Did Anyone Attend ASPN in Vegas this Week?

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drusso

drusso

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How was it? I'm hearing very positive things and possibly some new game-changing things coming out in 2022.
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It was good overall.

Cadaver lab and lecture series was well attended with exposure to a ton of different procedures both in the neuromodulation and minimally invasive spine space. Nice to be able to see what all is out there.

Saturday was the research data day and a lot of companies presented their 12,24,36 month data. Saluda, SIJ fusion, Reactiv8, Intracept being a few.

I think ASPN is well on its way to eclipse NANS because it’s branching out to beyond just neuromodulation. Of course just as with NANS there will always be questions about conflicts of interest (of which there are A LOT) but i think the conversations that are had at ASPN still hold value.
 
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I think he meant are we still blue suits and pointy toes shoes or is there fashion updates on the KOL cabal?

We all know about the vertebrogenic pain pandemic, the need for pain surgeons to do mini-fusions using similar equipment that did not work for the Neurosurgeons 20 years ago, that stenosis is treated by removing flavum (and dura if facets are too big), as well as PNS is the new SCS.
 
lobelsteve said:
I think he meant are we still blue suits and pointy toes shoes or is there fashion updates on the KOL cabal?

We all know about the vertebrogenic pain pandemic, the need for pain surgeons to do mini-fusions using similar equipment that did not work for the Neurosurgeons 20 years ago, that stenosis is treated by removing flavum (and dura if facets are too big), as well as PNS is the new SCS.
Click to expand...
Lol I love you
 
Reactiv8 is new to me. It’s PNS at bilateral L2 medial branch? For multifidus muscle? Don’t like the sound of it to be honest.
 
gaspasser786 said:
It was good overall.

Cadaver lab and lecture series was well attended with exposure to a ton of different procedures both in the neuromodulation and minimally invasive spine space. Nice to be able to see what all is out there.

Saturday was the research data day and a lot of companies presented their 12,24,36 month data. Saluda, SIJ fusion, Reactiv8, Intracept being a few.

I think ASPN is well on its way to eclipse NANS because it’s branching out to beyond just neuromodulation. Of course just as with NANS there will always be questions about conflicts of interest (of which there are A LOT) but i think the conversations that are had at ASPN still hold value.
Click to expand...
Anything else that you think was interesting?

I share Steve and agast concerns re pseudo fusions and multifidi stim. Never been a fan of SIJ fusion.

Am interested in intracept clinically but financially it doesn’t make sense unless HOPD, and I’m ASC/office based.
 
Agast said:
Reactiv8 is new to me. It’s PNS at bilateral L2 medial branch? For multifidus muscle? Don’t like the sound of it to be honest.
Click to expand...
Seems like PT for those who won’t do good PT. We were a trial site in fellowship. Procedure was easier than SCS, but they used a clunky old SCS, non-MRI compatible. Hopefully they’ve upgraded that? I kinda like the idea of it if we could do it using the more compact PNS systems with an external battery. Seems like multifidus strengthening might be helpful for the discogenic (excuse me, vertebrogenic) pain patients.
 
callmeanesthesia said:
Seems like PT for those who won’t do good PT. We were a trial site in fellowship. Procedure was easier than SCS, but they used a clunky old SCS, non-MRI compatible. Hopefully they’ve upgraded that? I kinda like the idea of it if we could do it using the more compact PNS systems with an external battery. Seems like multifidus strengthening might be helpful for the discogenic (excuse me, vertebrogenic) pain patients.
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Has stimulating a single medial branch been shown to strengthen core muscles? I seem to remember infomercials for a device that gave you abs.
 
I don't understand doing Reactiv8 instead of RFA, which seems to be what most are doing. Facet pain usually worse with extension, so activate the extensors?

As far as for discogenic, most of my discogenic pts are younger, active, well developed multifidi already.
 
RoloTomassi said:
I don't understand doing Reactiv8 instead of RFA, which seems to be what most are doing. Facet pain usually worse with extension, so activate the extensors?

