incorporating RFA into practice

[AndyDufrane]

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Hi I am looking into doing RFA in my practice, is it better to attend an isis course or have the medical device company send you for a course? any particular companies good to use? thank you in advance

 

[SSdoc33]

Hi I am looking into doing RFA in my practice, is it better to attend an isis course or have the medical device company send you for a course? any particular companies good to use? thank you in advance

its best to learn in fellowship

 

[Gauss]

if you have to choose: ISIS should be taught the way Bogduk designed the procedure. So go there

 

[bedrock]

if you have to choose: ISIS should be taught the way Bogduk designed the procedure. So go there

Definitely best to learn in fellowship. Remember you're burning nerves away which is much riskier than just injecting steroids in various places.

 

[specepic]

How much RFA did you do in resid./fellowship? Lumbar and Cerv

I did a lot of Lumbar in both, a little cerv as a resident, and some as a fellow but not lots of cases. I did an ISIS course dedicated to cerv RFA about 1 year into practice and it was great.

I would say that doing high quality cerv RFA is overall quite challenging.

If you did v. little RFA as a resid/ fellow, that fellowship was not a good one, but also, you should not do it in practice, a course will not be enough; if you did a decent amount and just need a refresher thats another story

 

[AndyDufrane]

How much RFA did you do in resid./fellowship? Lumbar and Cerv

I did a lot of Lumbar in both, a little cerv as a resident, and some as a fellow but not lots of cases. I did an ISIS course dedicated to cerv RFA about 1 year into practice and it was great.

I would say that doing high quality cerv RFA is overall quite challenging.

If you did v. little RFA as a resid/ fellow, that fellowship was not a good one, but also, you should not do it in practice, a course will not be enough; if you did a decent amount and just need a refresher thats another story

that is the problem, my fellowship was very clinic focused and not too procedure oriented, I was in on maybe one or two cases of lumbar RFA, no cervical, very few cervical procedures where I actually had hands on experience, there was plenty of observing cervical cases though which was essentially a waste of time, so overall, weak fellowship experience

 

[dc2md]

Absolutely start with a free course from Stryker (or Neurotherm, though I'm not positive they have one). I did one in residency and another in fellowship.

If you're still not comfortable, then go for the Isis course.

Best advice for cervical RFA is to get the pillar view and then a 15-20ish% contralateral oblique to get the mandible out of the way of the lateral masses. Way more to it, but that slight CLO helps a ton.
On an side note, a 50 degree CLO is essential for feeling comfortable doing cervical interlaminar ESI and 30-40 degree CLO for lower lumbar IL ESI.

Sent from my SCH-I535 using Tapatalk 2

 

[ampaphb]

Don't think this is either or - do both. Then call both Stryker and neurotherm, and have them arrange for you to spend a day with one of their instructiors, the way stim manufacturers do.

It isn't a fellowship, but it's a good start.

BTW, whether you go to a NASS course, ISIS, or ASIPP, the only thing that realy matterrs is who the individual instructors are. ISIS if Aprill, Dreyfuss, Whitworth, or Landers are teaching. NASS if Smuck or Melfi. Don't know the ASIPP instructors personally, so can't comment intellegently.

 

[AndyDufrane]

I am actually toying with the idea of doing an ACGME pain fellowship, not just expand my toolbox of procedures but also I seem to be running into alot of problems with credentialing for doing procedures in hospitals and getting a job, I am in an area sandwiched between philly and NYC, so the idea of non-ACGME spine fellowship is coming back to bite me in the behind

 

[olafa]

I am actually toying with the idea of doing an ACGME pain fellowship, not just expand my toolbox of procedures but also I seem to be running into alot of problems with credentialing for doing procedures in hospitals and getting a job, I am in an area sandwiched between philly and NYC, so the idea of non-ACGME spine fellowship is coming back to bite me in the behind

what fellowship was this??? May be useful for others so that they know what to expect in the lack of training. There are some great non-ACGME fellowships probably better than some of the large universities. Unfortunately there is no standard and each needs to be individually evaluated.

