SIJ RF Tips

[soccrwz]

How are you doing the SIJ RF, I've seen so many variations in tips and techniques, getting variable results, any suggestions? I don't have the option of cooled RF.

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[clubdeac]

I've done the cooled RF and lesion at the 1, 3 and 5 o'clock positions of the posterior S1-3 foramina (for the right side) and at the L5 DPR. Usually get 1-2 years relief. Tried Simplicity probe with only 4-6 most relief

 

[Vie221]

Cosman pallisade block. Had great results. I have done simplicity in the past, as well as thermal lesions at the foramen. Pallisade technique has been the most effective by far.

 

[ziggyziggy]

I've done the cooled RF and lesion at the 1, 3 and 5 o'clock positions of the posterior S1-3 foramina (for the right side) and at the L5 DPR. Usually get 1-2 years relief. Tried Simplicity probe with only 4-6 most relief

How long does it take for the whole procedure as you are doing 10 burns? Who is paying for it and how much?

 

[Ronin1]

I stopped using cooled RF years ago. It just takes too long. Similar results using Stryker venom at lateral borders 2 sets of lesions per side. Probably about 7-10 minutes total

 

[clubdeac]

How long does it take for the whole procedure as you are doing 10 burns? Who is paying for it and how much?

Did this a lot during the 6 years I was at the VA so didn't have to worry about the payers. It did take awhile though even after they developed their multilesioning capability. Probably would take me a full 1/2 hr

 

[lobelsteve]

Bipolar lesioning. I will place a needle between 12 and 6 o’clock on the outer edge of the pedicle then I will place a needle at 12 and 6 o’clock on the outer edge of the pedic. Then I’ll burn the top path and the bottom half separately. With a machine that can do four lesions at a time you can do two bipolar lesions at a time. L5 gets done separately

 

[ateria radicularis magna]

Bipolar lesioning. I will place a needle between 12 and 6 o’clock on the outer edge of the pedicle then I will place a needle at 12 and 6 o’clock on the outer edge of the pedic. Then I’ll burn the top path and the bottom half separately. With a machine that can do four lesions at a time you can do two bipolar lesions at a time. L5 gets done separately

This is my goal as well

 

[TIVAndy]

Whats the code for this? 64640?

 

[myrandom2003]

Where you buy that pallisade template thing for SI joint RF?

 

[Green Grass]

Bipolar lesioning. I will place a needle between 12 and 6 o’clock on the outer edge of the pedicle then I will place a needle at 12 and 6 o’clock on the outer edge of the pedic. Then I’ll burn the top path and the bottom half separately. With a machine that can do four lesions at a time you can do two bipolar lesions at a time. L5 gets done separately

There's a cadaver study out there showing this covers the most lateral branches. Now does that translate into better outcomes? No idea.

 

[Dansk2011]

Anyone have any good images they would be willing to share? Especially of the bipolar lesioning.

 

[Ferrismonk]

Where you buy that pallisade template thing for SI joint RF?

My cosman rep let me play with one when we got our new machine. The template is just a piece of plastic with holes drilled in it. Can't reuse or resterilize, $80 a piece if I recall correctly. No thanks.

 

[lonelobo]

There's a cadaver study out there showing this covers the most lateral branches. Now does that translate into better outcomes? No idea.

Don't think we will ever have great success with SIJ RF do to the fact of anterior innervation of joint

 

[myrandom2003]

Don't think we will ever have great success with SIJ RF do to the fact of anterior innervation of joint

I would really just want the spacing proportions and just mark them on the patient Pre-scrub.

One time fee


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[callmeanesthesia]

I would really just want the spacing proportions and just mark them on the patient Pre-scrub.

One time fee


Sent from my iPhone using SDN

1 cm apart. 5-7 needles depending on how broadly you want to cover (I do 7).

 

[clubdeac]

Here’s one pic... got lots more

 

[lobelsteve]

3 steps.

1. Normal lesion L5 at ala and S1 superior lateral quadrant
2. using S1 skin wheal, add 2 more wheals inferiorly about 1cm apart. Place 2 needles in middle wheal to hit 3 or 9 o'clock spot on S2 and S3 foramen. Top wheal needle goes to top of S2 foramen, Bottom wheal needle goes to top of S3 foramen.
3. Move only needles at top and bottom wheal to respective bottom fo S2 and S3 foramen.
Drink coffee.

 

[painfree23]

Here’s one pic... got lots more

So you only do 3 needles? How much is your fluoro obliqued? What order do you do for efficiency(L5 first then oblique later) ?

 

[clubdeac]

So you only do 3 needles? How much is your fluoro obliqued? What order do you do for efficiency(L5 first then oblique later) ?

I do four needles. I hadn't put the needle in at S3 yet. I go straight AP, no obliquity. I place L5 first and then just go down the line to S3. I have a mutligen machine so I do 4 burns at a time. Start with the needles at the 11 O'clock position if on the left side. Burn then move to 9 O'clock, burn then move to 7 O'clock. Pretty simple

 

[FF430]

At this year's AAPM meeting they were suggesting the following targets for lateral branch ablation:
RIGHT S1: 4:30,6:00, S2: 2:30, 4:00 and 5:30, S3: 1:00, 2:30
LEFT S1: 6:00, 7:30, S2: 6:30, 8:00 and 9:30, S3: 9:30, 11:00