As far as for discogenic, most of my discogenic pts are younger, active, well developed multifidi already.
Click to expand...
I just figured it was the typical follow the $ answer.
 
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lobelsteve said:
I think he meant are we still blue suits and pointy toes shoes or is there fashion updates on the KOL cabal?

We all know about the vertebrogenic pain pandemic, the need for pain surgeons to do mini-fusions using similar equipment that did not work for the Neurosurgeons 20 years ago, that stenosis is treated by removing flavum (and dura if facets are too big), as well as PNS is the new SCS.
Click to expand...

A lot of KOL's and pain surgeons disagree with these statements. They have strongly held convictions that we are facing a tidal wave of Modic-related back pain and an epidemic of cluneal neuralgia. A well-prepared interventionally-trained physician workforce will be essential to stem the tide of causalgia, disability, and chronic pain.
 
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Different docs have different philosophies for treating pain. The risks associated with some interventional procedures (minuteman, MILD, SIJ fusion, Reactiv8) are lower compared to surgery and there is data supporting their efficacy. Snatching a true surgical candidate from a spine surgeon and instead offering them these procedures isn’t the right way to go about it in my mind but in patients who aren’t candidates for surgery and have exhausted all other conservative therapies, why not offer them something else? Are we really doing right by them by offering repeat epidurals (that CMS is now cracking down on), PT, sedating meds with a high NNT, etc?
 
gaspasser786 said:
Different docs have different philosophies for treating pain. The risks associated with some interventional procedures (minuteman, MILD, SIJ fusion, Reactiv8) are lower compared to surgery and there is data supporting their efficacy. Snatching a true surgical candidate from a spine surgeon and instead offering them these procedures isn’t the right way to go about it in my mind but in patients who aren’t candidates for surgery and have exhausted all other conservative therapies, why not offer them something else? Are we really doing right by them by offering repeat epidurals (that CMS is now cracking down on), PT, sedating meds with a high NNT, etc?
Click to expand...
When we review the literature critically, it melts.

Also:

Black scrubs and Nike. Its 22, sport up or shut up as a KOL.

 
lobelsteve said:
When we review the literature critically, it melts.

Also:

Black scrubs and Nike. Its 22, sport up or shut up as a KOL.

Click to expand...
lobelsteve said:
When we review the literature critically, it melts.

Also:

Black scrubs and Nike. Its 22, sport up or shut up as a KOL.

Click to expand...

Looks like boomer is jealous he can’t sport anything other than an extra large jersey or flannel from Woolworth
 
🍿🍿🍿 👀

I’m sure Steve looks very nice in flannel. The 90s is making a comeback.
 
2020-02-21 13.46.22.jpg


Don't make me inflate your balloon.

And I don't own a flannel. But can check LL Bean.
 
I'm just waiting for the day we all cosplay as Dr. Pointy Shoes at the same conference and try to convince that special someone to take group photos with us.
 
Seems like the combo is:

Black scrubs, nike, ****-eating grin

Or

Blue suit, pointy ass shoes, ****-eating grin
 
Shoot, I'm goina have to go shopping before NANS...
 
Sooshi said:
I'm just waiting for the day we all cosplay as Dr. Pointy Shoes at the same conference and try to convince that special someone to take group photos with us.
Click to expand...
Whos that special someone? Dr. Timothy Deer?
 
Still interested in the conference stuff. Anything else interesting come up? Anyone come away with a new conviction to try new thing X or new thing Y?
For all the maligning of Kols, they are quite convincing salesmen.
 
