SIS annual conference key points

[bedrock]

I assume many of you are on your way home from the 2021 SIS conference.

While you are sitting in the airport, would you mind updating those of us who couldn't make it, on the key points you learned from 2021 SIS conference ?

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[drusso]

I assume many of you are on your way home from the 2021 SIS conference.

While you are sitting in the airport, would you mind updating those of us who couldn't make it, on the key points you learned from 2021 SIS conference ?

Nothing works injected intradiscal.
DRG is hyped.
MILD is hyped, but why not?
BVN Ablation is a real head-scratcher, but with the new code Hold On Tight-Baby because it's #ModicMania
Stim still works...until it doesn't. Maybe a new waveform will help...
Spacers don't really work but don't let that stop you.
The SIJ is still a pain in the butt.
Be really careful doing injections into the cervical spine.
Meta-analysis doesn't tell us anything new, but we're going to keep doing it anyway.
Why are those so many White Dudes in Pain/Spine Medicine?
Doctors are bad at health policy.
Why are there so many pain societies and can we all get alone? Answer, no.
The new rules are about MBB's and facets aren't going so well.
The new rules about ESI's are probably not going to go well.
Peripheral nerve stim? Meh...
Who the hell let the ER doctors in?

 

[bedrock]

Nothing works injected intradiscal.
DRG is hyped.
MILD is hyped, but why not?
BVN Ablation is a real head-scratcher, but with the new code Hold On Tight-Baby because it's #ModicMania
Stim still works...until it doesn't. Maybe a new waveform will help...
Spacers don't really work but don't let that stop you.
The SIJ is still a pain in the butt.
Be really careful doing injections into the cervical spine.
Meta-analysis doesn't tell us anything new, but we're going to keep doing it anyway.
Why are those so many White Dudes in Pain/Spine Medicine?
Doctors are bad at health policy.
Why are there so many pain societies and can we all get alone? Answer, no.
The new rules are about MBB's and facets aren't going so well.
The new rules about ESI's are probably not going to go well.
Peripheral nerve stim? Meh...
Who the hell let the ER doctors in?

LOL,
Thanks drusso.

Can you expand on some of those?

1- Is their absolutely no hope for anything injected intradiscal? What about combo of BMAC +PRP? Or was this just negative reports on non autologous commercial products?

2-Tell me more about DRG being overhyped as I am falling a bit out of love with it, but would love to see data, not my own anecdotes.

3- regarding stim works until it doesn't, did they comment at all about the longevity of one waveform vs another, such as Burst vs others?
3b- any new good waveforms on the horizon? and are they currently proprietary to one company?

4-I'm actually very curious to hear what they said about spacers. I don't do them and don't plan to offer them, but I would be happy to send some of my old stenotic patients for them, if there are any patient subcategories that would actually benefit from spacers

5- what are the new rules about MBB/facets that aren't going to go well?

6- What are the new rules about ESIs that aren't going to go well?

 

[lobelsteve]

Nothing works injected intradiscal.
DRG is hyped.
MILD is hyped, but why not?
BVN Ablation is a real head-scratcher, but with the new code Hold On Tight-Baby because it's #ModicMania
Stim still works...until it doesn't. Maybe a new waveform will help...
Spacers don't really work but don't let that stop you.
The SIJ is still a pain in the butt.
Be really careful doing injections into the cervical spine.
Meta-analysis doesn't tell us anything new, but we're going to keep doing it anyway.
Why are those so many White Dudes in Pain/Spine Medicine?
Doctors are bad at health policy.
Why are there so many pain societies and can we all get alone? Answer, no.
The new rules are about MBB's and facets aren't going so well.
The new rules about ESI's are probably not going to go well.
Peripheral nerve stim? Meh...
Who the hell let the ER doctors in?

Yup. Also:
Not much from KOLs. Except bashing their crappy studies. Literature review lecture crushed Deer, Depalma, others on mesenchymal sc intradiscal.

Amirdelfan K, Bae H, McJunkin T, DePalma M, Kim K, Beckworth WJ, Ghiselli G, Bainbridge JS, Dryer R, Deer TR, Brown RD. Allogeneic mesenchymal precursor cells treatment for chronic low back pain associated with degenerative disc disease: a prospective randomized, placebo-controlled 36-month study of safety and efficacy. Spine J 2020.

This get shredded as bad all around as far as data collection, bias, analysis. Basically a big industry funded lie.

 

[Agast]

Forget masks, I’m going to suffocate myself hollering to explain two sets of medial branch blocks followed by RFA to someone who needs hearing aids

 

[SSdoc33]

Forget masks, I’m going to suffocate myself hollering to explain two sets of medial branch blocks followed by RFA to someone who needs hearing aids

I sometimes dont offer a mbb just bc i dont want to explain it

 

[SC Tian]

A modified approach for cervical transforaminal esi was discussed.

 

[lobelsteve]

A modified approach for cervical transforaminal esi was discussed.

