I've noticed a number of pain docs in the community and a few academic centers performing endoscopic transforaminal and interlaminar lumbar decompressions. Anyone have experience with this? Something worth seeking out training for? Any issues alienating neurosurgery/ortho spine colleagues and referral sources? Is endoscopic financially worthwhile and more importantly, safe, in private practice? Will NASS lobbying eventually kill our ability to bill for endoscopic?
Future of pain docs performing endoscopic spine?
- Thread starter gasdocbro
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I do them. Financially its OK we have better paying procedures. Very difficult learning curve to get good at it IMO - start off with contained herniations, wide foramen L4/5 transforaminal - do inside/out technique - will get good results. Its all about initial needle placement - if that is off then the whole case will not go well. Eventually you can branch out to extruded fragments, more bony stenosis where you may need to reem etc. Interlaminar is much easier than transforaminal although stakes are higher - you are coming posterior and need to traverse LF without causing a dural tear, then you need to retract the nerves - again without causing a dural tear - invariably there is adhesions from whatever pathology your trying to fix so when you try to retract you will notice the dural sac and traversing nerve root not cooperate which makes it difficulty and more high risk. I've only done a few of these cases
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Asipp already has a course for this, several pain doctors do these cases. Useful skill to learn for endoscopic rhizotomy Which have good results
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I asked my neurosurgeon why he’s not interested in endoscopic surgery as part of a minimally invasive approach. To paraphrase, he said it’s hard to get good visualization and be sure of what you’re looking at Vs direct approach and factor in body habitus, the risk/reward was minimal and higher chance of failure. So I would not be surprised if this becomes more of a pain surgeon thing, since open surgery is not an option for us and there’s not going to be much competition for this from real surgeons.
Endoscopic rhizotomy would be less challenging but financially does not seem viable in my area, too many payers specify that they will not cover it.
Endoscopic rhizotomy would be less challenging but financially does not seem viable in my area, too many payers specify that they will not cover it.
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Nothing against those do want to do it, but outcomes aren't better than microdisc.
For endo rhizo, seems like overkill. The goal of endo is minimally invasive, and trad RFA is just that, and high yield enough with multiple burns if you want to be sure.
For endo rhizo, seems like overkill. The goal of endo is minimally invasive, and trad RFA is just that, and high yield enough with multiple burns if you want to be sure.
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LOFL at endoscopic RFA.
My friend who did them for awhile said he really didn't know what he was looking at but he knows where to put the scope. He would burn for 5 min. LOFL.
I'll stick with my Valium 4mg + 18g 2 min at 80-85 degrees, and when I retire I won't feel like a jerk.
2 minute burn vs 90 seconds (me) - have you done 90 seconds before - significant change in outcomes for you with the longer burn?
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There are several papers stating ERN is more durable and sustained for several years. 2 in pain medicine one recently and a Korean one
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Thanks, was not aware. Quality studies?
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Results: Of 55 patients with LFJP, 19 underwent ER, and 36 underwent RF. Both ER and RF groups showed significant decreases in NRS and ODI scores at 6 months and 12 months compared with baseline (P < 0.001). ER had significantly better efficacy than RF in NRS, ODI, and GIoC scores at 6 and 12 months (P < 0.05). The pain-free survival curves showed that the median pain-free duration was 20 months and 10 months in ER and RF, respectively.
Limitation: Patients were not randomized to different groups, which may have led to bias.
Conclusions: Both ER and RF can improve the pain and physical function in patients with LFJP. ER is associated with a longer operative duration and medical expenses; however, it provides more sustained efficacy than RF. The surgical choice should depend on the patients’ specific
Endoscopic rhizotomy for chronic lumbar zygapophysial joint pain - PMC
Chronic lumbar zygapophysial joint pain is a common cause of chronic low back pain. Percutaneous radiofrequency ablation (RFA) is one of the effective management options; however, the results from the traditional RFA need to be improved in certain ...
www.ncbi.nlm.nih.gov
Endoscopically Guided Foraminal and Dorsal Rhizotomy for Chronic Axial Back Pain Based on Cadaver and Endoscopically Visualized Anatomic Study
Background Conventional fluoroscopically guided continuous radiofrequency (CRF) and pulsed Radiofrequency (PRF) lesioning of the medial branch, dorsal ramus, a standard technique to treat facet pain, is compared to an endoscopic visually guided technique. The endoscopic technique ([Figure 1][1])...
www.ijssurgery.com
