Ganglion of impar RFA

[deleted875186]

Have a patient that would be a good candidate, 100% pain relief for a month on multiple occasional, coccyx pain and some symptoms with bowel movements.

Anyone have experience? Essentially I see people place an RFA needle just like an injection and proceed to sensory testing and ablate.

Conventional RF or pulsed? Any rectal injuries?

One needle or multiple?

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[Baron Samedi]

I've done a single case of conventional RFA. Got 6 months of relief. I also did motor testing to check for bowel spasm(would have been gross if positive, lol). Did it single needle, same technique as injection. 10mm curved.

 

[deleted875186]

I've done a single case of conventional RFA. Got 6 months of relief. I also did motor testing to check for bowel spasm(would have been gross if positive, lol). Did it single needle, same technique as injection. 10mm curved.

Did you advance the tip deeper then you normally would to get the active tip past through the disc, or just advance till the tip popped through and do some contrast??

 

[MitchLevi]

Good thread. I have a few of these.

 

[Baron Samedi]

Did you advance the tip deeper then you normally would to get the active tip past through the disc, or just advance till the tip popped through and do some contrast??

I went a few mm past the margin of the disc and verified with contrast. I probably lesioned part of the disc itself inadvertently. Maybe I should have billed for an IDET..

Transsacrococcygeal approach to ganglion impar: radiofrequency application for the treatment of chronic intractable coccydynia - PMC

Coccydynia is defined as pain in the coccygeal region. Among the many causes of coccydynia, the most common cause is trauma as a result of falling on the buttocks, repetitive microtrauma, or childbirth. Several methods are currently used for the ...

www.ncbi.nlm.nih.gov

 

[GoBeers]

what cpt do you use for RFA?
also what cpt do you use for standard ganglion impar injection?

 

[Baron Samedi]

what cpt do you use for RFA?
also what cpt do you use for standard ganglion impar injection?

64999 for the block.

Think I used 64999 for the RFA as well but its been some time. Not sure if it would be normally be covered since I am in a different medical system.

 

[Agast]

I code Ganglion impar blocks as small joint injections and dictate coccyx joint injection with the ganglion impar (consent for both). If you try to use the sympathetic block codes it will get thrown back at you for not meeting CRPS criteria.

 

[paindoctor2014]

Have had good luck with both the injection and rfa. Getting them covered is a whole different story.

64520 I think is the most appropriate code for the injection, but that gets denied most of the time.

64999 is the non-specified but most insurances won’t pay that at all.

 

[Orin]

I'm just not sure what we'd be RFing there. The ganglion isn't reliably located there. The blocks/neurolytic only work because you're in the tissue plane.

Nice review/discussion: One is the loneliest number: a review of the ganglion impar and its relation to pelvic pain syndromes - PubMed

It's like RFing chassaignac's tubercle and saying you're knocking out the stellate.

 

[Ducttape]

i have tried RF of ganglion impars without that much success.

definitely much less benefit than alcohol or phenol (alcohol essentially not available because of greedy Big Pharma). i use this only for cancer pain.

 

[Ligament]

I'm just not sure what we'd be RFing there. The ganglion isn't reliably located there. The blocks/neurolytic only work because you're in the tissue plane.

Nice review/discussion: One is the loneliest number: a review of the ganglion impar and its relation to pelvic pain syndromes - PubMed

It's like RFing chassaignac's tubercle and saying you're knocking out the stellate.

Well said!

 

[Baron Samedi]

I'm just not sure what we'd be RFing there. The ganglion isn't reliably located there. The blocks/neurolytic only work because you're in the tissue plane.

Nice review/discussion: One is the loneliest number: a review of the ganglion impar and its relation to pelvic pain syndromes - PubMed

It's like RFing chassaignac's tubercle and saying you're knocking out the stellate.

Interestingly, people have done that too.

Radiofrequency ablation of stellate ganglion in a patient with complex regional pain syndrome - PMC

Complex regional pain syndrome (CRPS) is characterized by a combination of sensory, motor, vasomotor, pseudomotor dysfunctions and trophic signs. We describe the use of radiofrequency (RF) ablation of Stellate ganglion (SG) under fluoroscopy, for ...

www.ncbi.nlm.nih.gov

 

[nvrsumr]

Mr mizpic had a sacral canal thermal technique for coccidynia that is on the forum