RFA w/ Stryker Venom Needles

[MD87]

When I square off the end plates individually, it’s often a PITA placing the L3 MB and L4 MB needles. Often with the increased lordosis/cephalad tilt to square off the L5 vertebral body, the needle entry points almost overlap and my L4 needle (I place L3 first) is banging into my L3. Maybe I’ll try it your way. I’m sure I can get it in the groove regardless, though it may not be parallel to the MB (according to old cadaveric studies, at least……..)

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[painfree23]

When I square off the end plates individually, it’s often a PITA placing the L3 MB and L4 MB needles. Often with the increased lordosis/cephalad tilt to square off the L5 vertebral body, the needle entry points almost overlap and my L4 needle (I place L3 first) is banging into my L3. Maybe I’ll try it your way. I’m sure I can get it in the groove regardless, though it may not be parallel to the MB (according to old cadaveric studies, at least……..)

I used to do it this way, but ur right…it was a PITA. So since have just been placing all of them with caudal tilt

 

[RoloTomassi]

When I square off the end plates individually, it’s often a PITA placing the L3 MB and L4 MB needles. Often with the increased lordosis/cephalad tilt to square off the L5 vertebral body, the needle entry points almost overlap and my L4 needle (I place L3 first) is banging into my L3. Maybe I’ll try it your way. I’m sure I can get it in the groove regardless, though it may not be parallel to the MB (according to old cadaveric studies, at least……..)

Crossing can happen even if you place at same time if the are in the same vertical line, as entry points for L4 and L5 are very close or on the same horizontal plane, and L3 lies so flat.

My L4 entry is the most lateral, and my L5 straight down, so at least those two don't cross. L3 I'll start more medial than L4, but it still hits L4 sometimes; if very lordotic I'll place L3 first to get it out of the way, then do 4/5 together.

 

[DrSwede]

Anyone doing a double burn using the 18 g venom in the lumbar area?

 

[Taus]

Anyone doing a double burn using the 18 g venom in the lumbar area?

Yes. Lesion one medial to lateral at junction. Lesion 2 ceph/caudal up base of wall sap.

When I square off the end plates individually, it’s often a PITA placing the L3 MB and L4 MB needles. Often with the increased lordosis/cephalad tilt to square off the L5 vertebral body, the needle entry points almost overlap and my L4 needle (I place L3 first) is banging into my L3. Maybe I’ll try it your way. I’m sure I can get it in the groove regardless, though it may not be parallel to the MB (according to old cadaveric studies, at least……..)

More of a problem for me on Cervical. Solution for me has been to purposely stagger my skin entry points medial/lateral

 

[DrSwede]

Yes. Lesion one medial to lateral at junction. Lesion 2 ceph/caudal up base of wall sap.


More of a problem for me on Cervical. Solution for me has been to purposely stagger my skin entry points medial/lateral

TY sir

 

[runfastnow]

Along the same lines, I have a Stryker multigen 2 rf machine. Looking to get pricing for 16 and/or 18 gauge cannulas but they keep pushing venom which is out of my price range. Any ideas on compatible cannulas that can work with this machine and how I would find out that info?

Do you like the Stryker Multigen 2? Only used Abbott in the past - which are fine but nothing fancy - but looking for new machine for ASC. Does anyone have insight to price difference between regular vs Venom and/or opinion on Venom creating any better outcomes vs doing 2 burns with regular needle?

... or does anyone have a RF machine they love (or hate)? They seem to be all the same and just race to the bottom for price.

 

[cowboydoc]

The multigen 2 is really nice. lots of power, can easily do bipolar lesions with the touch of a button. The venom needles allow me to do fewer lesions, but I'm still doing 2 at each location at least half the time.

I think we're paying $30 or more per needle, which is a lot more than a standard needle, I'm sure. I don't think the cost difference is worth the suspected saving of time in most instances.

 

[RoloTomassi]

The multigen 2 is really nice. lots of power, can easily do bipolar lesions with the touch of a button. The venom needles allow me to do fewer lesions, but I'm still doing 2 at each location at least half the time.

I think we're paying $30 or more per needle, which is a lot more than a standard needle, I'm sure. I don't think the cost difference is worth the suspected saving of time in most instances.

Have you seen anyone use Boston / Cosman Sidekick cannula with Venom probe? Supposedly cheaper and compatible

 

[Ronin1]

I like the venom for the fatties so I can do a perpendicular lesion. We have a multigen that we use for this but mostly use a newer Medtronic 18gauge with 10mm active tips

 

[cowboydoc]

Have you seen anyone use Boston / Cosman Sidekick cannula with Venom probe? Supposedly cheaper and compatible

Nope. Only have the multigen and venom where I am.

 

[SC Tian]

I used to do essentially exactly this. First several years in practice. Someone wiser than I suggested to look in AP, where my skin entry points are to reach the target with in plane technique. It is essentially always at the inferior aspect of transverse process one level below. Now, I oblique out approximately 15-20 until I can clearly make out the SAP/TP Junction, no tilt, enter skin level below at inferior aspect TP, advance out of plane. Confirm in AP, confirm in 30 oblique, slightly adjust here prn, check lateral, motor test and and burn. Comparing my pictures from this to my original post fellowship technique which was essentially as above/SIS, the pictures look identical in all views and my outcomes have not changed. The only thing that has changed is my procedure time and fluoro time has been dramatically diminished

Thanks for sharing, several years ago started using 1.5 inch as pointer approach laying from the skin entry point to sap/tp junction, ap view to finalize the needle, as i feel like tp was shortened, junction is not accurate in oblique view, i make sure the tip is below upper endplate, lateral view is redundancy to me, for purely checking purpose only.