Lumbar RFA with SCS in place?

[jimbomd]

Hello all,

Had a patient referred s/p L5-S1 ALIF and subsequent SCS placement with a paddle lead up to T9. The referring doc is asking for MBBs at L4 and L5 DR with subsequent possible RFA. Anyone have experience with doing an RF with a stim in place? Thanks!

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[lobelsteve]

No issues. Place ground pad near RF location on skin.

 

[facets]

The SCS reps have always told me to turn it off

 

[specepic]

The official word from BS is to not do it (RFA). Until the day of tort reform, I do not therefore. I can imagine that it prob wouldnt be an issue in reality

 

[lonelobo]

done it maybe 10 times , never an issue.

 

[emd123]

The official word from BS is to not do it (RFA). Until the day of tort reform, I do not therefore. I can imagine that it prob wouldnt be an issue in reality

I believe the concern is that it could hurt the battery and stim equipment, not the patient. The reps have told me the same thing, just turn the stim off. I've never seen it be an issue, it's so low voltage and current to begin with, and you're putting that same current up to their spine normally anyways.

 

[clubdeac]

I had one patient come back afterward stating the RF drained the IPG. He said after the procedure he was having to charge the batter daily whereas before it was more like weekly. Didn't know what to make of it other than replace the battery

 

[powermd]

I'll add my N=1 to the list. On the basis of everyone's experience here, I did a lumbar RF on a patient with a Medtronic SCS today without apparent issues.

 

[bedrock]

I've done about 10-12 RF on patients with SCS. Just have them turn off SCS, put ground very close to RF cannulae, no issues.

 

[lobelsteve]

Did left side today, right side 2 weeks ago. IPG on right flank. Ground pad between IPG and RFA probes.

 

[emd123]

I've continued without problem. Did RFa on a bladder Stim patient today also. Per urologist and rep, same rules, turn battery off and keep needles and grounding pad far away from battery and leads.

 

[drusso]

Never an issue. I do what Steve does.

 

[olafa]

I had one patient come back afterward stating the RF drained the IPG. He said after the procedure he was having to charge the batter daily whereas before it was more like weekly. Didn't know what to make of it other than replace the battery

that does not make sense? How would that happen it IPG is off. Have done it without problems, SCS turned of during procedure and not a prob.

 

[clubdeac]

that does not make sense? How would that happen it IPG is off. Have done it without problems, SCS turned of during procedure and not a prob.

Yeah I shrugged my shoulders and said the same thing. That's what he told me though

 

[ctts]

If you want to be safe, can do a true bipolar RF which does not require grounding pad. I have done this on one patient. Twice as many needle sticks for the patient though. And no additional reimbursement for the additional work.