RFA machine shopping: needs: perpendicular lesion ability and multilesion ability

[specepic]

Just as the thread title states. I currently utilize the Kimberly-Clark/halyard/Avanos machine. It is what I used in fellowship and when started in practice a little more than 10 years ago I got the same one.

I really like cooled RFA in the lumbar spine especially for obese patients or patients with tough anatomy. It is great to be able to come in perpendicular because you get a very true view of the junction being squared up and you are obliqued so you get anterior enough without getting caught up on the facet joint. However, when doing cooled RFA doing multiple lesions at once as a royal pain, by the time he set up all the plumbing you do not really save any time

I have looked at / demo'd the Stryker venom system. Although I suppose it could be used in a perpendicular fashion I do not think it is designed for that. I really like it for knee radiofrequency, the probes do not flop (top heavy) as much as on the cooled system and I could do all 3 lesions or 4 lesions at once, huge time savings and more comfort for the patient

What I am looking for is a system that may have the best of both worlds. Create a large lesion which could be appropriate for perpendicular needle placement in the lumbar spine, and also allows for easy multilesion

My machine also has the ability to do standard radiofrequency and I certainly do that quite a bit in the cervical spine and sometimes in the lumbar spine if they have clean anatomy---- but as above I am looking for additional capability.

I need a new machine anyways so the timing is good

I think I heard something about Boston Scientific having a machine but I do not know anything about it, I am open to other recommendations

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[bedrock]

Just as the thread title states. I currently utilize the Kimberly-Clark/halyard/Avanos machine. It is what I used in fellowship and when started in practice a little more than 10 years ago I got the same one.

I really like cooled RFA in the lumbar spine especially for obese patients or patients with tough anatomy. It is great to be able to come in perpendicular because you get a very true view of the junction being squared up and you are obliqued so you get anterior enough without getting caught up on the facet joint. However, when doing cooled RFA doing multiple lesions at once as a royal pain, by the time he set up all the plumbing you do not really save any time

I have looked at / demo'd the Stryker venom system. Although I suppose it could be used in a perpendicular fashion I do not think it is designed for that. I really like it for knee radiofrequency, the probes do not flop (top heavy) as much as on the cooled system and I could do all 3 lesions or 4 lesions at once, huge time savings and more comfort for the patient

What I am looking for is a system that may have the best of both worlds. Create a large lesion which could be appropriate for perpendicular needle placement in the lumbar spine, and also allows for easy multilesion

My machine also has the ability to do standard radiofrequency and I certainly do that quite a bit in the cervical spine and sometimes in the lumbar spine if they have clean anatomy---- but as above I am looking for additional capability.

I need a new machine anyways so the timing is good

I think I heard something about Boston Scientific having a machine but I do not know anything about it, I am open to other recommendations

Are you hospital based? I assume that is how you can afford cooled and the venom probes?

 

[specepic]

Are you hospital based? I assume that is how you can afford cooled and the venom probes?

yep hosp based

 

[Ronin1]

I have the cooled bayliss as well as a stryker. Never use the cooled feature after switching to venom. Just trialed the Medtronic unit and they have really large 16 g needles available that are inexpensive so I am probably going to switch to it to save disposal costs. Also MDT has a good lease deal where they give you the machine if you buy about 27k disposables over 3 years. This includes probes which in my case almost meets the minimum up front. It’s fairly user friendly.

 

[BobBarker]

Medtronic can do cooled. It is a good system. If you use MDT for SCS, you can work out a rebate.

 

[specepic]

I have the cooled bayliss as well as a stryker. Never use the cooled feature after switching to venom. Just trialed the Medtronic unit and they have really large 16 g needles available that are inexpensive so I am probably going to switch to it to save disposal costs. Also MDT has a good lease deal where they give you the machine if you buy about 27k disposables over 3 years. This includes probes which in my case almost meets the minimum up front. It’s fairly user friendly.

Excellent TY

 

[specepic]

So far staying on topic, good job boys (and girls?)!

 

[lobelsteve]

The machine does not make much of a difference. Patient selection with appropriate double diagnostic medial branch blocks is the best criteria. Using larger needles higher temperatures and longer burn times will yield you the best results.

 

[specepic]

So far staying on topic, good job boys (and girls?)!

The machine does not make much of a difference. Patient selection with appropriate double diagnostic medial branch blocks is the best criteria. Using larger needles higher temperatures and longer burn times will yield you the best results.

