new RFA machine (comparison and real-world usage)?

[CarabinerSD]

We're looking to upgrade our old Stryker Multigen (first generation) because the touch screen is glitchy & slow (otherwise a reliable workhorse). We are a small clinic so cost is the biggest factor (including probe & disposable cannula cost). We do not do enough SCS or Kypho cases to get a discounted deal with BoSci or Medtronic.

I read past topics and summarized what I've seen below.

Looking for feedback and opinions if you've used these systems before. Also best places to order RF cannula from?


Stryker

• *Pros:
  • Venom
  • Nitinol probes standard
• *Cons:
  • Cost
  • Incompatibility with aftermarket cannulas?

Medtronic Accurian

• *Pros:
  • Small foot print
  • Big touch screen
  • Can add coolRF component
• *Cons:
  • Requires hub to connect
  • Hub cord connection issues
  • Nitinol probes bending

BoSci Cosman

• *Pros:
  • Lower cost
• *Cons:
  • Durability?
  • Probes breaking

Abbott Neurotherm

• *Pros:
  • Lower Cost
  • Simplicity probe
• *Cons:

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[Iamnew2]

We're looking to upgrade our old Stryker Multigen (first generation) because the touch screen is glitchy & slow (otherwise a reliable workhorse). We are a small clinic so cost is the biggest factor (including probe & disposable cannula cost). We do not do enough SCS or Kypho cases to get a discounted deal with BoSci or Medtronic.

I read past topics and summarized what I've seen below.

Looking for feedback and opinions if you've used these systems before. Also best places to order RF cannula from?


Stryker

• *Pros:
  • Venom
  • Nitinol probes standard
• *Cons:
  • Cost
  • Incompatibility with aftermarket cannulas?

Medtronic Accurian

• *Pros:
  • Small foot print
  • Big touch screen
  • Can add coolRF component
• *Cons:
  • Requires hub to connect
  • Hub cord connection issues
  • Nitinol probes bending

BoSci Cosman

• *Pros:
  • Lower cost
• *Cons:
  • Durability?
  • Probes breaking

Abbott Neurotherm

• *Pros:
  • Lower Cost
  • Simplicity probe
• *Cons:

Don't do venom. Takes forever. And $$$.

 

[TheLoneWolf]

Cosman is solid.

 

[Laryngospasm]

Not sure how much bigger the screen needs to be than the Stryker. You need to go old school and burn one level at a time for a while lol

 

[callmeanesthesia]

Got a Cosman and had such issue with the probes breaking (even the Nitinol) that it’s now our backup unit and we got a great deal on a new Stryker. Have been very happy with that. Also did talk Cosman into giving us some free probes. Supposedly they are in the redesign process.

 

[Multimodal]

I switched from the neurotherm to the cosman 6 months ago since our ASC bought into all things Boston. Everything we do is with a standard RF needle, none of this venom/simplicity business so no benefit to having that option. I think they both work about the same in terms of ablation quality. It really comes down to personal preference with the user interface. The one big thing I like about Cosman are the shorter tails on the probes vs the neurotherm ones which would inevitably get tangled all the time.

 

[ziggyziggy]

Don't do venom. Takes forever. And $$$.

Venom saves time because you don't have to do multiple burns. Can you explain why it takes you forever? Have been using venom without issues. But agree its expensive.

 

[Ronin1]

Radionics..

 

[Ronin1]

Actually Medtronic has a good lease to own deal. You have to buy 30k worth of disposables including probes over 3 years and you get the generator for free. We just got one. Ordered 25 probes so they accelerate the contract to immediate ownership of the machine.

 

[Tboned]

Stryker MultiGen 2 does seem to be incompatible with other probes. For not compatible with diros trident (no adapter yet developed) or stratus nimbus for sure

 

[epidural man]

I think the question is about who's needles are the best.

I want a needle that has the beveled leading edge on the insulation part. Which one's have that? I know our neurotherm does, and our other machine (Bayless) doesn't.

 

[Ducttape]

replace the touchscreen. cheapest option.

 

[CarabinerSD]

replace the touchscreen. cheapest option.

We are going to delegate this machine to be a backup unit. Would like to invest in some newer equipment and not break the bank.

Cost wise, I know Stryker is most expensive, but what price range should I be expecting with the other vendors?

 

[Tboned]

We are going to delegate this machine to be a backup unit. Would like to invest in some newer equipment and not break the bank.

Cost wise, I know Stryker is most expensive, but what price range should I be expecting with the other vendors?

Stryker does not have to be the most expensive. It all depends on your setup/ situation. I’m in a large Ortho group, Stryker likes us, very favorable pricing.

 

[bedrock]

Stryker does not have to be the most expensive. It all depends on your setup/ situation. I’m in a large Ortho group, Stryker likes us, very favorable pricing.

