Experience with Intracept.

[bedrock]

spikes?

its weird how all of a $udden, the type$ of back pain can change. one minute, everyone has facet pain, then the next, its vertebrogenic. very very $trange....

Agree. Though for now intracept only pays well in hospital. Once it makes money in the ASC, Then MBB will crater.

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[RoloTomassi]

Due to reimbursement issues I now do most cases in outside ASC, make very little on the pro fee side. Make more per hour doing bread and butter.

 

[RoloTomassi]

Agree. Though for now intracept only pays well in hospital. Once it makes money in the ASC, Then MBB will crater.

Plenty of people have multifactorial pain that includes both. But there will be a decrease in patients that are given repeat RFAs q6mo with minimal results each time.

 

[clubdeac]

spikes?

its weird how all of a $udden, the type$ of back pain can change. one minute, everyone has facet pain, then the next, its vertebrogenic. very very $trange....

Right? Kinda like covid 😘

 

[lobelsteve]

spikes?

its weird how all of a $udden, the type$ of back pain can change. one minute, everyone has facet pain, then the next, its vertebrogenic. very very $trange....

Strange that this type of pain didn’t exist until the procedure was created.

 

[Orin]

spikes?

its weird how all of a $udden, the type$ of back pain can change. one minute, everyone has facet pain, then the next, its vertebrogenic. very very $trange....

It's a shiny new hammer for that pesky nail!

 

[pmrmd]

Strange that this type of pain didn’t exist until the procedure was created.

Axial back pain not responsive to facet intervention seemed to be around for as long as I can remember. You doing an ESI every 6-8 weeks for these people or presuming the answer lies with the P.T.?

 

[RoloTomassi]

Axial back pain not responsive to facet intervention seemed to be around for as long as I can remember. You doing an ESI every 6-8 weeks for these people or presuming the answer lies with the P.T.?

Surgeons have been fusing these for years. There's just a better option now. Kinda like how RFA has largely replaced IA facet injections.

 

[lobelsteve]

Axial back pain not responsive to facet intervention seemed to be around for as long as I can remember. You doing an ESI every 6-8 weeks for these people or presuming the answer lies with the P.T.?

Axial back pain is not vertebrogenic back pain.
Vertebrogenic pain is a subset of axial back pain.

We have seen a rise in this term several times, but only 173 articles in 65 years. No prior treatment was effective. #gamechangerNOTYET

 

[deleted472101]

We weren’t taught this properly in training so if we are taught now, yes we will see more of something regardless of money

 

[pmrmd]

Axial back pain is not vertebrogenic back pain.
Vertebrogenic pain is a subset of axial back pain.

View attachment 341965


We have seen a rise in this term several times, but only 173 articles in 65 years. No prior treatment was effective. #gamechangerNOTYET

Your post made the claim that vertebrogenic pain only began after the procedure was developed. In obvious reality the pain existed and we always mislabeled it as discogenic. Wouldn’t you agree?

 

[SSdoc33]

i believe its a real entity, and intracept may have some utility..... but dont tell me that there are now "spikes" in your clinic with these patients. you are now just paying more attention to modic changes

 

[Ducttape]

or some company is creating the term vertebrogenic pain to market a new procedure that switches focus to the vertebral nerves rather than the disc.

is it the nerve that is painful, or is it the disc that is causing the nerve to transmit pain signals?

after all, we don't do median branch blocks and RFAs because the median branch hurts...

 

[deleted472101]

i believe its a real entity, and intracept may have some utility..... but dont tell me that there are now "spikes" in your clinic with these patients. you are now just paying more attention to modic changes

This is an obvious statement.

 

[lobelsteve]

Your post made the claim that vertebrogenic pain only began after the procedure was developed. In obvious reality the pain existed and we always mislabeled it as discogenic. Wouldn’t you agree?

Nope. It is discogenic and they are using the term to get away from the failures of treating discs.

 

[drusso]

i believe its a real entity, and intracept may have some utility..... but dont tell me that there are now "spikes" in your clinic with these patients. you are now just paying more attention to modic changes

There's a coming tsunami of Modic-related pain. Five cases yesterday. It feels like waking up from a dream and finally seeing reality. #FryTheBone #ModicsAreReal #VivaHOPDSOS

 

[RoloTomassi]

Axial back pain is not vertebrogenic back pain.
Vertebrogenic pain is a subset of axial back pain.

View attachment 341965


We have seen a rise in this term several times, but only 173 articles in 65 years. No prior treatment was effective. #gamechangerNOTYET

Hmm only 45 hits for "facetogenic pain". RFA reps must've corrupted you.

 

[SSdoc33]

Surgeons have been fusing these for years. There's just a better option now. Kinda like how RFA has largely replaced IA facet injections.

just like the biased presentation at SIS, you present a false choice.

it is not "intracept or fusion". NONE of these patients should be fused. this should not be your indication, not should you use this as a rationale for the procedure. I agree with your earlier statements re: appropriate candidates for the procedure.

