CLO for cervcal RFA?

[callmeanesthesia]

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The modified swimmers view appears to have the patient in the lateral position with the arm raised slightly to improve the view. How would this improve visualization in a prone cervical rf?

I have tried it for RF with the patient prone - one arm up around the head, one arm down by side. There was a little better visualization but it was awkward and uncomfortable for the patient to stay that way for that long, and confused the nurse positioning the patient - I haven’t made it a routine part of my practice.

 

[Baron Samedi]

For those of you using the lateral view, how do you see the lower levels (ex: C6, C7). Do you just have someone tug the shoulder down?

Usually I just tell the patient to try and reach down to their toes and that is enough to get the shoulder out of the way. Sometimes things like centralizing and columating or coning in on those levels can help improve the image quality, too.

 

[jwalker12]

I use it every case. This should help.

https://ipmreportsjournal.com/current/pdf?article=MjAy&journal=10

for improving mbb w lateral view.

https://www.painphysicianjournal.com/current/pdf?article=NTIxMg%3D%3D&journal=111

The first link for rfa in CLO is not working. Do you have another link? thanks!

 

[SommeRiver]

...been awhile.

Did anyone watch this video? I do posterior and lateral cervical RF. Residency was all lateral, fellowship all posterior. Depends on my mood on any given day, and if you're massive I go lateral of course.

That video is a zhit RFA. Those needles look way anterior to me, plus it looks like his angle is off...That video was put on YouTube too...Dang. Lesion was 60 degrees?

 

[Vie221]

Not to hijack this thread but any tips for getting the jaw out of the way for prone cervical RF? I use a oakworks positioner with the neck flexed for upper cervical but have a really hard time positioning and getting a good pillar view on the lower joints without having the patient turn his/her head.

Do you guys keep the neck more extended when doing the lower facets?

 

[SommeRiver]

You can tilt to the head and enter the skin one level inferiorly.

 

[lobelsteve]

Not to hijack this thread but any tips for getting the jaw out of the way for prone cervical RF? I use a oakworks positioner with the neck flexed for upper cervical but have a really hard time positioning and getting a good pillar view on the lower joints without having the patient turn his/her head.

Do you guys keep the neck more extended when doing the lower facets?

Rotate the head 10 degrees or so when prone. If I am going for right RFA, I will turn their head to the left. Then I rotate a little CLO until the jaw and dental work is clear of the pillar. I use a posterior approach.

 

[Ligament]

...been awhile.

Did anyone watch this video? I do posterior and lateral cervical RF. Residency was all lateral, fellowship all posterior. Depends on my mood on any given day, and if you're massive I go lateral of course.

That video is a zhit RFA. Those needles look way anterior to me, plus it looks like his angle is off...That video was put on YouTube too...Dang. Lesion was 60 degrees?

Patients appears to be on side not prone, and the needle angle entry must therefore be extremely acute...HOWEVER, it "looks" decent on lateral, in as much as is needed for medlegal defence and billing. My take home is this is the fastest way to get a lateral image that looks acceptable. I would have loved to see an AP image and better image of the patient position to see what kind of lateral to medial needle trajectory was used. I'm guessing 50 degrees on this one.

EDIT: patient is indeed on side, and needle angle entry is around 45 degrees lateral to medial. He is using Stryker venom needles (I believe), which should compensate for lack of active tip contact with nerve, but still going to be ablating nerve wth needle tips only in this trajectory.

 

[cowboydoc]

Patients appears to be on side not prone, and the needle angle entry must therefore be extremely acute...HOWEVER, it "looks" decent on lateral, in as much as is needed for medlegal defence and billing. My take home is this is the fastest way to get a lateral image that looks acceptable. I would have loved to see an AP image and better image of the patient position to see what kind of lateral to medial needle trajectory was used. I'm guessing 50 degrees on this one.

EDIT: patient is indeed on side, and needle angle entry is around 45 degrees lateral to medial. He is using Stryker venom needles (I believe), which should compensate for lack of active tip contact with nerve, but still going to be ablating nerve wth needle tips only in this trajectory.

Looks like standard Stryker probes; I don’t see venom deployment, and the venom leads are white, standard are black, IIRC. Not impressed either way.

 

[Ligament]

Looks like standard Stryker probes; I don’t see venom deployment, and the venom leads are white, standard are black, IIRC. Not impressed either way.

Thanks for correcting me; I meant venom cannulae to be specific, and thought the venoms had the full black line across the hub? I'm not expert at the venom stuff however.