Nimbus Expandable Electrode

[NOSfan]

Has anyone tried the Nimbus Expandable Electrode yet? Interesting concept.

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[Doctodd]

$125 for a disposable needle is what i was told.....from RS Medical

 

[NOSfan]

Was quoted at $85 per needle....probably there some out there at $75

 

[Aether2000]

Perhaps you can run some tap water over the electrode and simply reuse it on the next patient....

 

[lobelsteve]

All of them are coming out with this.

Rf ain't broken and don't need fixing. Docs need better training. Go to an ISIS course and see a few guys use their techniques.

 

[clubdeac]

Ironically I just got a demo on this today. Looked kinda space agey, alien like. Appeared to make a large lesion on the demo slides they showed me. Not as big as cooled RF but still pretty good, especially when doing bipolar

 

[Doctodd]

Perhaps you can run some tap water over the electrode and simply reuse it on the next patient....

Where and when did you get a sense of humor?. How bout I just place it in the sterilizer? Or wouldn't the heat it emits automatically do that for me?

 

[ampaphb]

For those of us dinosaurs who still do two 90 degree 120 second lesions, the increased size of the lesion makes it more reasonable to do one burn rather than two

 

[Pacman27]

The cost seems too high for me, when we have something that works well already. Maybe for the lateral branch's

Are most of you using 18G 10mm tips and doing two burns?

Just curious to see what others are doing we do 2 burns at 90 degrees for 90 to 120 sconds

 

[Ligament]

The cost seems too high for me, when we have something that works well already. Maybe for the lateral branch's

Are most of you using 18G 10mm tips and doing two burns?

Just curious to see what others are doing we do 2 burns at 90 degrees for 90 to 120 sconds

I use 18 ga 10mm cannulae in all areas of the spine, 4 burns at 60 seconds at 80c at least.

Lumbar
burn, rotate 180, burn, move up SAP, burn, rotate 180, burn.

cervical:
In neck will move craniad/caudad according to Lord's dissections.

 

[PinchandBurn]

I agree with what Steve has said.

Water cooled RF and the like are claiming 'big' lesions are better. But is there really any science to it?

If you tk the regular RF needle and do a few lesions and 'burn' the nerve at a few places, wont it burn the nerve? What is the need to 'burn' the nerve at every point.


For example, if you have a nerve:

A----------------------B---------C---------D

and you burn at B. wont it kill the transmission from A to D ? What is the need to burn at B and C, as long as you have burned point B very well. I know this is quite simplistic, but it makes sense to me...

 

[Aether2000]

The medial branch innervates not only from the terminal end but also with branches that course over the lateral to superior aspect of the SAP. This is especially true after the initial denervation procedure with subsequent neural regrowth. Therefore, the larger the lesion on the lateral border of the SAP, the better, as long as the lesion does not extend into the neuroforamen, or onto the intermediate or lateral branches of the posterior primary rami.

 

[clubdeac]

I agree with what Steve has said.

Water cooled RF and the like are claiming 'big' lesions are better. But is there really any science to it?

If you tk the regular RF needle and do a few lesions and 'burn' the nerve at a few places, wont it burn the nerve? What is the need to 'burn' the nerve at every point.


For example, if you have a nerve:

A----------------------B---------C---------D

and you burn at B. wont it kill the transmission from A to D ? What is the need to burn at B and C, as long as you have burned point B very well. I know this is quite simplistic, but it makes sense to me...

Well according to ur illustration, if u burn A to D you're going to get twice as long relief than if u just burn from A to B

 

[bronchospasm]

Anyone using the nimbus? Experiences? Suggestions?

I am thinking of starting to use them for cervical RFA's using the lateral approach.

 

[NJPAIN]

Anyone using the nimbus? Experiences? Suggestions?

I am thinking of starting to use them for cervical RFA's using the lateral approach.

Poor man's Coolief??


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[DOctorJay]

I use them frequently. Well designed and easy to work with. They are expensive. My hospital wouldn't let me use them for routine cervical and lumbar cases but I do use them for SI and geniculates.


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[NJPAIN]

Are you still seeing Insurance reimbursement for genicular RF or are these cash pay? I haven't done one since people started talking about reimbursement issues. However, since the Coolief piece on TV the calls are rolling in again


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[DOctorJay]

I haven't had a case in a while but recently signed a patient up for the blocks so we will see if there are any issues.


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[Dr. Ice]

If I was an out of network doc I would probably market coolief much more. If I had an rf machine in my office I would also be more inclined to market it more. Doing it in an asc at Medicare rates is not cost effective at all.

OTOH if a patient is in agony and is not surgical I would consider it or if some douche joint surgeon jacked someone up and doesn't want to do a revision and instead insisted that the patient's residual knee pain "is coming from their spine"...oh yeah cause that has happened...I would do it..

 

[NJPAIN]

If I was an out of network doc I would probably market coolief much more. If I had an rf machine in my office I would also be more inclined to market it more. Doing it in an asc at Medicare rates is not cost effective at all.

OTOH if a patient is in agony and is not surgical I would consider it or if some douche joint surgeon jacked someone up and doesn't want to do a revision and instead insisted that the patient's residual knee pain "is coming from their spine"...oh yeah cause that has happened...I would do it..

Are we all convinced that Cooled RF or Nimbus needles are necessary to get optimal results? I don't personally have a large enough N in my own practice to know. But, with all of these patients calling for Coolief I want to be honest and tell them if the procedure with standard 16 needles is equivalent.


