Endoscopic rfa
Started by Dr. Ice
Wasn't this the silly stuff Laser Spine was doing
Compare it to conventional with the analogy.
RFA: Driving from Phila to NYC.
Endoscopic RFA: Driving from Phila to NYC, but go through Detroit and dig a tunnel from Detroit to NYC.
RFA: Driving from Phila to NYC.
Endoscopic RFA: Driving from Phila to NYC, but go through Detroit and dig a tunnel from Detroit to NYC.
D
deleted993114
No- I had to review their cases for Blue Cross. They use percutaneous dilators (like the legit matrix system), but that is where the conventional medicine stops. They do a modification of a minimally invasive foramenotomy, then the laser treatments begin.
Every case I reviewed had exactly the same treatment, regardless of symptoms or radiographic pathology. In addition, they would do two epidural steroid injections (during their three day treatment stay) that used doses of steroid about 5X what you would normally use. It was very eye opening to see what they were actually doing.
It is not surprising they went belly up- it was a racket.
We were foolish enough many years ago to do some "spinal endoscopy". It was like reading a book with the pages about an inch from your face and was a complete waste of time and money. Given that, I look for pain docs to soon revive that procedure and start charging cash only for that treatment.
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deleted993114
I'm taking a wild guess, but the first option is the right one, correct?
PS- As you are an instructor as the SIS courses, what are the current suggestions for stimulation prior to lesioning? I know that at one point they suggested that stim (either motor or sensory) was not really advised anymore. Is that still true? I still do sensory in the neck, but don't stim anymore in the back. I still stim for sphenopalantines and other ganglions as well.
Have things changed?
The course I attended about a year ago SIS didn’t advocate any sensory/motor stim only proper radiological placement of needles in the AP, oblique, lateral views. When I discussed with the various instructors one did nothing, one did stim/motor, everyone else just motor. I still do motor for safety. I used to do stim and motor but haven’t noticed any difference in results
I believe algosdoc did such procedures or was at least trained this...not sure but he might want to opine. He has a lot of great experience to share.
Totally unnecessary procedure IMHO. I personally would not allow this to be an approved procedure for a pain physician in my ASC.
No role for sensory stim. Motor stim is a safety feature proving your interpretation of the fluoro is correct and that you are not in the vicinity of the root
I am not a sis course teacher.
I am not a sis course teacher.
I guess my question is, if I decide to let this doc do this in the asc, are there specific things I should worry about? Would it be prudent to allow it only if they have surgical back up in case things go south? Is this procedure taught in pain fellowships nowadays?
I've never heard of this procedure being taught in any fellowship...could be so but I've never heard of it.
Several pain practices in maryland, new york, and texas do this, not only ortho or NSG. The equipment is expensive so the only way to make it economically viable is ASC/hospital. Joimax is a company that will train you, apparently they last longer than standard RFA. I do clinic based procedures mostly so way more than I could afford at this time. Just because you haven't heard of it doesn't mean its bad. After all there is a pain article every month in pain medicine about endoscopic procedures, the reimbursement and equipment make it prohibitively expensive unless part of a multispecialty group or you have an independent ASC. Endoscopic procedures have not been embraced as heavily as fusions, although MIS spine procedures (endoscopic procedures) are more commonly performed in europe
You cannot define the medial branch visually with an endoscope. There is significant fat over the nerve....there is no benefit to endo RF. Yes, I tried them.
