pars defect block

[fastosprintini]

dear colleagues, a surgeon requests that I do above block on one of his patients (failed back), on the risk of looking clueless, what is that?
can anyone help me out with a description of this block
thank you, fasto

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[SSdoc33]

if you can solve failed back syndrome with a pars block, then i'm miles davis.

 

[Tenesma]

i believe this is one of the problems of serving as lackeys to the surgeons... i have trained all of my referring surgeons that I don't do procedures on demand, but that I will be glad to evaluate the patient and make recommendations.... I explain to them that i am a consultant... if they already know what the patient needs then they can send the patient to Interventional Radiology....

otherwise, you get silly requests... btw, having done a few pars defect injections, i have yet to see any of them (except 1 who had a few days of complete relief) do better...

 

[fastosprintini]

dear colleagues , thank you for the helpful responses....
i always think that if i don't have to contribute something meaningful then its better to stay quiet..
fasto

 

[PMR 4 MSK]

I've had surgeons ask me to do it diagnostically - lay down some lido on the pars defect and see if their pain goes away for a couple hours. If so, they'll fuse - mainly see this in bilaters pars defects with grade 1-2 listhesis without instability on flexion and extension views.

Just guide a needle to the pars defect obliquely - aim for the scotty dog collar (instead of his chin or ear), check AP, lat and oblique - sometimes you can put the needle into the gap, so beware you don't go through it and go intrathecal.

 

[fastosprintini]

thank you PMR, that clarified it for me
fasto

 

[Pain_doc]

Ok, resurrecting this one. I've just received requests for pars injections on 3 different patients this past week (from 3 different spine surgeons). Is there some new literature out there about par injections----and subsequent fusions would be my guess??

 

[Tenesma]

they are going to get fused no matter what... pars defect w/ listhesis with back pain - they will diagnose unstable listhesis, easy justification for fusion...

 

[Pain_doc]

I don't doubt that each will be offered a fusion. But what's with the sudden uptick in pars injection. Maybe the insurers are requiring it prior to fusion😉