Lumbar MBBs in AP view?

[arabesquepres]

Does anyone do their lumbar MBBs and RFAs in the AP view, without utilizing the oblique? Is the target then 10 o’clock (left) and 2 o’clock (right) on the pedicle? What have your results been (especially in comparison to the oblique view)?

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[GlowInTheDark]

Yes. Come in from an entry point inferior and lateral and walk it in so you get in the superior portion of pedicle/TP junction.

Results have been that I’m faster.

 

[stsa84]

I go AP for MBB's if pedicles are pretty clear. If not fairly normal, will oblique. Saves a fair bit of time. Always go oblique with caudal tilt for RFA.

 

[thecentral09]

I go AP for MBB's if pedicles are pretty clear. If not fairly normal, will oblique. Saves a fair bit of time. Always go oblique with caudal tilt for RFA.

Agree with this. And always check a lateral, very common to get hung up on posterior facet rather than junction

 

[Baron Samedi]

Agree with this. And always check a lateral, very common to get hung up on posterior facet rather than junction

If you're going to check a lateral then you've negated the entire benefit of doing the procedure in AP which is speed and decreased rads exposure. Might as well just do it in oblique then and spare yourself the lateral view.

 

[MD87]

If you're going to check a lateral then you've negated the entire benefit of doing the procedure in AP which is speed and decreased rads exposure. Might as well just do it in oblique then and spare yourself the lateral view.

Insurance mandates 2 views.

 

[Baron Samedi]

Insurance mandates 2 views.

Huh, wasn't aware but good to know.

 

[BobBarker]

Two images I think. Not two views. AP one and AP two.

 

[MitchLevi]

MBB only AP.

RFA AP, oblique and lateral. I do the procedure only in AP and lateral though. I get an oblique pic for documentation only. I don't use that view for needle placement 95% of the time.

 

[RoloTomassi]

MBB only AP.

RFA AP, oblique and lateral. I do the procedure only in AP and lateral though. I get an oblique pic for documentation only. I don't use that view for needle placement 95% of the time.

Exactly the same for me

 

[MitchLevi]

Exactly the same for me

Our solidarity feels amazing!

 

[Ronin1]

You would be surprised how often a perfect pa image is not deep enough. I check lateral every time. Adds maybe 30 seconds to procedure time. Often I advance after lateral view

 

[RoloTomassi]

You would be surprised how often a perfect pa image is not deep enough. I check lateral every time. Adds maybe 30 seconds to procedure time. Often I advance after lateral view

+1. And make sure it's a true lateral, corrected for rotation and wag, or else it can look way off.

 

[Taus]

Is it really that much more time and effort to just go to 15-20 oblique where you can clearly see the target in junction, even with very hypertrophic sap, advance all needles in this view til os at exact target and call it a day?

 

[RoloTomassi]

Is it really that much more time and effort to just go to 15-20 oblique where you can clearly see the target in junction, even with very hypertrophic sap, advance all needles in this view til os at exact target and call it a day?

I find that even starting with oblique, some need 15-20 deg, some need more if huge facets. And depending on how much oblique, "in the groove" doesn't always result in the best medial-lateral location on AP, so you still have to adjust on AP. And I think lateral is a must regardless of how you start, so it doesn't save time there.

 

[deleted131481]

Are you all doing 6 needles at once in AP or still 3?

I do oblique 3 needles then the other side. If you're using 3 needles this doesn't add any time. It takes the tech an extra 3 seconds to turn oblique the other side while I am injecting LA on the first side.

 

[deleted875186]

Are you all doing 6 needles at once in AP or still 3?

I do oblique 3 needles then the other side. If you're using 3 needles this doesn't add any time. It takes the tech an extra 3 seconds to turn oblique the other side while I am injecting LA on the first side.

I would agree with this. This is how I do it. 15-20 degrees oblique, no lateral, all three or four needles at once on one side and then do the other sided. Will take a single AP after all needles placed and as noted above occasionally a bit too lateral or off, but adequate for an MBB.

 

[RoloTomassi]

Are you all doing 6 needles at once in AP or still 3?

I do oblique 3 needles then the other side. If you're using 3 needles this doesn't add any time. It takes the tech an extra 3 seconds to turn oblique the other side while I am injecting LA on the first side.

MBB 6 needles same time in AP.

RFA 3 needles one side at a time, bc 6 venoms would break the bank, and doesn't save a ton of time, since I mark and numb the second side while burning.

 

[Ferrismonk]

Insurance mandates 2 views.

I have not seen this, just "imaging" saved. Do you have a reference?

 

[oneforfighting]

MBB 6 needles same time in AP.

RFA 3 needles one side at a time, bc 6 venoms would break the bank, and doesn't save a ton of time, since I mark and numb the second side while burning.

What's your technique for doing MBB all in AP? Is your entry point a bit lateral and inferior for the L3, L4 MBs and then direct superomedially? Or do you go straight down coaxially?

 

[stsa84]

What's your technique for doing MBB all in AP? Is your entry point a bit lateral and inferior for the L3, L4 MBs and then direct superomedially? Or do you go straight down coaxially?

I just go coaxial. If one needle is sitting obviously higher than another, I'll walk it lateral until it slides off the facet to TP.

 

[RoloTomassi]

I just go coaxial. If one needle is sitting obviously higher than another, I'll walk it lateral until it slides off the facet to TP.

I go about a cm lateral to those red dots and angle in medially

 

[oneforfighting]

Do you do the same for cervical MBBs?

 

[RoloTomassi]

Do you do the same for cervical MBBs?

Yes, but just a bit lateral to the waist since there's no facet to clear. It makes staying on os while walking off easier.

 

[Forwho]

I was trained 3 oclock and 9 oclock of pedicle. But I've been doing more like 10 and 2, just makes more sense for me. All in AP, no lateral or oblique views.

 

[MD87]

I have not seen this, just "imaging" saved. Do you have a reference?

Strangely, I don’t. I swear I saw this somewhere, as well as contrast dye being required for MBBs. Now I’m looking for it and can’t find it anywhere, so maybe I’m wrong.

I also thought somewhere I saw 2 views were required for ESI, but I can’t find that now either.

 

[specepic]

The problem with going AP and not checking a lateral is you are going to end up not deep enough, a lot (IMHO)

a hypertrophic facet is blocking where you want to get, if going straight AP

 

[Ducttape]

it was previously listed in Medicare LCDs.