA/ESI after that. Much easier to deal with such imagined complaints after IA facets compared to someone convinced that their "nerve burning" caused damage to other nerves, or the epidural injection "damaged their spinal cord/nerves", BS.

Does anyone do cervical facets or just MBB/RFA?

MVA always

 

[strike5858]

This is what I was thinking, have a bilateral upper cervical MBB I booked, going to try prone with lateral approach on each side.

Can you guys describe the technique for lateral and posteriolateral approach for upper cervical facet joints with prone positioning?

I can visualize how to go about this, what are important considerations and pitfalls.

I do all my Cmbbs prone at this time but bilateral takes me very long and there is definitely room for improvement of my technique when doing this procedure.

 

[mohandess]

I do TON in lateral decubitus. For all other levels prone with cephlad tilt on fluoro.