How much do you pay per RF cannula?

Stryker is generally always the most expensive RF equipment.

 

[cowboydoc]

How much do you pay per RF cannula?

Stryker is generally always the most expensive RF equipment.

Coolief: “Hold my beer.”

 

[DesertDoc16]

Cosman has been solid. No issues with the nitinol probes. I think the probes have a 1 years warranty.

 

[bedrock]

Coolief: “Hold my beer.”

lol. I mean for standard thermal RF. Obviously cooled RF is its own category.

 

[RoloTomassi]

I like Venom needles. Don't understand the post about taking longer. Still do 2 burns but feel like it's the equivalent of 3 burns of traditional. Costly though.

 

[SEpainfree]

We have had good luck with cosman so far. Had one unit about 2 years. Trouble free enough that we bought another. Got a good deal ( as far as I know) on the 2nd generator when bundled with a bunch of cannulas and nitinol (sp) probes. Feel free to msg me if you need any specifics.

 

[chibadriver]

I like Venom needles. Don't understand the post about taking longer. Still do 2 burns but feel like it's the equivalent of 3 burns of traditional. Costly though.

Happy with Stryker Multigen 2 w/venom, bought two units that were refurbs. You doing two burns with 20ga? This was my practice as well but I recently made the jump to 18ga and now do one big fat one. Surprisingly well tolerated… so far. Still do two or three burns with a 20ga and 5mm tip for cervical (wrapping around the pillar).

 

[Yo GabbaPentin]

My experience with Cosman. Numerous and frequent probes breaking after roughly 1 year. All cords are junk and have been replaced several times. Machine has been sent out fr repair twice. Bought it 2.5 years ago. It’s trash.

 

[geauxg8rs]

My experience with Cosman. Numerous and frequent probes breaking after roughly 1 year. All cords are junk and have been replaced several times. Machine has been sent out fr repair twice. Bought it 2.5 years ago. It’s trash.

When you say break, do you mean physically break? Or your probes stop sensing temp or some other electrical malfunction? are these nitinol or steel?

 

[bedrock]

My experience with Cosman. Numerous and frequent probes breaking after roughly 1 year. All cords are junk and have been replaced several times. Machine has been sent out fr repair twice. Bought it 2.5 years ago. It’s trash.

We have had good luck with cosman so far. Had one unit about 2 years. Trouble free enough that we bought another. Got a good deal ( as far as I know) on the 2nd generator when bundled with a bunch of cannulas and nitinol (sp) probes. Feel free to msg me if you need any specifics.

Only had cosman machine for 6 months, but so far no issues and working fine. far less expensive than stryker.

 

[RoloTomassi]

Happy with Stryker Multigen 2 w/venom, bought two units that were refurbs. You doing two burns with 20ga? This was my practice as well but I recently made the jump to 18ga and now do one big fat one. Surprisingly well tolerated… so far. Still do two or three burns with a 20ga and 5mm tip for cervical (wrapping around the pillar).

I do 18 ga 10 mm curved for everything. 2 burns. Used to use 20 ga for cervical but switched to 18, not much diff in tolerability.

For lumbar first burn is deep on the lateral, all needles oriented in same direction, V spanning SAP-TP corner, burn. Then 90 deg twist to point the tip caudal, walking back a bit, burn again.

For cervical I have the V span across the width of facet on lateral, deep. Burn, them back up a bit, burn again.

Lot of 1% for placement and 2% before burns.

 

[callmeanesthesia]

When you say break, do you mean physically break? Or your probes stop sensing temp or some other electrical malfunction? are these nitinol or steel?

I had both issues with both types of probes. Some bent and snapped, some just stopped heating or sensing temp. it’s now our backup machine and we bought a Stryker (got a great deal on a new unit). The Cosman/BoSci RF told us they are in the process of re-engineering the probes but no ETA.

 

[chibadriver]

I do 18 ga 10 mm curved for everything. 2 burns. Used to use 20 ga for cervical but switched to 18, not much diff in tolerability.

For lumbar first burn is deep on the lateral, all needles oriented in same direction, V spanning SAP-TP corner, burn. Then 90 deg twist to point the tip caudal, walking back a bit, burn again.

For cervical I have the V span across the width of facet on lateral, deep. Burn, them back up a bit, burn again.

Lot of 1% for placement and 2% before burns.

I go back and fourth on the 5mm for cervical. Seems like some patients have really shallow articular pillars, I guess that shouldn’t matter. I don’t like that I can’t use the venom with a 5mm anyway. I’ll try the 18/10 on my next one. Do you bipolar the TON with this setup?