 

[Ducttape]

160 hits for "facet mediated pain".

2429 hits for "facet arthropathy".

4800 hits for "lumbar spondylosis"

otoh,
536,196 hits for "experimental procedure"

 

[RoloTomassi]

160 hits for "facet mediated pain".

2429 hits for "facet arthropathy".

4800 hits for "lumbar spondylosis"

otoh,
536,196 hits for "experimental procedure"

What has now been coined vertebrogenic pain was always just referred to as severe DDD, severe spondylosis, endplate degeneration, reactive marrow changes, etc. My point was it's inaccurate to search a newly coined term and say it's a made up diagnosis based on number of hits

 

[Tboned]

What has now been coined vertebrogenic pain was always just referred to as severe DDD, severe spondylosis, endplate degeneration, reactive marrow changes, etc. My point was it's inaccurate to search a newly coined term and say it's a made up diagnosis based on number of hits

I agree with this… I think the terminology has evolved and become more specific. If you want to continue call it discogenic then fine. If you want to adopt the new terminology fine. You could call it discovertebral if you wanted, whatevs

 

[lobelsteve]

There's a coming tsunami of Modic-related pain. Five cases yesterday. It feels like waking up from a dream and finally seeing reality. #FryTheBone #ModicsAreReal #VivaHOPDSOS

Opened your eyes to see back pain as a pain physician because you have new toys to sell.

 

[lobelsteve]

It's all smoke and mirrors to sell the latest and greatest widget. Remember the IDET.

 

[SSdoc33]

It's all smoke and mirrors to sell the latest and greatest widget. Remember the IDET.

its very easy to dismiss it off-hand, but im willing to give it a chance. im pretty conservative with this sort of stuff. the basic science at least makes sense.

that being said, i havent done any, and don't even know any of any local docs who do the procedure

 

[Ducttape]

What has now been coined vertebrogenic pain was always just referred to as severe DDD, severe spondylosis, endplate degeneration, reactive marrow changes, etc. My point was it's inaccurate to search a newly coined term and say it's a made up diagnosis based on number of hits

What's in a name? That which we call a rose
By any other name would smell as sweet



lets start calling facet arthropathy "medial branchogenic pain" to get coolief approved by insurance...

 

[drusso]

It's all smoke and mirrors to sell the latest and greatest widget. Remember the IDET.

IDET worked until the RCT came out.

 

[lobelsteve]

IDET worked until the RCT came out.

IDET worked until the Saal brothers cashed the check

 

[drusso]

IDET worked until the Saal brothers cashed the check

Jeffrey Saal, MD | Board Certified Physiatrist in Redwood City and Santa Clara, CA | SOAR Spine and Orthopedics

Learn more about Jeffrey Saal, MD who provides a variety of Board Certified Physiatrist services to the patients of SOAR Spine and Orthopedics. To book an appointment, please call us at 650-628-8401 or visit our office in Redwood City and Santa Clara, CA.

soarspine.com

 

[pmrmd]

Nope. It is discogenic and they are using the term to get away from the failures of treating discs.

That sounds like a definitive statement without the evidence to support it. I kind of think that with all the treatment failures maybe the target was incorrect.

 

[lobelsteve]

That sounds like a definitive statement without the evidence to support it. I kind of think that with all the treatment failures maybe the target was incorrect.

Are you saying there is facetogenic, discogenic, and vertebrogenic pain syndromes?

 

[SSdoc33]

Are you saying there is facetogenic, discogenic, and vertebrogenic pain syndromes?

sounds reasonable to me. harder to tell the difference between discogenic and vertebrogenic, though. also, id imagine that discogenic and vertebrogenic pain coexist more frequently as they are both anterior column

 

[pmrmd]

Are you saying there is facetogenic, discogenic, and vertebrogenic pain syndromes?

Can you articulate a good reason why this is not possible? A pain can be discal with a tear, with possible MRI finding, and probably a younger individual, and possibly from the endplate in an older person after degeneration has put more forces onto the bone than usual. Seems totally reasonable and almost like we have been missing the obvious for a long time.

 

[drusso]

Can you articulate a good reason why this is not possible? A pain can be discal with a tear, with possible MRI finding, and probably a younger individual, and possibly from the endplate in an older person after degeneration has put more forces onto the bone than usual. Seems totally reasonable and almost like we have been missing the obvious for a long time.

I'm seeing an epidemic of Modic-related back pain. It almost makes me wonder if SARS-Cov-2 causes vetebrogenic changes due to inflammation, microvascular disease, or other mechanisms.

 

[Ferrismonk]

I'm seeing an epidemic of Modic-related back pain. It almost makes me wonder if SARS-Cov-2 causes vetebrogenic changes due to inflammation, microvascular disease, or other mechanisms.

A lot more people have been vaccinated against COVID than have had COVID. Maybe it's a vaccine reaction?

 

[Nodolor]

A lot more people have been vaccinated against COVID than have had COVID. Maybe it's a vaccine reaction?

