Lay an 18g on the skin over the target area, mark the top and bottom, and lay a ruler over those points and mark off 1 cm intervals. Numb and insert needles. Other thing to keep in mind is needle cost in private practice. At $12-15 each it adds up given the comparatively poor reimbursement. I’ve modified my technique over time to save time and money.
This is fantastic. Thank you. What is your typical bipolar burn? 120 sec at 80 Celsius?
How many do you use and how many burns do you have to do per side?
150 seconds 85 degrees (what the Cosman rep had recommended when I spoke to him)
5 needles, no grounding pad, doesn’t seem too bad to me. I do the L5DR, then move those 2 needles and place the other 3 for the sacrum. Could do it with 4 by moving the top needle to the end of the line for the second sacral burn, but that would be several extra fluoro shots and add some time.
3 needles. One at L5 DPR and one at S1 and S2.
I do the Palisade technique because I read a study a while back that showed it had one of the highest likelihoods of capturing the nerves, while monolpolar techniques were much lower. I’ve done it that way though on a few very skinny patients where I was worried the needle perpendicular to the skin could burn their skin. In those though it’s very easy to lay the needle parallel to the surface of the sacrum so you get a 1 cm long burn adjacent to the foramen.
No S3?
Why? I feel like I see results almost as good as lumbar RFA, minimal procedural pain. What technique are you using?
Deleted my reply that was basically reiterating this post. I do palisade technical as well. Say for left side - the lateral branches can come anywhere from 1 to 5 o'clock so palisade makes sense to me as most likely to catch it.
Medicare and the local Medicaid plan pay for it. The two of those are probably 70% of my practice. Private insurance usually denies it.
Medicare advantage plans also don't cover, in my area. I offered one patient to do cash pay, and she said, "why don't I just go to Dr X for fusion? That will be covered, and then it'll be fixed for good!"
we are only doing it for medicare patients and in office. no longer at ASC where it wasnt even reimbursing $100 so not worth the time we found out.
IPA? beer? go beers!
Fyi, If you localize from the AP and from the lateral to the periosteum, the procedure is much much less painful.
And how often do they come back to you because that fusion "didn't work"?
Yep. I’d love to not take any of them. Would rather take straight Medicare instead of advantage.
Great idea. I hope to sell my partners on that.
