-
CycleTrack and SDN are teaming up to make medical school admissions more transparent and accessible! Read the announcement to learn how we’re supporting the future of CycleTrack’s free application-tracking tools .
Get help with your application
Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.
I do lateral mbb bilateral. I just flip them after the first side.
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.
Advertisement - Members don't see this ad
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.
Prone, posterior, bilateral
MBB: Prone, posterior, bilateral.
RFA: Lateral position, one side per visit.
RFA: Lateral position, one side per visit.
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
(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
I think it’s the balding guy in the articles pictures
D
deleted875186
This is what I was thinking, have a bilateral upper cervical MBB I booked, going to try prone with lateral approach on each side.
D
deleted875186
Does anyone do cervical facets or just MBB/RFA?
Yes.
Advertisement - Members don't see this ad
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?
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.
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.
I do TON in lateral decubitus. For all other levels prone with cephlad tilt on fluoro.
