Max # of levels for RF

[nvrsumr]

Have a friend reviewing a case of a Doc who did C2 thru T1 RF on a patient. Put the guy under with propofol woke him up to test MBB response then knocked him back out and burned away....

Are there any guidelines/studies regarding max levels to RF? I can think of any but know some folks on here have an exhaustive knowledge of the literature.

Even better the guy was young with a TBI and significant cognitve issues.

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[Pacman27]

Terrible, this the exact reason why we will not survive

 

[bedrock]

Terrible, this the exact reason why we will not survive

agree completely.

For NVR, I don't have any guidelines to point your friend to. I would recommend he contact ISIS. They might have something published somewhere. There are the most reputable organization on this sort of thing.

 

[pastafan]

agree completely.

For NVR, I don't have any guidelines to point your friend to. I would recommend he contact ISIS. They might have something published somewhere. There are the most reputable organization on this sort of thing.

+1. Bogduk has stated that in 90% of his patients he performs one level.

 

[emd123]

Since Medicare and other insurances are limiting facet MBB and rf sessions, doing only one level, and then having to go back and do another level or two later, may not be feasible.

Okay, Bogduk does 1 level, but how many nerve/joint levels are people who don't have textbooks named after them, doing in general?

 

[epidural man]

Have a friend reviewing a case of a Doc who did C2 thru T1 RF on a patient. Put the guy under with propofol woke him up to test MBB response then knocked him back out and burned away....

Are there any guidelines/studies regarding max levels to RF? I can think of any but know some folks on here have an exhaustive knowledge of the literature.

Even better the guy was young with a TBI and significant cognitve issues.

I think you need to use the data on prevalence of facet disease (see the RF chapter in Raj's textbook). C2/3 and C5/6 (I think, may be C4/5) are by FAR the most common places. So if they have a headache associated with pain, do TON, C3, C4. If they have the common referral pattern and pain pattern for the C5/6, do C4,5,6.

 

[stim4u]

BCBS in NJ limits to 2 levels. This is little restrictive for some patients. I believe 3 levels max is more appropriate if clinically indicated.

 

[SSdoc33]

BCBS in NJ limits to 2 levels. This is little restrictive for some patients. I believe 3 levels max is more appropriate if clinically indicated.

unilaterally or bilaterally?

ie: 2 levels total?

 

[stim4u]

unilaterally or bilaterally?

ie: 2 levels total?

there is no logic here, just 64635 times 1 (b/l or not) and 64636 times one per session (b/l or not). same for cervical region.
You can make the case that this would be three medial branches rhizotomized, which treats 1.5 segments of the spine, not truly 2 levels.