RFA multiple burns

[deleted875186]

For the people that do a lumbar RFA with multiple burns, why do you do multiple burns? Do you move the needle slightly in between burns? Do you check motor is negative between every burn? Do you think multiple burns is truly more efficacious? Do you check sensory stimulation during your RFAs or just trust needle placement?

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[Laryngospasm]

I don’t do it. Some do. Most rotate 180.

 

[Taus]

I use an 18g venom. I burn medial to lateral at the base of sap/tp junction, retract then advance up base of wall sap and burn cephalad/caudal. Fully covers the target zone as seen in sis text.

I think just rotating 180 degrees may be a waste of time as an 18g will lesion laterally to tip by diameter of cannula.

perhaps overkill and not needed, but I’d rather carpet bomb the area and if rfa fails I can’t question me missing the nerve. I hesitate changing as my results have been quite good

 

[deleted875186]

I use an 18g venom. I burn medial to lateral at the base of sap/tp junction, retract then advance up base of wall sap and burn cephalad/caudal. Fully covers the target zone as seen in sis text.

I think just rotating 180 degrees may be a waste of time as an 18g will lesion laterally to tip by diameter of cannula.

perhaps overkill and not needed, but I’d rather carpet bomb the area and if rfa fails I can’t question me missing the nerve. I hesitate changing as my results have been quite good

Do you sensory and motor test initially, inject local, and then do multiple burns? Do you inject more local between burns? Test motor again, or you figure as long as your needle doesn’t move anymore anterior than no need to test motor again?

 

[Crybaby]

I will repeat burn once or sometimes twice. I slightly reposition my probes to maximize surface area as the needles supplied to me are 20 gauge. I feel like since needles are placed I don't have to do much to give them a bit more coverage- that is my reasoning.

I check motor stim prior to numbing and than I trust imaging AP and Lat. I do not repeat motor testing given I have already numbed the area.

I only do sensory if I am going after pudendal N.

 

[callmeanesthesia]

2 burns, 1.5 minutes each. rotate the needle 180 in between. No repeat testing. I think the in vitro studies show lesion continues to grow up to about 2.5 minutes (no time to go look up the ref right now) so I figure worst case it still ends up being a bigger lesion than 1 burn, and turning the needle may make it significantly bigger like a venom.

 

[Nodolor]

stopped rotating 180 about 5 years ago and anecdotally have noticed no difference in results

 

[bedrock]

Agree with two burns x 90 seconds to cover entire groove, however I think 180 degrees between them burns areas that are less likely to contain the medial branches. I rotate 100 degrees, which creates a more consistent wide lesion of the MB area.
I don’t retest motor for the second lesion.

 

[deleted875186]

Agree with two burns x 90 seconds to cover entire groove, however I think 180 degrees between them burns areas that are less likely to contain the medial branches. I rotate 100 degrees, which creates a more consistent wide lesion of the MB area.
I don’t retest motor for the second lesion.

I don’t really curve needles very much, only slight if any curve, and often times just use a straight needle. I imagine rotating needle only does anything if you have an agreed I’ve curve?

 

[Baron Samedi]

If I don't get satisfactory sensory stim but like the needle placement I'll rotate and burn a second time. I don't recheck motor. I don't routinely sedate, so I'm pretty confident if I'm burning a nerve root my patient will tell me.

 

[bedrock]

I don’t really curve needles very much, only slight if any curve, and often times just use a straight needle. I imagine rotating needle only does anything if you have an agreed I’ve curve?

rotating a straight needle doesn’t help anything.
Whether you rotate or not, I’d recommend a curved needle. Definitely more effective for spine RFA, than straight.

 

[pmrmd]

I rotate so that the tip is angled toward TP the first burn and up the SAP the second. The degrees of rotation reflect that, whatever the number is for that particular case.