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Only when it hurts.We never really treated tarlov cysts in fellowship. Do you think it’s a pain source ?
But really. No.
Only when it hurts.We never really treated tarlov cysts in fellowship. Do you think it’s a pain source ?
We never really treated tarlov cysts in fellowship. Do you think it’s a pain source ?
Never a reason to do a caudal.
Why not S1? S2?
We never really treated tarlov cysts in fellowship. Do you think it’s a pain source ?
I do caudals under ultrasound for OB patients
That is not pain.
Pregnant ladies can get lumbar radiculopathy as well?
This was briefly touched on previously, but I have a question regarding TFESI in fusion patients. The question isn’t regarding efficacy, which is certainly an important issue, but rather getting the needle in the right spot. I’ve done a lot of these, and the contrast usually isn’t perfect, but after checking a few views I’m usually confident it’s epidural. Today, I had a patient with L4-S1 lami/fusion with moderate canal stenosis at L3/4, no significant L4/5 NFS. All left-sided pain, sent for left L4 TFESI. I tried from 2 different starting points and both times failed (second time more inferolateral, though my first attempt was already somewhat inferolateral to the target). I kept hitting what I think was fusion mass, not a screw - couldn’t get medial enough. I couldn’t push through the fusion mass (22g needle). I wasn’t even close.
My question is - is it sometimes literally just impossible to do these in patients with fusions? Any way to determine this prior to attempting the injection other than getting a CT? Certain things to look for on an XR?
Absolute nonsense.Never inject a foramen with more than moderate stenosis. True in fellowship, true still.
Absolute nonsense.
The stenosis is the nidus of pain. That is exactly where you should go
So it is not just political stupidity on your part?
Radiographic finding is not clinical symptoms. Pain from sensory nerve to cord to brain.
Whether from mechanical etiology: bone, ligament, disc. Or from chemical etiology from tear in disc. Medicine in the epidural space travels 1 down and 3 up. Putting a needle where no extra space exists might be why lots of doc’s patients have painful injections and why people spear roots.
No thanks.
Absolute nonsense.
The stenosis is the nidus of pain. That is exactly where you should go
Where r u getting this 1 down 3 up deal?
Furman.
The whole idea why TFESI works better is because you put the medication closest to the area of pathology. Severe right L5S1 NF stenosis get a right L5 TFESI. Yes, you will feel paresthesias but you will get the bedt chance of pain relief with me. Or, you could go to lobel and he will inject your foot and hope some medication gets to the stenosis
This is medicine, not politics. Be a big boy and stick to the subject
S1 will definitely get there, but why not L5? Bc there 'might' be pain or paresthesia? L5 will work better. Has to. There is no research on this, just annecdotes. Try going right at the problem and i bet you will see better outcomes. The shot will be marginally more painful and the outcome marginally betterYou can S1 and drown that L5 nerve with no pain...Same outcome.
There is a great video from SIS made by Tim Maus from the Department of Radiology at Mayo on the topic of "Planning Lumbar TFESI-based on Imaging" that addresses this issue. Very enlightening.
I'll go to the stenosed level too, slowly and stay a bit lateral or posterior or if TF approach blocked then lateral IL at that level.The whole idea why TFESI works better is because you put the medication closest to the area of pathology. Severe right L5S1 NF stenosis get a right L5 TFESI. Yes, you will feel paresthesias but you will get the bedt chance of pain relief with me.
I would love to hear advice on how to avoid getting pressure parathesias from TFESI with a tight neuroforamen. I know some people say they do these routinely and the patient never feels a thing, but I just don’t see how this is physically possible. Even when I inject REALLY slowly. I can always get through the procedure, but that dermatomal discomfort is common. The only thing I have found helpful when the foramen shows nothing but nerve root, is that retrodiscal is better tolerated than subpedicular. Otherwise, I am one of those people who will go to an adjacent level.
But there are plenty of docs with more experience than me, so I would love to learn your tricks...
How do I find this Maus video you speak of, internet?
Especially when combined with threading a catheter through the needle to the level of L5/S1, this injection works well.I just do caudals in those L5-S1 fusion patients. I discovered they were just as happy with the results and it saved me so much time and grief.
Click attached pics. Couple S1 TFs I've done recently.Anyone able to post pics of their needle entry point(s) for L5 and S1 TFESIs? I have been getting poor epidural spread lately and need to look at my technique again.
My average pt in the military is like 30 years old.Awesome flow.
Where do you find these good looking spines?
Do you get involved in all the disability determinations, or is that another department?My average pt in the military is like 30 years old.
Trust me, it's not any better. It's probably the biggest motivator for me leaving the military. They have unrealistic expectations, poor procedural tolerance, and lots of secondary gain issues.can we trade?
please???????
Thankfully no. Every now and then I get asked for my "expert opinion" to which I almost universally respond "pt's pain is unlikely to improve while they remain in the military."Do you get involved in all the disability determinations, or is that another department?