I wish the reactiv8 thing would check out. Do you guys look at the paraspinals on the MRI? Its always starts to atrophy around the L3/4 and gets worse the lower you go.
Especially worse in those with repeated RFA that also innevitably ablate the nerves innervating all three paraspinals muscle groups (multiple EMG studies published showing denervation) it just leads to more and more weakness.
 
myrandom2003 said:
I wish the reactiv8 thing would check out. Do you guys look at the paraspinals on the MRI? Its always starts to atrophy around the L3/4 and gets worse the lower you go.
Especially worse in those with repeated RFA that also innevitably ablate the nerves innervating all three paraspinals muscle groups (multiple EMG studies published showing denervation) it just leads to more and more weakness.
Click to expand...
Several studies actually show no discernable segmental atrophy of the multifidus at long-term follow-up. The question is, is this clinically relevant.

www.researchgate.net

The Significance of Multifidus Atrophy After Successful Radiofrequency Neurotomy for Low Back Pain | Request PDF

Request PDF | The Significance of Multifidus Atrophy After Successful Radiofrequency Neurotomy for Low Back Pain | To determine the presence of lumbar multifidus atrophy and pain after successful lumbar medial branch radiofrequency neurotomy for zygapophysial... | Find, read and cite all the...
www.researchgate.net www.researchgate.net

Among patients with lumbar pain originating from facets in the setting of degenerative spondylolisthesis who underwent lumbar RFA, the observed advancement of spondylolisthesis is clinically similar to the estimated maximum baseline of 2% per year change. The study findings did not find a destabilizing effect of lumbar RFA in advancing spondylolisthesis in this patient population.

Lumbar Spondylolisthesis Progression: What is the Effect of Lumbar Medial Branch Nerve Radiofrequency Ablation on Lumbar Spondylolisthesis Progression? A Single-Center, Observational Study
 
soccrwz said:
Several studies actually show no discernable segmental atrophy of the multifidus at long-term follow-up. The question is, is this clinically relevant.

www.researchgate.net

The Significance of Multifidus Atrophy After Successful Radiofrequency Neurotomy for Low Back Pain | Request PDF

Request PDF | The Significance of Multifidus Atrophy After Successful Radiofrequency Neurotomy for Low Back Pain | To determine the presence of lumbar multifidus atrophy and pain after successful lumbar medial branch radiofrequency neurotomy for zygapophysial... | Find, read and cite all the...
www.researchgate.net www.researchgate.net

Among patients with lumbar pain originating from facets in the setting of degenerative spondylolisthesis who underwent lumbar RFA, the observed advancement of spondylolisthesis is clinically similar to the estimated maximum baseline of 2% per year change. The study findings did not find a destabilizing effect of lumbar RFA in advancing spondylolisthesis in this patient population.

Lumbar Spondylolisthesis Progression: What is the Effect of Lumbar Medial Branch Nerve Radiofrequency Ablation on Lumbar Spondylolisthesis Progression? A Single-Center, Observational Study
Click to expand...

I didn’t read the spondy study. But the other one, The study quoted has 5 patients with a single unilateral rfa session and reimaged at 17-26 months (well beyond the typical 12 months of re-innervation) and none of those 5 patients needed repeat rfa.
Could not see any other demographics of the patients. Not my usual patient population.

Our patient population is more likely already having pain and muscle weakness and 1-2 rfa a year ongoing. Would like to see that study.

Let me find those emg studies showing collateral muscle denervation after Rfa. It was from the pmr guys at university of Colorado.


If the muscles are insignificant, why bother with PT and core strengthening then other than to appease insurance?
 
Agast said:
Reactiv8 is new to me. It’s PNS at bilateral L2 medial branch? For multifidus muscle? Don’t like the sound of it to be honest.
Click to expand...

As a “restorative” treatment in the right patient (predominant axial LBP, atrophy, etc)
it actually makes some sense to me. Not the same treatment and not the same MOA as MB PNS ala SPRINT. Also, their business model up until now has been way different than SPRINT. Sprint has been “ try it for everything”. SPR is trying to build their book of business and skimp on support to make their numbers look good for acquisition by a larger company. Mainstay (Reactiv8) has acquisition in the long term rather than short term plan. I think they tried to stay away from the KOL BS but I think they have realized that it’s tough to build business in pain medicine based on outcomes alone. In this generation of pain doc it’s ALL about using what the cool kids (KOLs) are using. It could be total ineffective trash but if the cool kids are flashing it on FB/LinkedIn…gotta have it. Just like my fifth grader LOL.
 
myrandom2003 said:
I didn’t read the spondy study. But the other one, The study quoted has 5 patients with a single unilateral rfa session and reimaged at 17-26 months (well beyond the typical 12 months of re-innervation) and none of those 5 patients needed repeat rfa.
Could not see any other demographics of the patients. Not my usual patient population.

