Cervical RFA settings

[thecentral09]

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Hey guys, just wanted to pick everyone’s brain on the specific settings are used for cervical RFA, I have been doing 18 gauge needles, 80°C for 105 seconds. Two lesions, usually with a needle turn 90° between lesions. Obviously motor test before hand. My outcomes have been very good long-term, however have been having a significant amount of post procedural pain for 4 to 6 weeks, likely post procedural neuritis. I’m thinking about changing to only one lesion, and wanted to hear what everyone else is doing. I started adding dex at the end, But hasn’t seem to help my post procedural pain

 

[soccrwz]

20G, 60 seconds then 60 seconds and turn; no dex; occasional post up pain, but less with smaller needles; follow up 4 weeks after; one side at a time; I use 18g in the lumbar

 

[Ferrismonk]

20G, 10mm curved tip, one lesion, 80C for 60s. No steroid. Outcomes good.

 

[SommeRiver]

20g, 80 degrees, 90 sec, dex if they don't have a PMH and whether or not my glucose is normal.

 

[jsaul]

you are probably getting much longer lasting results with the 18g needle but the trade off in neuritis

I use 18 gauge 10mm active curved tip. do multiple burns at 80 for 90 sec
yes i get some post op neuritis but then they get 1-2 years of relief or longer

 

[Ligament]

Currently at 80 deg fro 60sec x 2 burns at each level at least. Did 90 deg for 60sec for a while, seemed to have worse neuritis issues.

In the lumbar spine use 85 deg for 60sec x 2 burns at each level at least.

 

[Ducttape]

20 gauge, 80 degrees for120 seconds x2 for cervical.

I'm not specifically studying it, but no anecdotal complaints of neuritis.

 

[SommeRiver]

20 gauge, 80 degrees for120 seconds x2 for cervical.

I'm not specifically studying it, but no anecdotal complaints of neuritis.

You do 4 min?

 

[lobelsteve]

@Ducttape started the fire.......

 

[DrSpine]

Old thread that I'm bringing up. I noticed when I did 90 seconds single burn at 80 degrees Celsius, higher # of post-ablation neuritis. Doing 60 seconds now only, and no instances of it so far. Even did TON with 60 seconds; which often would have a far higher incidence of neuritis.

 

[jsaul]

Old thread that I'm bringing up. I noticed when I did 90 seconds single burn at 80 degrees Celsius, higher # of post-ablation neuritis. Doing 60 seconds now only, and no instances of it so far. Even did TON with 60 seconds; which often would have a far higher incidence of neuritis.

What size needle you using

 

[callmeanesthesia]

18g curved. 80 deg, 90 sec x2, turn 180 in between. No steroid - they’re already getting enough in other areas. The higher in the c spine, the more neuritis I see. Probably 30% at C2-3. I just warn people beforehand to expect it. If it’s really bad I give them some gabapentin or tramadol.

 

[painfree23]

Surprised to see so many not use steroid. I’m scared of neuritis so use it everytime. Maybe I should stop.

 

[callmeanesthesia]

Surprised to see so many not use steroid. I’m scared of neuritis so use it everytime. Maybe I should stop.

The Impact of Local Steroid Administration on the Incidence of Neuritis following Lumbar Facet Radiofrequency Neurotomy - PubMed

Radiofrequency neurotomy, radiofrequency ablation, neuritis, corticosteroid, lumbar facet pain, post neurotomy neuritis.

pubmed.ncbi.nlm.nih.gov

I didn’t notice any change in frequency after I stopped.

 

[bedrock]

Surprised to see so many not use steroid. I’m scared of neuritis so use it everytime. Maybe I should stop.

I wouldn’t bother other than for TON.

 

[Multimodal]

Surprised to see so many not use steroid. I’m scared of neuritis so use it everytime. Maybe I should stop.

I have been using steroid too after my RFAs because I have personally seen it cut down on the incidence of neuritis significantly. I read an article in 2018 about how there was no difference in incidence of neuritis with steroid after RFA so I stopped using it and had many calls that drove me nuts. since using 5mg/3 level RFA again, I maybe get 1-2/month and its usually mild. perhaps less than 5 /year that are severe enough to warrant some gaba/lyrica and /or tramadol as others have said and usually those help.

 

[lobelsteve]

I have been using steroid too after my RFAs because I have personally seen it cut down on the incidence of neuritis significantly. I read an article in 2018 about how there was no difference in incidence of neuritis with steroid after RFA so I stopped using it and had many calls that drove me nuts. since using 5mg/3 level RFA again, I maybe get 1-2/month and its usually mild. perhaps less than 5 /year that are severe enough to warrant some gaba/lyrica and /or tramadol as others have said and usually those help.

Do you think you saw increase in neuritis or do you have documentation. Reason we do studies is because only one great/awful outcome is more likely to change our practice as compared to reading an article that says the opposite. Bias is too strong when it is our own patients and practice.

 

[SSdoc33]

no steroids w/RF for me

 

[jsaul]

i use 18 gauge 10mm active curved tip for the cervicals. I have not used any steroids in over 3 years. get TON neuritis every now and then that goes away in a few weeks . Patients are told to expect this.

 

[SommeRiver]

I've had a bad...4ish months with neuritis. Anecdotes being worthless, bc of COVID-19 vaccines I've had to hold dex. It FEELS like it's happening a lot.

 

[MD87]

I have been doing 80 degrees for 150 seconds with 20g venom needles in the cervical spine, only 1 burn. Same thing for lumbar but 18g. Have not had any neuritis in lumbar, have had it in cervical spine.

150 seconds is based on my assumption that we taste like chicken: https://www.painphysicianjournal.com/current/pdf?article=NDYyMA==&journal=107

 

[Ligament]

Surprised to see so many not use steroid. I’m scared of neuritis so use it everytime. Maybe I should stop.

I stopped about 8 years ago and saw no significant negative impact on neuritis.