 

[RoloTomassi]

I go back and fourth on the 5mm for cervical. Seems like some patients have really shallow articular pillars, I guess that shouldn’t matter. I don’t like that I can’t use the venom with a 5mm anyway. I’ll try the 18/10 on my next one. Do you bipolar the TON with this setup?

No I just do it like a medial branch

 

[BobBarker]

I have a multigen 1 and a MDT I use at the hospital and the old neurotherm at the office.

The Stryker is 6 years old. Our first unit only made it 3 months and failed but never had an issue with the replacement. I use it all of the time still but use the MDT needles due to cost. They work fine with the venom cannula. I have 11 cannula that are 6 years old and they look basically new still. One had a tiny bit of discoloration and the hospital took it out of service but it was fine. Any RF needle works fine with it. I have used Epimed and DU Medical also.
Stryker needles and grounding pads are too expensive

The Medtronic is good. Very fast to test with it. But we have the hub issues same as most people. Our 2nd hub works much better. Some of the nitinol probes are a little bent as you mentioned. They are a higher gauge than the Stryker Venom nitinols and appear less durable. It can do cooled and I have used it but can not afford to use it often. We got the unit for free essentially bulk buying IPGs.

I use the Stryker and the MDT on the same procedure days as I have 24 MDT electrodes and 11 Stryker electrodes and by using both machines we almost never have to turn over the electrodes for same day use.

Neurotherm (the old one) is fine. It seems to work without issues. The probes don’t seem as durable but we are using steel ones and I’m sure the clinic staff are helping destroy them much faster. Needles are cheap.

long story short: the RF equipment are just a commodity. Go with whatever rep you like best, cheapest, etc.

If I was outfitting another office I would probably try the new neurotherm.

no experience with cosman. Boston is just renter if our market after a several years absence.

 

[Yo GabbaPentin]

When you say break, do you mean physically break? Or your probes stop sensing temp or some other electrical malfunction? are these nitinol or steel?

All of the above. Some break, some stop functioning. Both types. Total garbage.

 

[Nodolor]

I have a multigen 1 and a MDT I use at the hospital and the old neurotherm at the office.

The Stryker is 6 years old. Our first unit only made it 3 months and failed but never had an issue with the replacement. I use it all of the time still but use the MDT needles due to cost. They work fine with the venom cannula. I have 11 cannula that are 6 years old and they look basically new still. One had a tiny bit of discoloration and the hospital took it out of service but it was fine. Any RF needle works fine with it. I have used Epimed and DU Medical also.
Stryker needles and grounding pads are too expensive

The Medtronic is good. Very fast to test with it. But we have the hub issues same as most people. Our 2nd hub works much better. Some of the nitinol probes are a little bent as you mentioned. They are a higher gauge than the Stryker Venom nitinols and appear less durable. It can do cooled and I have used it but can not afford to use it often. We got the unit for free essentially bulk buying IPGs.

I use the Stryker and the MDT on the same procedure days as I have 24 MDT electrodes and 11 Stryker electrodes and by using both machines we almost never have to turn over the electrodes for same day use.

Neurotherm (the old one) is fine. It seems to work without issues. The probes don’t seem as durable but we are using steel ones and I’m sure the clinic staff are helping destroy them much faster. Needles are cheap.

long story short: the RF equipment are just a commodity. Go with whatever rep you like best, cheapest, etc.

If I was outfitting another office I would probably try the new neurotherm.

no experience with cosman. Boston is just renter if our market after a several years absence.

if you ever watch staff sterilize the probes, it is easy to see why they don't last

 

[ziggyziggy]

I like Venom needles. Don't understand the post about taking longer. Still do 2 burns but feel like it's the equivalent of 3 burns of traditional. Costly though.

I do 18 ga 10 mm curved for everything. 2 burns. Used to use 20 ga for cervical but switched to 18, not much diff in tolerability.

For lumbar first burn is deep on the lateral, all needles oriented in same direction, V spanning SAP-TP corner, burn. Then 90 deg twist to point the tip caudal, walking back a bit, burn again.

For cervical I have the V span across the width of facet on lateral, deep. Burn, them back up a bit, burn again.

Lot of 1% for placement and 2% before burns.

I thought the whole reason of using venom was to not do the turn as it give more spherical lesion. If you are doing 2 burns in different plane than its another story.

It's sad that we all have to rely on how it "feels" and there is so much variability in our procedure even when using same equipment.

 

[RoloTomassi]

I thought the whole reason of using venom was to not do the turn as it give more spherical lesion. If you are doing 2 burns in different plane than its another story.

It's sad that we all have to rely on how it "feels" and there is so much variability in our procedure even when using same equipment.

I was always taught it's more of an oval, so if you twist 90 you get a plus sign shape. I did say that I twist and walk back on lumbar, and just pull back on cervical, so even if it's spherical, it would be two spheres next to each other, not overlapping.