NANS 2025 Orlando Recap?
Started by drusso
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-we need to do more PNS
-closed loop will redefine SCS
-we are possibly underutilizing neuromodulation
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Not sure which below are real or sarcastic as a brand new attending:
- No one really knows how to manage SIJ pain long term, or even what it is. Many people can’t even manage it short term. (Semi joking but I actually loved this set of lectures all about how SIJ injections are a coin toss for most docs and how fusion, stim, and RFA all have weak outcomes.) I leave all SIJ to my partner who loves to fuse and this reassured me I was right to.
- Every stim company’s magic beans are better than their competitors magic beans
- All the real docs do SPRINT for every pain indication, even if they don’t know why it works.
- The Injectrode is actually a pretty slick device that I think has the potential to take on SPRINT once it’s live.
- We are going to be hearing A TON about AI in SCS in the coming years.
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Sorry, but that SIJ lecture sounds heavily compromised by industry. All designed to fool supposedly smart doctors into thinking that only really expensive irreversible surgical devices work better than less expensive and reversible conservative options.
I have helped many SIJ patients by getting them to PTs who are truly skilled in SIJ, including SIJ manipulation and by doing many hundreds of SIJ injections with steroids and/or PRP, and over a hundred SIJ ablations. Very rarely have I had a complete treatment failure of SIJ pain with using one or all four those options, though SIJ ablations and PT manipulation are both technique sensitive.
You’re dooming most of your SIJ patients to a lifetime of pain if you just punt them all to your SIJ fuse happy partner without first doing the right thing for these patients and first treat them with one or all of those four conservative options.
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Good for you. My technique must be off because my SIJ RFAs are less than stellar. Even tried going more CLO to run more parallel with the nerves but no difference. Used twice the amount of needles, too. Went closer to the foremen etc.
PNS. PNS everywhere and in everything
I didn’t do a good job summarizing the lectures. It was definitely not fuse or PNS heavy. It basically argued that none of them have any better evidence than just SIJ injections. But they also presented good data about how many SIJ injections are really outside the joint. Maybe it’s limited experience but I have had very few SIJ home runs.
But I agree, PT and biomechanics is better.
One of the SIJ Fusion KOL's from FL is in our Dick of the Week thread for bragging about his Dx SIJ block in preparation for SIJ fusion. He missed the joint and posted the arthrogram showing so.
link
The problem when these KOL idiots start claiming SIJ injections fail is they start publishing as such and then payors use their idiotic papers to write new policy such as we have now with the “two diagnostics of 75% with the first being short acting and the second being long acting”
Where can I find such thread?
Private forum
i wish we still had SIJ RFA covered
Can't you just ablate the middle cluneal nerves?
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One does not ablate cluneals. They need to be hydrodissected or electrically modulated.
