Does this actually happen?

Started by mille125
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RoloTomassi said:
I'm with @SpineandWine
Axial back pain without disc/endplate changes and not presenting like SIJ gets MBB. Regardless of age or facet appearance. Moderate yield. Even some where I was sure it would be disc/endplate and just doing a facet rule out comes back positive. RFA or PRP. Same algorithm with C and T.
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No, man. Theres no algorithm. Why are you PRPing these folks?

Mbbs and RFs are for facet OA. Your results will be really crappy if you expand your ‘algorithm’

My suspicion is that you will have ‘moderate’ yield with your mbbs and poor results with your RFs. Classic case of pts tricking themselves into thinking it works. They will come back at 3 months and say ‘RF worked in the beginning but now I feel like I did before the shot’
 
SSdoc33 said:
No, man. Theres no algorithm. Why are you PRPing these folks?

Mbbs and RFs are for facet OA. Your results will be really crappy if you expand your ‘algorithm’

My suspicion is that you will have ‘moderate’ yield with your mbbs and poor results with your RFs. Classic case of pts tricking themselves into thinking it works. They will come back at 3 months and say ‘RF worked in the beginning but now I feel like I did before the shot’
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Incidence and risk factors are one thing. History and physical exam is where it’s at.
He’s mentioning he’s ruled out everything but history and physical is pointing to classic facet disease without MRI evidence in otherwise patient you wouldn’t expect (younger). Tried everything else
 
SpineandWine said:
Incidence and risk factors are one thing. History and physical exam is where it’s at.
He’s mentioning he’s ruled out everything but history and physical is pointing to classic facet disease without MRI evidence in otherwise patient you wouldn’t expect (younger). Tried everything else
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Exam is crap for lbp. Mbb simply bc it hurts in extension is a very very soft indication in a 35 y/o. Again, it’s not egregious….. but it just won’t really work and shouldn’t be how you think about treating these folks
 
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SpineandWine said:
I follow LCDs. Question I’m asking is if MRI is normal but clinically seems arthritis in younger patient without centralized pain
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If MRI and xray are normal, I don't do MBB.

But I am comfortable with xray and exam/history showing findings and proceeding without MRI.

It will be interesting to see how MRI ordering patterns change after ASM goes into effect.
 
mille125 said:
If MRI and xray are normal, I don't do MBB.

But I am comfortable with xray and exam/history showing findings and proceeding without MRI.

It will be interesting to see how MRI ordering patterns change after ASM goes into effect.
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Intetesting
Why is that? MRI may under report facet findings. Spect is best but no one gets those


I get MRI on everyone and now because of AI, they are denying injections in red white blue Medicare if MRI is less than 1 year old.

That being said, it’s not uncommon for MRI to be negative in positive facet disease state
While not super common, it can happen and I think worth while to offer MBBs esp if they have had other modalities


I would not offer ESI for radicular pain when MRI is clean (because MRI is essential) for correlation of symptoms
 
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SSdoc33 said:
Exam is crap for lbp. Mbb simply bc it hurts in extension is a very very soft indication in a 35 y/o. Again, it’s not egregious….. but it just won’t really work and shouldn’t be how you think about treating these folks
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Obviously it’s not my go to and it doesn’t occur a lot in my practice (maybe 1 or 2 in a year) but I would offer if they fail all other modalities

Here’s another question for you- how often are you doing L4-L5Dr RFA vs L3-4-5Dr and how are you making that determination?
Before rule change, were you doing L2-5Dr on most patients?
Are you using imaging to pick out levels or palpating under X-ray clinically
 
SpineandWine said:
Obviously it’s not my go to and it doesn’t occur a lot in my practice (maybe 1 or 2 in a year) but I would offer if they fail all other modalities

Here’s another question for you- how often are you doing L4-L5Dr RFA vs L3-4-5Dr and how are you making that determination?
Before rule change, were you doing L2-5Dr on most patients?
Are you using imaging to pick out levels or palpating under X-ray clinically
Click to expand...
mostly L3MB, L4MB and L5 DR. i try to confirm on physical exam and imaging. if there is hardware i go avoe or below or if there is active facet inflammation say at L3-4 facet on MRI I go L2, L3, and L4. rarely do i do just 2 needles
 
SpineandWine said:
Intetesting
Why is that? MRI may under report facet findings. Spect is best but no one gets those


I get MRI on everyone and now because of AI, they are denying injections in red white blue Medicare if MRI is less than 1 year old.

That being said, it’s not uncommon for MRI to be negative in positive facet disease state
While not super common, it can happen and I think worth while to offer MBBs esp if they have had other modalities


I would not offer ESI for radicular pain when MRI is clean (because MRI is essential) for correlation of symptoms
Click to expand...
For what it's worth, in this particular patient the MBB offered zero relief.
 
SpineandWine said:
Most people who have low back pain don’t need two level facet ablations.
If you palpate under X-ray, it’s tylicallly just the L5-S1 joint
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The L4-5 joint is consistently the worse looking joint on imaging and the majority of instability and listhesis occurs at this level. I believe studies have shown this level to be more commonly implicated
 
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I think it’s like 50/50-ish. You may be right on this point (about L4-5 being more implicated) but I doubt both joints need ablations in everyone whether you’re using MRI or palpation.
I truly believe palpation is better way
 
SSdoc33 said:
palpation means almost nothing

‘Only the needle knows’ -nik
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Go to any of SIS labs and talk to the docs.
Most will tell you same
I’m just pointing out that if your goal is to avoid excess procedures, not all require two facet ablations
MRI is not everything. I wasn’t practicing at this time but presumably you were doing 3 level facet ablations based on — (unsure…) before this rule change prior to 2020

I’ve successfully taken care of low back pain with just 1 level ablation plenty of times
 
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Does Lumbar Medial Branch Radiofrequency Neurotomy Cause Multifidus Atrophy?

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RoloTomassi said:
I'm with @SpineandWine
Axial back pain without disc/endplate changes and not presenting like SIJ gets MBB. Regardless of age or facet appearance. Moderate yield. Even some where I was sure it would be disc/endplate and just doing a facet rule out comes back positive. RFA or PRP. Same algorithm with C and T.
Click to expand...
What do you do for endplate changes?
 
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