O god

 

[RoloTomassi]

Nope. It is discogenic and they are using the term to get away from the failures of treating discs.

Innervation of pathologies in the lumbar vertebral endplate and intervertebral disc

www.ncbi.nlm.nih.gov

The Role of the Vertebral End Plate in Low Back Pain

End plates serve as the interface between rigid vertebral bodies and pliant intervertebral disks. Because the lumbar spine carries significant forces and disks don't have a dedicated blood supply, end plates must balance conflicting requirements of being ...

www.ncbi.nlm.nih.gov

 

[Dr. Ice]

Once the SIS docs start being able to do it at the ascs that they own, they will be able to publish “strong data” and research to suggest that it is a worthwhile and efficacious treatment

 

[drusso]

Once the SIS docs start being able to do it at the ascs that they own, they will be able to publish “strong data” and research to suggest that it is a worthwhile and efficacious treatment

Which docs are doing it now instead?

 

[Dr. Ice]

Which docs are doing it now instead?

 

[epidural man]

Did my first case today.

It reminds me of when I did my first nucleoplasty. I was so excited. What a great name - was it Dekompressor?

I'm much less enthusiastic this time, however.

 

[drusso]

Did my first case today.

It reminds me of when I did my first nucleoplasty. I was so excited. What a great name - was it Dekompressor?

I'm much less enthusiastic this time, however.

Dekompressor Discectomy | Lewiston Orthopedics, Lewiston, ID

Click to learn more about dekompressor discectomy, which is performed by the specialty-trained spine doctor at Lewiston Orthopedics in Lewiston, Idaho.

www.lewistonortho.com

 

[epidural man]

By the way, speaking of MODIC - I still wish we would figure out the infection thing.

One study for, one study against.

 

[Espn123]

spikes?

its weird how all of a $udden, the type$ of back pain can change. one minute, everyone has facet pain, then the next, its vertebrogenic. very very $trange....

Your most virtuous spike must be 99214

 

[SSdoc33]

Your most virtuous spike must be 99214

as a matter of fact E/M is indeed undervalued

 

[RoloTomassi]

it is not "intracept or fusion". NONE of these patients should be fused.

Did this case today. Severe axial LBP. Failed RFA. Failed TFESI and ILESI. Stenosis severe but not as bad on axials. If Intracept not an option, and fails SCS, you wouldn't even consider fusion extension? Anecdotal but I'll let you know how she does 2 weeks after L1/2/3 BVNA

 

[Crybaby]

Did this case today. Severe axial LBP. Failed RFA. Failed TFESI and ILESI. Stenosis severe but not as bad on axials. If Intracept not an option, and fails SCS, you wouldn't even consider fusion extension? Anecdotal but I'll let you know how she does 2 weeks after L1/2/3 BVNAView attachment 342610

If they were to extend that fusion- it would be 3 additional vertebral levels fused. If successful, she maybe would have 1-2 good years before adjacent level degeneration kicks and this will be a miserable back once again.

 

[RoloTomassi]

If they were to extend that fusion- it would be 3 additional vertebral levels fused. If successful, she maybe would have 1-2 good years before adjacent level degeneration kicks and this will be a miserable back once again.

Right, not saying it's a good option, but one of the few left, and I don't get good results with SCS on cases like this

 

[SSdoc33]

Did this case today. Severe axial LBP. Failed RFA. Failed TFESI and ILESI. Stenosis severe but not as bad on axials. If Intracept not an option, and fails SCS, you wouldn't even consider fusion extension? Anecdotal but I'll let you know how she does 2 weeks after L1/2/3 BVNAView attachment 342610

you moved the goal posts, as there are confounding factors here....

that being said: if no radicular pain, then no fusion. fusion WILL NOT help the axial LBP.

there does appear to be severe stenosis supra-adjacent to the fusion, so i may consider a lami if the legs are a problem

 

[RoloTomassi]

you moved the goal posts, as there are confounding factors here....

that being said: if no radicular pain, then no fusion. fusion WILL NOT help the axial LBP.

there does appear to be severe stenosis supra-adjacent to the fusion, so i may consider a lami if the legs are a problem

Wasn't trying to and that wasn't the best example in terms of surgical pros/cons but I guess we'll have to disagree on the axial pain component. I work in a surgical group with very conservative surgeons. I have tons of patients pending Intracept and those who can't wait any longer get surgery. Many are a lot better. Definitely not high success rate but I don't think it's 0 as you do.

 

[lobelsteve]

View attachment 342610

Severe axial LBP. Failed RFA. Failed TFESI and ILESI.

Which facets? ESI for axial LBP? Not reasonable. Not going to work. Fusion for axial LBP, not going to work. Stenosis, shmenosis- who cares for axial LBP, it is not causing the problem. Facets ruled out, BVNA reasonable given alternative of SCS, meds, PT.

Would have done L2-3 only, if I did these. Or Belbuca 150 bid and good luck.