 

[Disciple]

what fellowship was this??? May be useful for others so that they know what to expect in the lack of training. There are some great non-ACGME fellowships probably better than some of the large universities. Unfortunately there is no standard and each needs to be individually evaluated.

Yes, we need standards. That is the primary criticism of PMR fellowships by other specialties. The AAPMR should head this up, as they seem interested in defining and expanding the knowledge base of the field.

A thought, emulate the model used by ortho. They sponsor all kinds of fellowships (i.e. spine, upper extremity, arthroplasty, etc.) but have only 2 ACGME subspecialties (sports, hand).

 

[RUOkie]

Yes, we need standards. That is the primary criticism of PMR fellowships by other specialties. The AAPMR should head this up, as they seem interested in defining and expanding the knowledge base of the field.

A thought, emulate the model used by ortho. They sponsor all kinds of fellowships (i.e. spine, upper extremity, arthroplasty, etc.) but have only 2 ACGME subspecialties (sports, hand).

that was one of the recommendation of the Vertical Spine planning committee that just presented to the BOG. I don't know what the board is gonna say yet though.

 

[bedrock]

Yes, we need standards. That is the primary criticism of PMR fellowships by other specialties. The AAPMR should head this up, as they seem interested in defining and expanding the knowledge base of the field.

A thought, emulate the model used by ortho. They sponsor all kinds of fellowships (i.e. spine, upper extremity, arthroplasty, etc.) but have only 2 ACGME subspecialties (sports, hand).

Most orthopedic sports fellowships are not ACGME, because no one wants to deal with all the ACGME hassles for fellowship. Same reasons for all the spine fellowships in the PMR world. No one in the orthopedic world even cares if someone did a ACGME sports fellowship vs non-ACGME. When I was at Harvard a few years ago, all their orthopedic sports fellowship spots were non ACGME. Doesn't hurt the surgeons as they just need to be boarded in orthopedics.

Unfortunately doing interventional spine/pain, is hard in many areas without ACGME pain certification, despite the fact that many ACGME fellowships are inferior to university based spine fellowships from a procedural standpoint.

 

[Disciple]

Most orthopedic sports fellowships are not ACGME, because no one wants to deal with all the ACGME hassles for fellowship. Same reasons for all the spine fellowships in the PMR world. No one in the orthopedic world even cares if someone did a ACGME sports fellowship vs non-ACGME. When I was at Harvard a few years ago, all their orthopedic sports fellowship spots were non ACGME. Doesn't hurt the surgeons as they just need to be boarded in orthopedics.

Unfortunately doing interventional spine/pain, is hard in many areas without ACGME pain certification, despite the fact that many ACGME fellowships are inferior to university based spine fellowships from a procedural standpoint.

That's the issue. Nobody is going to challenge the expertise of Orthopedic Surgery when it coming to structural MSK, whatever part of the body it is.

The whole argument for requiring ACGME this or that just to perform basic injections/procedures is based on whether or not there are standards in training, i.e. quality control, public safety, etc.

Create standards and that argument goes away, or at least becomes a more difficult position to defend.

PM&R is in a position of strength in the new system. We have some leverage. We are preferred to treat MSK issues by insurers, etc. because we are seen as more conservative (i.e. cheaper). Not sure if the leadership realizes this.

 

[RUOkie]

PM&R is in a position of strength in the new system. We have some leverage. We are preferred to treat MSK issues by insurers, etc. because we are seen as more conservative (i.e. cheaper). Not sure if the leadership realizes this.[/QUOTE]

I believe that they do now. The BOG created two "vertical planning committees" this past year one for spine care and the other for stroke care. One of the spine care committee's recommendations was exactly what you suggested.

Now, whether they choose to put their eggs in that basket is another story all together.