Lumbosacral RFA Benefit

[manowar rules]

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A good c-arm tech is worth their weight in gold (or Christmas bonuses). Mine is great, just a few years younger than me and joined our clinic right when I first built our flouro suite and transitioned from the ASC. I hope he’s here until I retire. He smokes like a chimney but I’ve learned to stop bothering him about it.

 

[DoYouEvenLiftBro]

You’ll see a massive drop in calculated time/exposure with the low dose and pulse

Most of my stim trials and implants are 20-30 seconds

MILD is likely my biggest exposure going live with hands in the beam for the ligament (any tips with that appreciated)

 

[BobBarker]

I did a bilateral lumbar RFA today at the ASC with a scrub tech running the c arm. 17s. Not sure how that compares in office. I took quite a few lateral images getting depth optimal.

 

[BoardingDoc]

Correct I typically just open up my hands or look at the screen and my MA takes a pic.

I take a big step backwards and they take a picture.

 

[sdnuser001]

I don’t think the people with <10s fluoro are getting to the lateral pillar at the waist. I think it’s all on posterior pillar/lamina. Safe, but likely a complete sham procedure.

Disagree. Look at the attached pics, a large amount of the MB runs laterally along the lamina. I've experimented with different techniques and placing needle parallel on the posterior pillar works just as well as going deep to the lateral pillar. In fact, when doing bilateral RF its my preferred approach. The risk of drop head is very low but would rather be safe and catch as few motor fibers as possible which staying posterior allows for.

 

[RoloTomassi]

Disagree. Look at the attached pics, a large amount of the MB runs laterally along the lamina. I've experimented with different techniques and placing needle parallel on the posterior pillar works just as well as going deep to the lateral pillar. In fact, when doing bilateral RF its my preferred approach. The risk of drop head is very low but would rather be safe and catch as few motor fibers as possible which staying posterior allows for.

1. You miss the more proximal articular branches
2. How do you burn parallel if targeting posterior?

 

[BobBarker]

Eyeball math. Access around midline or maybe even opposite side. Bend of the needle pointing anterior to try to hug the lamina. Probably is harder to do than one would think.

 

[bedrock]

Disagree. Look at the attached pics, a large amount of the MB runs laterally along the lamina. I've experimented with different techniques and placing needle parallel on the posterior pillar works just as well as going deep to the lateral pillar. In fact, when doing bilateral RF its my preferred approach. The risk of drop head is very low but would rather be safe and catch as few motor fibers as possible which staying posterior allows for.

You’re misunderstanding the anatomy. The dorsal ramus medial exits the neuroforamen and then travels dorsally to supply the facet joints. If you only place the RF needle parallel on the posterior pillar you are missing many medial branch sensory fibers, because you are only cauterizing the distal portion but not the mid portion of the medial branch sensory nerves, which means an incomplete burn, and incomplete pain relief.

 

[clubdeac]

Disagree. Look at the attached pics, a large amount of the MB runs laterally along the lamina. I've experimented with different techniques and placing needle parallel on the posterior pillar works just as well as going deep to the lateral pillar. In fact, when doing bilateral RF its my preferred approach. The risk of drop head is very low but would rather be safe and catch as few motor fibers as possible which staying posterior allows for.

I’ve seen this pic and we discussed this on another thread. I don’t think you’re catching a majority of the articular branches if staying back.

Also interestingly, I used this technique a month ago on a very thin elderly woman bc I was afraid of complications. she ended up getting drop head. 🤔

 

[Ducttape]

You’ll see a massive drop in calculated time/exposure with the low dose and pulse

Most of my stim trials and implants are 20-30 seconds

MILD is likely my biggest exposure going live with hands in the beam for the ligament (any tips with that appreciated)

is this after you collimate? collimate to the targetted space on CLO and your hands shouldnt be in the field. if you have to hold the trocar, hold it above the ball that is (supposed to) secure it.

 

[sdnuser001]

1. You miss the more proximal articular branches
2. How do you burn parallel if targeting posterior?

Parallel as in the needle lies flat on lamina going medial to lateral. Similar to how I do SIJ ablations.

I understand the argument that you may not be catching as many medial branch sensory fibers but in real life I haven't seen a significant difference in outcomes between this and the traditional approach which I still do.

 

[bedrock]

Parallel as in the needle lies flat on lamina going medial to lateral. Similar to how I do SIJ ablations.

I understand the argument that you may not be catching as many medial branch sensory fibers but in real life I haven't seen a significant difference in outcomes between this and the traditional approach which I still do.

An important question would be what is your realistic and consistent % relief and duration of relief your patients obtain when you’ve done traditional cervical RFA?

 

[MitchLevi]

Parallel as in the needle lies flat on lamina going medial to lateral. Similar to how I do SIJ ablations.

I understand the argument that you may not be catching as many medial branch sensory fibers but in real life I haven't seen a significant difference in outcomes between this and the traditional approach which I still do.

Post procedure pictures if you don't mind. You're missing a lot of nerve.

 

[sdnuser001]

Post procedure pictures if you don't mind. You're missing a lot of nerve.

Will do. I learned the technique from one of the frequent posters on this forum but can't seem to find the pic anymore. I know it's on one of the cervical RFA threads

 

[painisfear]

i dont even say anything, i just use my fingers to communicate and they know what im doing

Same. Sometimes they just look at what I’m doing (when I look at the monitor they take a picture if it’s after I adjusted the needle and my hand is moved). Sometimes I signal with my fingers like I’m taking a picture on a camera and then they know to take a picture.