Our patient population is more likely already having pain and muscle weakness and 1-2 rfa a year ongoing. Would like to see that study.

Let me find those emg studies showing collateral muscle denervation after Rfa. It was from the pmr guys at university of Colorado.


If the muscles are insignificant, why bother with PT and core strengthening then other than to appease insurance?
Click to expand...
That first study is from Dreyfuss and april btw, the god fathers of RFA. Also from PM&R Journal.

In a larger case series of 27 patients, MRI was done prior to and following lumbar RFA to assess the bulk of the multifidus, and for evidence of disc and facet joint degeneration § No change in muscle mass or degeneration of the facet joints was observed, though a greater amount of disc degeneration was noted compared with unaffected levels (14.9% versus 4.6%). Wilke et al. Spine 1995 Smuck et al. Spine J 2015 Stegemöller et al. Spine J 2015

What is defined as core strengthening, which has been debated. Do you find PT helps the majority of your lower back pain patients? Part of it is tincture of time, so is it PT or you waited 6 weeks? LBP is vague part of the reason they removed it, and also making it difficult to study. Retraining the muscles for loading is part of it like proper lifting technique.

Are people jumping to this after PT and before RFA? Who covers this?
 
NJPAIN said:
As a “restorative” treatment in the right patient (predominant axial LBP, atrophy, etc)
it actually makes some sense to me. Not the same treatment and not the same MOA as MB PNS ala SPRINT. Also, their business model up until now has been way different than SPRINT. Sprint has been “ try it for everything”. SPR is trying to build their book of business and skimp on support to make their numbers look good for acquisition by a larger company. Mainstay (Reactiv8) has acquisition in the long term rather than short term plan. I think they tried to stay away from the KOL BS but I think they have realized that it’s tough to build business in pain medicine based on outcomes alone. In this generation of pain doc it’s ALL about using what the cool kids (KOLs) are using. It could be total ineffective trash but if the cool kids are flashing it on FB/LinkedIn…gotta have it. Just like my fifth grader LOL.
Click to expand...
What bugs me is if stimulating the multifidus muscles is that impactful, the best result would likely be using more than 1 lead bilateral. But the path of least resistance is going with the two leads that you know will be approved by insurance. Which means we are just accepting a lesser procedure/lesser outcome out of convenience, and that’s not innovation.
 
lobelsteve said:
I think he meant are we still blue suits and pointy toes shoes or is there fashion updates on the KOL cabal?

We all know about the vertebrogenic pain pandemic, the need for pain surgeons to do mini-fusions using similar equipment that did not work for the Neurosurgeons 20 years ago, that stenosis is treated by removing flavum (and dura if facets are too big), as well as PNS is the new SCS.
Click to expand...
I just had a discussion with the CEO and training folks of MinuteMan procedure. We will see how it goes.
 
I've done one patient with a SPRINT SPR into the multifidus (bilateral).

I am going to do 10 or so patients to see how it goes. If it works well, I might try Reactiv8.
 
epidural man said:
I've done one patient with a SPRINT SPR into the multifidus (bilateral).

I am going to do 10 or so patients to see how it goes. If it works well, I might try Reactiv8.
Click to expand...
Aren’t they quite different stimulation paradigms? Or is SPRINT able to do motor stimulation (in a sophisticated enough manner that it isn’t torture)?
 
callmeanesthesia said:
Aren’t they quite different stimulation paradigms? Or is SPRINT able to do motor stimulation (in a sophisticated enough manner that it isn’t torture)?
Click to expand...
I think the reactiv8 people say they are different. It’s current through a wire - how different can it be. The question is what wave patterns each use. I have no idea about that.

Anyone else know?
 
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