Is anyone doing this two needle technique for RFA?

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GottaHaveIt

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I saw Dr. Chapman's video a while back where he does the two needle technique.

Then more recently I actually found the article describing the technique.
pubmed.ncbi.nlm.nih.gov

Two-Needle Technique for Lumbar Radiofrequency Medial Branch Denervation: A Technical Note - PubMed

The detailed two-needle approach to lumbar RF medial branch denervation appears to be promising in terms of projected treatment success by coagulating a large volume of tissue, in a cost- and time-efficient manner.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

Does anyone use this? I usually use cooled RF but certain insurances refuse to cover it. Trying to get the best possible results when hsing conventional thermal RF and I was considering using this.
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It’s not a bad idea - but more costly (if you’re using double the number of needles) or time consuming (if using the same number of needles you usually use). But there are other ways to increase lesion size besides Coolief like the Nimbus needle
 
I did something similar recently because a patient had a sacral nerve stimulator, and hadn’t turned it off. I’m always a bit cautious around devices - in fellowship we had a stimulator that was supposedly damaged by an RF.

It was definitely more time consuming. I did bilateral sacral ala, then bilateral L5, then bilateral L4. I did just one burn at leach level, whereas normally I would turn the needles and re-run it. I was able to just reorient the needles from the same entry point, but it was a lot of back and forth AP to lateral.
 
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This is one I did. It was on a young patient with partial relief with single needle traditional 20g probes. Made a big difference.

2B5D6A69-DA30-4F34-8FFE-BEBF6B49830D.jpeg

9C807716-89CA-448C-911C-71E876166EDD.jpeg
 
His employer self insures. So can do almost anything as long as it makes sense. This was office based also. I think they really just care about keeping patients away from the hospital.
 
BobBarker said:
This is one I did. It was on a young patient with partial relief with single needle traditional 20g probes. Made a big difference.

View attachment 350658
View attachment 350659
Click to expand...
I would like to do this for some of my patients if it would give a better outcome.

Was this bipolar?
If monopolar, what would it make it better than two burns with one needle?
 
GottaHaveIt said:
I saw Dr. Chapman's video a while back where he does the two needle technique.

Then more recently I actually found the article describing the technique.
pubmed.ncbi.nlm.nih.gov

Two-Needle Technique for Lumbar Radiofrequency Medial Branch Denervation: A Technical Note - PubMed

The detailed two-needle approach to lumbar RF medial branch denervation appears to be promising in terms of projected treatment success by coagulating a large volume of tissue, in a cost- and time-efficient manner.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

Does anyone use this? I usually use cooled RF but certain insurances refuse to cover it. Trying to get the best possible results when hsing conventional thermal RF and I was considering using this.
Click to expand...
Slightly off topic, but doesn't coolief use the same cpt codes? I thought you could burn lumbar with coolief without anything additional as far as auth goes.
 
Ferrismonk said:
Slightly off topic, but doesn't coolief use the same cpt codes? I thought you could burn lumbar with coolief without anything additional as far as auth goes.
Click to expand...
correct, but i think because its done at 60 degrees as opposed to 80degress, some insurers dont cover it
 
Ferrismonk said:
ah. Whenever I do coolief, I mention how the tissue becomes 80 degrees. Haven't had any issues.
Click to expand...
Lesion temperature was 80 C with cannula tip held at 60 C for 2:30

Accurate documentation is important or they weasel out of paying
 
drrosenrosen said:
I've done this bipolar technique for genics since we don't have coolief. Haven't tried it for spine
Click to expand...
Any observations of doing it that way for genicular vs monopolar with one needle per nerve? I’ve thought of trying bipolar for genicular but haven’t figured out what I’d do for needle position and approach. Can you share your technique/approach? I’m in private practice so Coolief is a non-starter.
 
my anecdotal experience with with bipolar on genicular is that they work better than monopolar. haven't done for lumbar - i'm sure it has better chance of working but my current monopolar technique lasts long enough i am content with so far.
 
callmeanesthesia said:
Any observations of doing it that way for genicular vs monopolar with one needle per nerve? I’ve thought of trying bipolar for genicular but haven’t figured out what I’d do for needle position and approach. Can you share your technique/approach? I’m in private practice so Coolief is a non-starter.
Click to expand...
Just like the pics of the lumbar - one needle right where you'd normally place it, and another right next to it. With 18ga needles, 5-10mm apart seems to create the largest bipolar lesion. Not dissimilar to doing the Cosman palisade technique for SIJ RF - just get the needle tips parallel to each other
 
drrosenrosen said:
Just like the pics of the lumbar - one needle right where you'd normally place it, and another right next to it. With 18ga needles, 5-10mm apart seems to create the largest bipolar lesion. Not dissimilar to doing the Cosman palisade technique for SIJ RF - just get the needle tips parallel to each other
Click to expand...
Main thing I’m interested in the best angle and axis of approach - needles from the lateral/medial aspect of leg with one needle distal to the other? Or one needle posterior to the other? Or needle entry from the anterior leg, with one needle tip more distal than the other? Which would be optimal would seem to depend on which genicular nerve anatomical diagram you look at.
My typical approach has been anterior to posterior needle placement, starting at the posterior aspect of femur, then withdrawing the needle slightly and re-burning, total of 3 burns. Decent responder percentage (I’d say similar to lumbar/cervical) but unsatisfactory duration. Lots of patients coming back after 4-6 months with return of pain. This suggests to me I’m perpendicular to the nerve, so not ablating a very long segment of it.
 
callmeanesthesia said:
Main thing I’m interested in the best angle and axis of approach - needles from the lateral/medial aspect of leg with one needle distal to the other? Or one needle posterior to the other? Or needle entry from the anterior leg, with one needle tip more distal than the other? Which would be optimal would seem to depend on which genicular nerve anatomical diagram you look at.
My typical approach has been anterior to posterior needle placement, starting at the posterior aspect of femur, then withdrawing the needle slightly and re-burning, total of 3 burns. Decent responder percentage (I’d say similar to lumbar/cervical) but unsatisfactory duration. Lots of patients coming back after 4-6 months with return of pain. This suggests to me I’m perpendicular to the nerve, so not ablating a very long segment of it.
Click to expand...
Posting images of needle placement you are using would be helpful.
 
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