Cervical RFA needle - curved or straight active tip?

[CarabinerSD]

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Currently using 10mm curved tip for cervical but getting a few nasty neuritis cases. A colleague suggested 5mm straight tip to try instead of what I'm using. Do you guys find straight 5mm active tip better for cervical RFA?

 

[Taus]

Currently using 10mm curved tip for cervical but getting a few nasty neuritis cases. A colleague suggested 5mm straight tip to try instead of what I'm using. Do you guys find straight 5mm active tip better for cervical RFA?

The curve has nothing to do with your neuritis rates. I find it much easier to steer and walk off os to lateral pillar w curve.

Neuritis happens.

 

[SSdoc33]

neuritis is good. means your are doing it correctly

 

[bedrock]

Currently using 10mm curved tip for cervical but getting a few nasty neuritis cases. A colleague suggested 5mm straight tip to try instead of what I'm using. Do you guys find straight 5mm active tip better for cervical RFA?

Your colleague is wrong. Doing poor quality RFA isn’t the answer to a few neuritis cases.

Definitely recommend sticking with 10mm curved active tip.

Some may disagree, but I haven’t had a single significant neuritis case since started adding 0.75ml of 0.25% bupivacaine and 10mg depomedrol at each cervical RFA lesion location a couple years ago. I recommend it. No neuritis cases and overall more satisfied patients.

 

[BobBarker]

Yes, I have lots of neuritis. Just part of burning the nerve.

 

[clubdeac]

you guys using 18g or 20g in the neck? I forget what the consensus is

 

[BobBarker]

I use 20g for everything.

 

[bedrock]

you guys using 18g or 20g in the neck? I forget what the consensus is

18G for all levels of spine RFA except very petite necks. 18G provides larger more reliable lesions, and 18G cannulae are easier to direct quickly vs 20G.

I went to 20G in the neck for a while but found I was faster with better long term clinical results using 18G.

 

[Gnarvin]

I am using 20g 10mm curved active tip in the C spine. I tried 18 gauge in the C spine for a while and didn’t see any anecdotal improvement in clinical results. I might give the 18g in the C spine a try again though as in theory the bigger lesion could improve outcomes.

 

[SSdoc33]

I use 20g for everything.

same

bob is playing fast and loose with his c-arm licensing requirements

 

[BobBarker]

lol. That is for the software the MA’s use to move the images into the emr. I told them I would pay for the license but it like a weird pride thing that they keep just resetting their trial period.

 

[MitchLevi]

More than half of my pts get neuritis C3 and lower, and virtually all get it when I lesion the TON. I use dexamethasone 10mg and split it equally at each level, but I do not put steroid at C6 or lower because those levels almost never get neuritis.

LOL at no neuritis.

A 5mm active tip is inferior to the 10mm active tip, and curved vs straight does not really matter, but I do believe curved is probably better bc you can rotate the bevel and create a bigger lesion, and steering is far better of course. Less needle adjustments = happier pts.

I usually do 20g, but I am starting to work in an 18 on occasion. I do believe an 18g at the TON is better, because you're carpet bombing with that thing.

 

[buddababa]

Yes, I have lots of neuritis. Just part of burning the nerve.

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Not sure if you know that you have 11 days left in your trial period.

 

[1 Up]

Your colleague is wrong. Doing poor quality RFA isn’t the answer to a few neuritis cases.

Definitely recommend sticking with 10mm curved active tip.

Some may disagree, but I haven’t had a single significant neuritis case since started adding 0.75ml of 0.25% bupivacaine and 10mg depomedrol at each cervical RFA lesion location a couple years ago. I recommend it. No neuritis cases and overall more satisfied patients.

I still get the occasional neuritis despite adding Dex. This has been studied. Doesn't seem to make a difference. Thinking about no longer adding the steroid.

 

[giddyup]

you guys using 18g or 20g in the neck? I forget what the consensus is

18 lumbar 20 cervical for me. always curved 10 active tip

 

[MD87]

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I still get the occasional neuritis despite adding Dex. This has been studied. Doesn't seem to make a difference. Thinking about no longer adding the steroid.

I have never done it without dex. But I am not impressed by dex’s ability to prevent neuritis in my patients lol

 

[bedrock]

I still get the occasional neuritis despite adding Dex. This has been studied. Doesn't seem to make a difference. Thinking about no longer adding the steroid.

Dex is very weak.

Try adding 10mg of depo with 0.5ml of bupivacaine to each cervical RFA lesion sites for several months and then compare your numbers of patients with neuritis.

 

[BobBarker]

I prescribe 20mg prednisone x 7 days if they have neuritis. Prescribe it less than 30% of the time. So wouldn’t recommend just giving everyone dex.

 

[RoloTomassi]

I do18ga curved 10mm Sidekick 90x90x1 for everything

 

[Painologist]

I do curved 18 ga 10 mm needles for everything as well. Have never had a severe neuritis that required treatment. I don't pre-treat with any steroids either.

 

[CarabinerSD]

Yes, I have lots of neuritis. Just part of burning the nerve.

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That's some really nice picture man. Can you mark where your skin entry typically would be since we know where the end point is but I am curious where you start out at.

Also can patients tolerate an 18g RFA needle in the neck w/o sedation? I only do local anesthetics and use 18g for lumbar but can't imagine driving 18g into neck w/o sedation.

 

[MD87]

That's some really nice picture man. Can you mark where your skin entry typically would be since we know where the end point is but I am curious where you start out at.

Also can patients tolerate an 18g RFA needle in the neck w/o sedation? I only do local anesthetics and use 18g for lumbar but can't imagine driving 18g into neck w/o sedation.

Yes. First, 1% skin wheel. Then place 25g 3.5 inch needle down to target. Then inject 0.5-1cc of 1% on bone. Then withdraw needle slowly while injecting more 1% along the way. Patient feels nothing.

 

[BobBarker]

I start a little over one level back.

 

[mygalperin]

Currently using 10mm curved tip for cervical but getting a few nasty neuritis cases. A colleague suggested 5mm straight tip to try instead of what I'm using. Do you guys find straight 5mm active tip better for cervical RFA?

5mm cannulas exist for cervical RFs, do not create something that has not been recommended, meaning use 10 mm. And you will have lesser problems, smart people before you already did it

 

[mygalperin]

Yes, I have lots of neuritis. Just part of burning the nerve.

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Not a bad placement, except for c3, a bit high, should be more close to the middle

 

[Taus]

Not a bad placement, except for c3, a bit high, should be more close to the middle

Incorrect. Why do you think middle is target at c3?

 

[lobelsteve]

Incorrect. Why do you think middle is target at c3?

Newbie on here. Has lots of opinions. Few posts. Might need an Introduce yourself/bio thread. Training varies. Dogma predominates.

 

[BobBarker]

He did. He even put it in the correct forum.