Cervical RFA - active tip 5mm or 10mm?

[CarabinerSD]

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I've been using 5mm curved active tip for my RFA needles for years since that's how we were trained in fellowship. Wondering if others are using 10mm curved active tip with better / longer results or is it too much burning area which could worsen neuritis?

 

[Taus]

10. Plenty of room from posterior pillar to anterior for the 10mm to sit and burn maximum length of nerve.

 

[RoloTomassi]

Have always used 10. I don't think there's any evidence that longer = more neuritis

 

[BobBarker]

I get a lot of neuritis. It’s just part of the procedure and the expected outcome with a well placed lesion.

 

[DOctorJay]

Always 10. Just warn patients ahead of time and they do fine. If they can’t tolerate call in some gaba/lyrica.

 

[bedrock]

Always [emoji[emoji6][emoji6]]. Just warn patients ahead of time and they do fine. If they can’t tolerate call in some gaba/lyrica.

Agree that warning ahead of time is important for cervical RFA.

 

[clubdeac]

Have always used 10mm curved tip

 

[bedrock]

10mm is standard of care. Use those.

 

[CarabinerSD]

Thanks guys will swap over 10mm for better burn.

 

[thecentral09]

10 cm, 18g, 2 lesions. Steroid at end. Almost no post procedure neuritis since adding kenalog

 

[Taus]

10 cm, 18g, 2 lesions. Steroid at end. Almost no post procedure neuritis since adding kenalog

I do that on lumbar… some concern about aberrant vessels in c spine, Dex only for me

 

[bedrock]

I do that on lumbar… some concern about aberrant vessels in c spine, Dex only for me

Personally, I don't find steroids at end of RFA procedure to be that necessary for lumbar cases. I do find them useful for patients to tolerate the first week after a cervical or thoracic RFA. I always add depo/kenalog and bup to lesion area after T and C spine RFA if not diabetic.

I don't think the aberrant vessels are still a risk right after an ablation. For cervical/thoracic RFA, I withdraw 5mm, so the needle tip is in the middle of lesion, before I inject the depo/kenalog + bup. Any aberrant vessel in that zone would have been destroyed by the ablation that just happened.

 

[Snowmen96]

I do that on lumbar… some concern about aberrant vessels in c spine, Dex only for me

I can understand that preoccupation for TFESI or an I-A injection, but for an RFA, if there was aberrant vascular anatomy, that artery has just been thoroughly destroyed anyway IMO.

 

[DoYouEvenLiftBro]

Any worry with adding particulate, and size of particulate in cervical spine? I’ve heard of two, non reported, cord strokes from mbb with steroid no contrast in cervical spine..

 

[bedrock]

Any worry with adding particulate, and size of particulate in cervical spine? I’ve heard of two, non reported, cord strokes from mbb with steroid no contrast in cervical spine..

See post #12

 

[Snowmen96]

Any worry with adding particulate, and size of particulate in cervical spine? I’ve heard of two, non reported, cord strokes from mbb with steroid no contrast in cervical spine..

As mentioned, post #12 gives an excellent explanation.

It's also hard to understand why someone would use a corticosteroid, let alone a particulate one (in the cervical spine, no less) in a MBB when multiple studies demonstrate that there is no clear benefit to adding corticosteroids to a nerve block.