Simplicity - SIJ denervation

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NJPAIN

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Hadn't done one of these for a little over a year. Did one today and took me nearly 30 minutes to get satisfactory placement. I've asked before but will ask again, anyone have any tricks other than using a spinal needle as a finder? Any tips on how low and lateral to enter skin and hit sacrum. Anyone insert with curve upward rather than recommended downward position?


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I use Nimbus needles instead to create multiple bipolar lesions. Much better tolerated. Pretty good results.
 
I'll try to find some images.

The pearl: square up the L5-S1 disk. Decline the II 65 degrees to the feet. You will then be roughly parallel to the dorsal surface of the sacrum. You will see the S1 SAP up top.

Then drive a 5" 22ga spinal needle starting at the bottom of the sacrum to the S1 TP.

Look again at the L5-S1 squared disk space. Is the needle lateral to the sacral neuroforamina? Good.

Take a lateral view. Spinal needle should be parallel to the dorsal surface of the sacrum. If not, adjust your trajectory.

Then go back to the II declined view. Remove the spinal needle. As you do so, inject 5cc 4% lidocaine.

Next, advance the simplicity probe. You got to really push that thing forcefully, run it against the bone the whole way up.
 
How much are these probes? Do you need a newer rf machine? Mine is old, but can support the venoms. Will it work?
 
Ligament said:
I'll try to find some images.

The pearl: square up the L5-S1 disk. Decline the II 65 degrees to the feet. You will then be roughly parallel to the dorsal surface of the sacrum. You will see the S1 SAP up top.

Then drive a 5" 22ga spinal needle starting at the bottom of the sacrum to the S1 TP.

Look again at the L5-S1 squared disk space. Is the needle lateral to the sacral neuroforamina? Good.

Take a lateral view. Spinal needle should be parallel to the dorsal surface of the sacrum. If not, adjust your trajectory.

Then go back to the II declined view. Remove the spinal needle. As you do so, inject 5cc 4% lidocaine.

Next, advance the simplicity probe. You got to really push that thing forcefully, run it against the bone the whole way up.
Click to expand...

If you can post some images that would be great. Another case in a few weeks.


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Last edited:
I'd be curious to hear about anyone's technique who is doing it with standard 18 or 20g cannula. I use Nimbus at one asc in bipolar coming in perpendicular to os. Works decent. Similar to cooled rf technique which I did in fellowship. Other asc won't let me use a non-Stryker brand cannula as voids generator warranty per rep. Not gonna be able to get around that. I can use venom but never done SI RF coming in parallel to nerve. I can kinda made it up, but don't know best way to do it, where to enter, etc.


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You can go perpendicular to the nerve with venom. That is how Stryker teaches it at the course.
 
BobBarker said:
You can go perpendicular to the nerve with venom. That is how Stryker teaches it at the course.
Click to expand...

Really? Interesting. Strip lesion in bipolar from top S1 on down to bottom S3 or single lesions at tips like cooled rf? I looked through their white papers from reps a while back and didn't seem to give much of a wide lesion distal to tip unless I missed it.


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Ligament said:
Bill 64640 x 3, 64635 x 1,
Click to expand...

Are you performing the procedure on Medicare patients? If so, check your contractor's LCD. Ours stated that SIJ RF, in no uncertain terms, is not covered. You can't hide behind peripheral nerve RF. It took a while for me to find this, as it was buried in a blanket "pain management" coverage document.

"Radiofrequency ablation used for sacro-iliac joint pain is considered not medically necessary/investigational whether performed using traditional, cooled, or pulsed radiofrequency."
 
powermd said:
Are you performing the procedure on Medicare patients? If so, check your contractor's LCD. Ours stated that SIJ RF, in no uncertain terms, is not covered. You can't hide behind peripheral nerve RF. It took a while for me to find this, as it was buried in a blanket "pain management" coverage document.

"Radiofrequency ablation used for sacro-iliac joint pain is considered not medically necessary/investigational whether performed using traditional, cooled, or pulsed radiofrequency."
Click to expand...

Good point, but if you have to really search for it, the Medicare people don't know either. I don't try to find ways not to get paid.

I believe you're in the northeast, Vermont or nearby?
I averaged 9-10 simplicity SIJ RF per year while working for 5 years in the Philadelphia area. Half of those were Medicare patients. I got paid for 47 out of 48 cases. Only one commercial Cigna patient didn't get paid.
 
bedrock said:
Good point, but if you have to really search for it, the Medicare people don't know either. I don't try to find ways not to get paid.

I believe you're in the northeast, Vermont or nearby?
I averaged 9-10 simplicity SIJ RF per year while working for 5 years in the Philadelphia area. Half of those were Medicare patients. I got paid for 47 out of 48 cases. Only one commercial Cigna patient didn't get paid.
Click to expand...

The idea is to get paid, and KEEP IT!
 
Ligament said:
I'll try to find some images.

The pearl: square up the L5-S1 disk. Decline the II 65 degrees to the feet. You will then be roughly parallel to the dorsal surface of the sacrum. You will see the S1 SAP up top.

Then drive a 5" 22ga spinal needle starting at the bottom of the sacrum to the S1 TP.

Look again at the L5-S1 squared disk space. Is the needle lateral to the sacral neuroforamina? Good.

Take a lateral view. Spinal needle should be parallel to the dorsal surface of the sacrum. If not, adjust your trajectory.

Then go back to the II declined view. Remove the spinal needle. As you do so, inject 5cc 4% lidocaine.

Next, advance the simplicity probe. You got to really push that thing forcefully, run it against the bone the whole way up.
Click to expand...

I've got another SImplicity on Friday. If you can locate those images that would be a help.
 
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