Cervical TFESI needle

[giddyup]

What does everyone use for these - Quincke? Chiba? Length/Gauge?

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[BobBarker]

I have used the skin local hypo and 1.5” or 2.5” 22g spinals. No stylette, hooked up to extension tubing filled with contrast.

 

[Tboned]

25 g 1.5” or 2.5”

 

[nvrsumr]

27g 1 1/2

 

[manowar rules]

25g 2”

 

[knoxdoc]

25g 2.5" Quincke, 3.5" for fluffies

 

[JFS]

27 1.25” hypo (just because it comes with my kit, otherwise I’d prefer 27 1.5)

25G 2.5” Quincke ~20% of the time. 3.5” for fluffies.

Hooked up from the get go to extension tubing prefilled with contrast like Bob

 

[SC Tian]

25 g 2.5 " quincke for all patients, no stylette

 

[SpineandWine]

25 2.5”

 

[SpineandWine]

@Ducttape, what needle do you use for your cervical TFESIs?

 

[paindoc007]

Why do you guys do these ?

 

[kstarm]

I haven't thought about starting with the extension tubing connected. For those that do, do you connect before every type of injection or just this one? Does your assist do this before you get in, or do you connect as part of your prep? I can't really think of any extra risk when starting with the tubing connected...I think Ill give this a try

 

[lobelsteve]

I haven't thought about starting with the extension tubing connected. For those that do, do you connect before every type of injection or just this one? Does your assist do this before you get in, or do you connect as part of your prep? I can't really think of any extra risk when starting with the tubing connected...I think Ill give this a try

What do you mean assist? Do you actually have somebody else glove up during an injection?

 

[Taus]

I haven't thought about starting with the extension tubing connected. For those that do, do you connect before every type of injection or just this one? Does your assist do this before you get in, or do you connect as part of your prep? I can't really think of any extra risk when starting with the tubing connected...I think Ill give this a try

Someone else draws up, leaves a nice air bubble in the tubing and you air embolism the cord or brain?

 

[SpineandWine]

At the ASC for a local hospital, there is a nurse gloved up who hands me my syringes drawn up and labeled

I don’t have that luxury - actually it’s a pain because they’re slower than me add to the SOS blubber

 

[lobelsteve]

Adds risk. No benefit. Never event.

 

[Ducttape]

@Ducttape, what needle do you use for your cervical TFESIs?

i dont do cervical TFESI.

 

[Baron Samedi]

I haven't thought about starting with the extension tubing connected. For those that do, do you connect before every type of injection or just this one? Does your assist do this before you get in, or do you connect as part of your prep? I can't really think of any extra risk when starting with the tubing connected...I think Ill give this a try

I do this for SGBs. The tubing allows me to hold the needle upright when shooting fluoro without getting my hand in the way.

 

[Taus]

I do this for SGBs. The tubing allows me to hold the needle upright when shooting fluoro without getting my hand in the way.

Also, don’t have to futz around with getting the stylet out and attaching the tubing with the needle in the foramen right next to the nerve.

 

[RM38]

Why do you guys do these ?

I do a fair amount of these because I work in a large neurosurgery group that does a lot of minimally invasive foraminotomies. The surgeons want this prior to being willing to commit to surgery. They also will order if they are unsure about an 1 or 2 level ACDF. I only do 1 level and side at a time and review images before. I am not hesitant to abort/cancel or switch order to interlam if visualization is poor, artery is in a bad spot or if patient can’t hold proper position. I will also do this if I think the order is not appropriate, which is usually only the case with a couple of the PAs. Surgeons are typically much more vigilant about ordering the appropriate procedure and many will only order it if it will potentially impact their operative plan. I use 25G 2.5 spinal. Some of my partners use 25 2 inch. My overall volume is probably 2-5 per week and I would say I do more than double the volume of interlams compared to TFESI.

 

[PainMD23]

2.5" spinal; 3.5" on larger patients

 

[bedrock]

I do a fair amount of these because I work in a large neurosurgery group that does a lot of minimally invasive foraminotomies. The surgeons want this prior to being willing to commit to surgery. They also will order if they are unsure about an 1 or 2 level ACDF. I only do 1 level and side at a time and review images before. I am not hesitant to abort/cancel or switch order to interlam if visualization is poor, artery is in a bad spot or if patient can’t hold proper position. I will also do this if I think the order is not appropriate, which is usually only the case with a couple of the PAs. Surgeons are typically much more vigilant about ordering the appropriate procedure and many will only order it if it will potentially impact their operative plan. I use 25G 2.5 spinal. Some of my partners use 25 2 inch. My overall volume is probably 2-5 per week and I would say I do more than double the volume of interlams compared to TFESI.

Do you mean laminoforaminotomies?

It’s very rare these days to see any spine surgeon offer a true foraminotomy.

 

[RM38]

Do you mean laminoforaminotomies?

It’s very rare these days to see any spine surgeon offer a true foraminotomy.

Correct. The majority of the time they are doing both

 

[Centurion38]

Correct. The majority of the time they are doing both

Heavy on the lamino light on the foramino

 

[bedrock]

Heavy on the lamino light on the foramino

Exactly. They are lying through their teeth. They are just doing a laminectomy.