Do you all see a day where these are done in the office with oral sedation like Kypho currently is?
Probably -- many people who perform these efficiently and localize well are requiring minimal sedation via MAC.
It is a lot more hammering in hard bone. Blood splashing on the c arm routinely.
Especially with removing the J-stylet and back flow during ablation for those on AC.
Here to share some pictures for S1 bvrfa today, not sure if everyone uses same approach, 25 degree oblique, leave trochar in pedicle, easy to reach midline, less than 30 mins for both 5 and S1. Ignore it if we are on the same page.
Are you consistently doing 25 deg oblique at S1 from a true Ferguson view? And are you going co-axial after going oblique with the triangular border?
Please expand on your efficiency tips. Intracept takes forever for me, and I want to get faster.
This question is also for the group. Let’s all please share intracept efficiency ideas.
Measure pedicular width and determine which sides to perform at each level.
Even out the bed especially for lateral tilt before the case begins -- it'll help your fluoro tech get views more efficiently.
Line up superior end plate and start from a true AP.
Rule of thumb is 5 x lumbar level to determine how much to oblique (ex. L3 = 15, L4 = 20), then adjust based on optimized pedicular view.
Spinal needle to assess trajectory.
0.5% Bupi with epi 1:200,000 on the way out with spinal needle and creating a wheel.
Follow the trajectory of the spinal needle.
Use a long hemostat near the handle under live fluoro to get the trajectory you want.
Don't hesitate to use bevel tip to correct early on before you cross mid-pedicle.
Straight shot from mid pedicle to posterior VB wall in lateral view will save you a lot of time for driving the J-stylet/nitinol stylet. Once you breach the posterior VB wall in lateral view it'll be more work to try to correct the cephalocaudal trajectory simultaneously with the mediolateral trajectory; this is where the most time is wasted.
Low threshold for using the straight stylet if you're close to midline but don't have enough threads left, especially for S1. Will get you to a good 7 min lesion location most of the time.
Pinch the probe wire to the handle so it's out of the way when you're doing another level while the first is cooking -- recommend contralateral side so nothing is in your way.
Lesion size is 5mm @ 7 min vs 6mm @ 15 min.
Squeeze out the edema around the entry site.
Dermabond, steri-strips, and Tegaderm for closure.
Interested to see other people's tips.
Why?
The only bleeding in kypho comes when the balloon is deflated or the stylet is out and the needle tip is in the middle of a vertebral body.
Zero blood on needle entry or placement.
You guys using lido with epi on the skin (hope so)?
Should absolutely be doing local with epi.
Agreed limited bleeding on entry.
The J-stylet used to create the curved track before placing the RFA probe is quite stiff -- can splatter during exchange even with using towels.
Often getting blood backflow during the ablation. Anecdotally, feels like more bleeding encountered vs kypho.
Suspecting it's likely because the target is closer to Hahn's canal/vertebral vascular foramen. Also, no cancellous bone compaction with ballooning or sealing with cementation.
