Lumbar RFA with VNS

[Dansk2011]

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Can't remember if this was brought up before on this forum so I apologize but anyone done this safely? Need to see neurology before the program VNS or do bipolar vs conventional? Treating lumbar spine.

 

[clubdeac]

I think for lumbar you’ll be fine but should probably double check with implanting doc

 

[Dansk2011]

I reached out to the device company and they gave me the most generic and least helpful answer. Go figure.

 

[nvrsumr]

There is a long thread on rfa with pacer and scs that touches on this. Just do bipolar and sleep well better that night. Or punt and sleep like a baby.

 

[Orin]

Limited literature but extrapolates to be safe.

https://www.sciencedirect.com/science/article/pii/S0987705324000546

"Safety standards from the manufacturer state that radiofrequency ablation devices may damage the generator. Recommendations are made (i) to minimize the current that flows into the generator and lead system, and (ii) to position the electrodes as far as possible from the generator and lead [12]. In our patient's case, we believe that there was no current flow through the VNS therapy system. Impedance parameters were unchanged after RFA, despite known long-term durability issues with the implanted lead model (M302) [1]. The radiofrequency energy likely remained confined to the antral pulmonary veins, with a hot spot located far from the generator and lead."

I'd agree that bipolar has the lowest liability but I would place the grounding pad on the contralateral buttock and proceed as you normally would.

 

[CB1Antagonist]

I have done a few lumbar RFAs in VNS patients using the standard monopolar technique with zero issues.

 

[clubdeac]

Limited literature but extrapolates to be safe.

https://www.sciencedirect.com/science/article/pii/S0987705324000546

"Safety standards from the manufacturer state that radiofrequency ablation devices may damage the generator. Recommendations are made (i) to minimize the current that flows into the generator and lead system, and (ii) to position the electrodes as far as possible from the generator and lead [12]. In our patient's case, we believe that there was no current flow through the VNS therapy system. Impedance parameters were unchanged after RFA, despite known long-term durability issues with the implanted lead model (M302) [1]. The radiofrequency energy likely remained confined to the antral pulmonary veins, with a hot spot located far from the generator and lead."

I'd agree that bipolar has the lowest liability but I would place the grounding pad on the contralateral buttock and proceed as you normally would.

I’ve damaged an SCS battery during an RF

 

[SSdoc33]

I’ve damaged an SCS battery during an RF

Are you sure? What’d they tell you?

 

[clubdeac]

Are you sure? What’d they tell you?

Well nothing. This was 2 yrs out of fellowship. After I did the RF, the patient said his SCS quit working. Rep came in and interrogated it and said battery was completely dead. I think it was only a few years old. I attributed it to my RF but who knows

 

[Orin]

I’ve damaged an SCS battery during an RF

Sure, was it a Nevro battery?

SCS is a little different than VNS. The older SCS IPGs were most sensitive for sure. If you want guidelines, follow the ones regarding surgical electrocautery devices and go with bipolar

The American Society of Pain and Neuroscience (ASPN) Guidelines for Radiofrequency Ablative Procedures in Patients with Implanted Devices - PMC

Radiofrequency ablation (RFA) is a treatment modality used in interventional pain management to treat several conditions including chronic neck or back pain, sacroiliac joint pain, major joint pain, and pain from sites that can be isolated to a ...

pmc.ncbi.nlm.nih.gov

Safety and Management of Implanted Epilepsy Devices for Imaging and Surgery - PMC

Permanently implanted devices that deliver electrical stimulation are increasingly used to treat patients with drug-resistant epilepsy. Primary care physicians, neurologists, and epilepsy clinicians may encounter patients with a variety of implanted ...

pmc.ncbi.nlm.nih.gov

Keeping the grounding pad away from the IPG and send the cervical stuff to an academic center that can assess the VNS pre/post.