I spoke too soon

 

[deleted131481]

We have the MDT Accurian RF machine as well and have been happy with it - used the cooled only twice but seemed to go well. Only used one probe but multiple would likely be cumbersome. The interface is decent regarding saved settings, pulsed, and bipolar modes. Probes seem to have held up so far. No idea about cost - we are hospital based for at least a few more months.

 

[Ducttape]

reviving this thread...

opinions amongst various RF units?

my 10 year old neurotherm unit is going to cost $3000 to repair.

the other thread seems to suggest that Stryker is a no go.

Abbott rep states that there is a new model, called Ionic.

how are the coolief or MDT machines for standard RF?

 

[DOctorJay]

when we demo'd the Medtronic machine it looked like the lesions were quite large and seemed like it wouldn't even be necessary to use the cooled RF capability of that system. we ended up sticking with our neurotherm units however.

 

[callmeanesthesia]

It’s not cooled but regardless, I wouldn’t recommend the Cosman (Owned by Boston Scientific). The Nitinol probes have terrible durability, and our machine just broke after less than 2 years. Hopefully still under warranty but we are going to be looking into other options. I like the Stryker unit but their disposables are much more expensive. Sounds like the Medtronic is nice - I’ll have to check that out. I do almost all Nevro SCS so no help there on pricing. The Stryker rep said he could work with me some on the price of Kypho supplies if I had their RF machine but the RF machine and disposable price was not negotiable.

 

[clubdeac]

you can do multi-lesion now with the Kimberly Clark cooled machine

 

[Ducttape]

when we demo'd the Medtronic machine it looked like the lesions were quite large and seemed like it wouldn't even be necessary to use the cooled RF capability of that system. we ended up sticking with our neurotherm units however.

any reason you stuck with Neurotherm?

 

[DOctorJay]

any reason you stuck with Neurotherm?

no issues with our current machines and some of us like using the Nimbus needles for certain cases which I don't believe are compatible with the Medtronic system

 

[Ligament]

Just as the thread title states. I currently utilize the Kimberly-Clark/halyard/Avanos machine. It is what I used in fellowship and when started in practice a little more than 10 years ago I got the same one.

I really like cooled RFA in the lumbar spine especially for obese patients or patients with tough anatomy. It is great to be able to come in perpendicular because you get a very true view of the junction being squared up and you are obliqued so you get anterior enough without getting caught up on the facet joint. However, when doing cooled RFA doing multiple lesions at once as a royal pain, by the time he set up all the plumbing you do not really save any time

I have looked at / demo'd the Stryker venom system. Although I suppose it could be used in a perpendicular fashion I do not think it is designed for that. I really like it for knee radiofrequency, the probes do not flop (top heavy) as much as on the cooled system and I could do all 3 lesions or 4 lesions at once, huge time savings and more comfort for the patient

What I am looking for is a system that may have the best of both worlds. Create a large lesion which could be appropriate for perpendicular needle placement in the lumbar spine, and also allows for easy multilesion

My machine also has the ability to do standard radiofrequency and I certainly do that quite a bit in the cervical spine and sometimes in the lumbar spine if they have clean anatomy---- but as above I am looking for additional capability.

I need a new machine anyways so the timing is good

I think I heard something about Boston Scientific having a machine but I do not know anything about it, I am open to other recommendations

How do you afford the $850 cooled RF probes which are used once then thrown in the trash?

 

[Ligament]

you can do multi-lesion now with the Kimberly Clark cooled machine

So you could do four cooled lesions at $850 x 4 probes = $3400 in disposable costs????

 

[lobelsteve]

How do you afford the $850 cooled RF probes which are used once then thrown in the trash?

Just wipe them off with a rag, just like the dipstick when checking your oil.

 

[Orin]

So you could do four cooled lesions at $850 x 4 probes = $3400 in disposable costs????

You would do four cooled lesions with one probe kit. At 2 minutes and 30 seconds per burn.
It takes a while.

Wait until you do an SI Joint.

 

[SommeRiver]

Neurotherm here - No issues.

 

[pmrmd]

I'm looking for another unit also. I may just get another Neurotherm 1100 used somewhere but Cosman is giving a super deal on a new system.