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[pastafan]

Are we all convinced that Cooled RF or Nimbus needles are necessary to get optimal results? I don't personally have a large enough N in my own practice to know. But, with all of these patients calling for Coolief I want to be honest and tell them if the procedure with standard 16 needles is equivalent.


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No, good results with standard RFA. N~180

 

[ampaphb]

Cosman first released 16g RF canulas in 2013. If you are doing one SI RF a week, you are diagnosing way more SIJ dysfunction than the published literature

 

[DOctorJay]

Cosman first released 16g RF canulas in 2013. If you are doing one SI RF a week, you are diagnosing way more SIJ dysfunction than the published literature

Agree, I've done maybe 5 in the past year


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[NJPAIN]

Agree, I've done maybe 5 in the past year


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I've done 3-4 SIJ with 18ga using palisade technique and 2 Simplicity in the last 12 months or so. I did 2 Coolief SI a few years back. I think my best results are the palisade technique and that is the easiest for me and the patient. I got ZIP results with Coolief but it could have been my poor technique and crappy landmarks in old patients. Simplicity is a trauma case in my hands. I've tried to get support/training/preceptorship from St Jude but they don't give a rat's --- about that product line.

I'm more interested if I can legitimately claim that 16 ga conventional RF and Coolief are equivalent for genicular.


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[lobelsteve]

Bipolar lesion using neurotherm machine appears to help as much as simplicity. And without the trauma.

 

[Taus]

I've done 3-4 SIJ with 18ga using palisade technique and 2 Simplicity in the last 12 months or so. I did 2 Coolief SI a few years back. I think my best results are the palisade technique and that is the easiest for me and the patient. I got ZIP results with Coolief but it could have been my poor technique and crappy landmarks in old patients. Simplicity is a trauma case in my hands. I've tried to get support/training/preceptorship from St Jude but they don't give a rat's --- about that product line.

I'm more interested if I can legitimately claim that 16 ga conventional RF and Coolief are equivalent for genicular.


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If you fan out the 16g ceph/caudal for 3 burns per geniculate nerve I would think so, but don't think anyone can make a definitive claim.

I've been doing my SIJ w palisade w 18g standard rf needle in bipolar per cosman article w decent success. Empirically same as results w cooled rf (did 15-20 cooled in fellowship). Quick and easy to do.

I was doing bipolar w Nimbus in sij but was repeatedly getting tech errors on machine as temp would rise too fast and it would shut off. The same needle/electrode then used in monopolar w no issues. Customer service was useless so I got fed up and go standard 18g rf needle.

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[clubdeac]

I had some amazing results with cooled RF of the SIJ back in the day. Haven't done one in awhile though. I've also used standard 18g needles with a very steep approach "lying" the standard RF needle on the sacrum. Works ok but not quite as well as my cooled RF's. I usually got 80%+ relief for 12-18 months with those, better than my standard lumbar RF results

 

[Ligament]

Cosman first released 16g RF canulas in 2013. If you are doing one SI RF a week, you are diagnosing way more SIJ dysfunction than the published literature

This was Peter's last post on SDN. RIP Peter.

 

[Aether2000]

OMG- you mean end of life?

 

[bedrock]

I had some amazing results with cooled RF of the SIJ back in the day. Haven't done one in awhile though. I've also used standard 18g needles with a very steep approach "lying" the standard RF needle on the sacrum. Works ok but not quite as well as my cooled RF's. I usually got 80%+ relief for 12-18 months with those, better than my standard lumbar RF results

interesting that yours turned out so well and not for NJpain. I guess this is fairly technique sensitive. I have a chronic SIJ issue for which I'm thinking about having cooled RF, but these different responses to the same procedure do worry me.

Anybody know a pain physician skilled with cooled RF in the San Diego area? Will go to LA if I need to. Will pay cash if needed.

 

[NJPAIN]

I think it is VERY technique dependent. Landmarks can be difficult to see in old patients or ones with lots of bowel gas. The Epsilon template was annoying. The few I did took a long time.


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[clubdeac]

interesting that yours turned out so well and not for NJpain. I guess this is fairly technique sensitive. I have a chronic SIJ issue for which I'm thinking about having cooled RF, but these different responses to the same procedure do worry me.

Anybody know a pain physician skilled with cooled RF in the San Diego area? Will go to LA if I need to. Will pay cash if needed.

Key is being able to visualize the posterior sacral foramen and making sure you burn close to the foramen. The nerve path varies the farther you get from the source. I've probably done 50+ over the last 8 years. Very good results. And patient selection is key! Patient usually has a positive Fortin finger sign (60% ppv), 2-3/5 positive provocative SIJ maneuvers and + response to at least 2 SIJ injections.

 

[bedrock]

interesting that yours turned out so well and not for NJpain. I guess this is fairly technique sensitive. I have a chronic SIJ issue for which I'm thinking about having cooled RF, but these different responses to the same procedure do worry me.

Anybody know a pain physician skilled with cooled RF in the San Diego area? Will go to LA if I need to. Will pay cash if needed.

Appreciate deacs comments on technique.

Anybody know a pain doc doing cooled SIJ RFA in San Diego/LA?

 

[DOctorJay]

Appreciate deacs comments on technique.

Anybody know a pain doc doing cooled SIJ RFA in San Diego/LA?

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Lise Wiltse, MD
Anesthesia Medical Group
3626 Ruffin Rd
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Scripps
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Scripps Clinic Medical Group
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Scripps Clinic Medical Group
15004 Innovation Dr, # S97
San Diego, CA 92128
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