 

[Ligament]

You would do four cooled lesions with one probe kit. At 2 minutes and 30 seconds per burn.
It takes a while.

Wait until you do an SI Joint.

I've done many SI joints with cooled RF since it was released about 10 years ago. So boring. God I hated doing those.

 

[callmeanesthesia]

I'm looking for another unit also. I may just get another Neurotherm 1100 used somewhere but Cosman is giving a super deal on a new system.

My partner and I got a great deal on a Cosman system almost exactly 2 years ago. Electrodes have all broken and been replaced, many of them several times, and the machine just broke and we have to pay at lease $2000 to send it back for repair.

 

[The JockDoc]

Does anyone have contact info for a Medtronic rep? I've been having trouble getting ahold of them.

 

[bedrock]

I’d get a Neurotherm machine. Inexpensive machine and cannulae. Simplicity 95% as effective as cooled for SIJ RF, in 1/3rd the time, for half the cost.

No problem getting 16G cannulae for peripheral joint RFA, unlike Stryker.

Definitely no on buying Stryker due to cost, and definite no on cosman due to fragility and no special features like simplicity RFA. No on Avanos because way too expensive and slow.

Really comes down to Neurotherm and Medtronic. Medtronic is much more expensive and I hear they haven’t worked all the bugs out yet with their new machine.

However, Medtronic 2.0 machine may be the one to get, but neurotherm would be my choice if buying during the next 5 years.

 

[drusso]

The machine does not make much of a difference. Patient selection with appropriate double diagnostic medial branch blocks is the best criteria. Using larger needles higher temperatures and longer burn times will yield you the best results.

...and real Ballers don't check a sensory stim...

 

[callmeanesthesia]

I’d get a Neurotherm machine. Inexpensive machine and cannulae. Simplicity RF 95% as effective as cooled for SIJ RF, in 1/3rd the time, for hand the cost.

No problem getting 16G cannulae for peripheral joint RFA, unlike Stryker.

Definitely no on buying Stryker due to cost, and definite no on cosman due to fragility and no special features like simplicity RFA.

Avanos way too expensive and slow.

Really comes down to Neurotherm and Medtronic. Medtronic is much more expensive and I hear they haven’t worked all the bugs out yet with their new machine.

However, Medtronic 2.0 machine may be the one to get.

Did a lot of simplicity in fellowship. In practice I’ve been doing the palisade technique. I read a meta-analysis that showed significantly higher efficacy with the palisade technique and the article was very critical of Simplicty. I remember the Neurotherm we had seemed a little antiquated, but not sure if that was an older generation machine?

 

[BobBarker]

I have the MDT machine as do every other physician who has upgraded machines in my area. I have not heard of any problems. It has been perfect so far. It is a little computer so any upgrades will just be software based for the next 10 years.

 

[bedrock]

Did a lot of simplicity in fellowship. In practice I’ve been doing the palisade technique. I read a meta-analysis that showed significantly higher efficacy with the palisade technique and the article was very critical of Simplicty. I remember the Neurotherm we had seemed a little antiquated, but not sure if that was an older generation machine?

I did a lot of SIJ RF my first 10 years in practice. Did both simplicity and pallisade SIJ RFA on many of the same patients for their repeat RFA. One year pallisade and the next year, simplicity. I found the pallisade to definitely work well, but it was not as effective as simplicity in most patients.

Meta-analysis doesn't mean Sh&t as you know.

 

[callmeanesthesia]

I did a lot of SIJ RF my first 10 years in practice. Did both simplicity and pallisade SIJ RFA on many of the same patients for their repeat RFA. One year pallisade and the next year, simplicity. I found the pallisade to definitely work well, but it was not as effective as simplicity in most patients.

Meta-analysis doesn't mean Sh&t as you know.

How much do the simplicity probes cost you? I never even tried to get them because I had recalled from fellowship that they were about $500 each and I’m in private practice. I did like doing them.

 

[drusso]

How much do the simplicity probes cost you? I never even tried to get them because I had recalled from fellowship that they were about $500 each and I’m in private practice. I did like doing them.

You can get the cost down to around $200 and just charge the patient cash.

 

[bedrock]

You can get the cost down to around $200 and just charge the patient cash.

This

 

[Ligament]

How much do the simplicity probes cost you? I never even tried to get them because I had recalled from fellowship that they were about $500 each and I’m in private practice. I did like doing them.

$250 / ea