Just need to make the vertebral artery go somewhere else. I cannot see a reason to ever offer ctfesi over cesi.

https://link.springer.com/content/pdf/10.1007/s40141-013-0013-2.pdf

 

[Dr. Ice]

I sometimes dont offer a mbb just bc i dont want to explain it

But IA facets aren’t covered..what’s one to do..

 

[Ferrismonk]

I sometimes dont offer a mbb just bc i dont want to explain it

Exactly what the insurance company wants you to do.

 

[Dr. Ice]

Exactly what the insurance company wants you to do.

Even if you do explain it at nauseam, they will still come back without their pain diary and will say that “epidermal or cortisone shot didn’t work.” And then you probe them and they say “well I felt pretty good for about 4 hours and then the pain came right back” and then you say, well that sounds like a positive diagnostic block, we should repeat it to confirm,
and they say “why would I repeat something that didn’t work.” 🤦🏽‍♂️

And the docs who are burnt out will start to say..well I have this device..you can hang out with it for 60 days....

And others will say, well you see this on your MRI..those other docs treating your arthritis were all wrong, we need to burn another type of nerve...

And then still others will say..if we take blood out of you, and inject it back into your spine..we can heal your spine...hallelujah

And at the end..those who are really burnt out will say...ok so you need a series of three epidurals and you need to be knocked out so I don’t have to talk to you at all and my nurs/pa/np will refill you hydro so you need to come back..

 

[RoloTomassi]

3b- any new good waveforms on the horizon? and are they currently proprietary to one company?

Anything about Saluda Evoke?

 

[myrandom2003]

A modified approach for cervical transforaminal esi was discussed.

Tell us more

 

[SC Tian]

Tell us more

 

[SC Tian]

Tell us more

 

[RoloTomassi]

Thanks. Seems to be a subtle difference. If anything, overshooting the modified gets you closer to VA? Does not make me want to abandon IL or transfacet in favor of this

 

[Doctodd]

ok so you need a series of three epidurals and you need to be knocked out so I don’t have to talk to you at all

ahhhh the good old days

 

[lobelsteve]

I was impressed with Samer Narouze. He gave Lecture regarding ultrasound and interventional care. He was unable to come up with any compelling use other than stellate and intercostal nerve blocks for interventional care using US. Counterpoint lectures ripped him apart..

 

[SC Tian]

Thanks. Seems to be a subtle difference. If anything, overshooting the modified gets you closer to VA? Does not make me want to abandon IL or transfacet in favor of this

IMO, this is the approach used by Mayor and some in stanford. Using this more oblique angle on SAP, needle can be placed more distally to avoid vascular or nerve injury.

 

[Nodolor]

IMO, this is the approach used by Mayor and some in stanford. Using this more oblique angle on SAP, needle can be placed more distally to avoid vascular or nerve injury.

Didn't think many were still doing cervical TFESI.....unless this board is not a good representation of the field in general.

 

[SC Tian]

Didn't think many were still doing cervical TFESI.....unless this board is not a good representation of the field in general.

This is a FYI about message from sis annual mtg, also not still doing, but a revisit, imho.🙂

 

[bedrock]

LOL,
Thanks drusso.

Can you expand on some of those?

1- Is their absolutely no hope for anything injected intradiscal? What about combo of BMAC +PRP? Or was this just negative reports on non autologous commercial products?

2-Tell me more about DRG being overhyped as I am falling a bit out of love with it, but would love to see data, not my own anecdotes.

3- regarding stim works until it doesn't, did they comment at all about the longevity of one waveform vs another, such as Burst vs others?
3b- any new good waveforms on the horizon? and are they currently proprietary to one company?

4-I'm actually very curious to hear what they said about spacers. I don't do them and don't plan to offer them, but I would be happy to send some of my old stenotic patients for them, if there are any patient subcategories that would actually benefit from spacers

5- what are the new rules about MBB/facets that aren't going to go well?

6- What are the new rules about ESIs that aren't going to go well?

So no one really answered any of my questions. Would appreciate some constructive replies from the group

 

[cowboydoc]

I was impressed with Samer Narouze. He gave Alex her regarding ultrasound and interventional care. He was unable to come up with any compelling reason other than stellate and intercostal nerve blocks for interventional care using US. Counterpoint lectures ripped him apart..

He did a talk with Eric Grigsby, MD (Napa Pain) that I watched. He was touting a u/s suboccipital block at that time.

 

[Spine MD]

LOL,
Thanks drusso.

Can you expand on some of those?

1- Is their absolutely no hope for anything injected intradiscal? What about combo of BMAC +PRP? Or was this just negative reports on non autologous commercial products?

2-Tell me more about DRG being overhyped as I am falling a bit out of love with it, but would love to see data, not my own anecdotes.

3- regarding stim works until it doesn't, did they comment at all about the longevity of one waveform vs another, such as Burst vs others?
3b- any new good waveforms on the horizon? and are they currently proprietary to one company?

4-I'm actually very curious to hear what they said about spacers. I don't do them and don't plan to offer them, but I would be happy to send some of my old stenotic patients for them, if there are any patient subcategories that would actually benefit from spacers

5- what are the new rules about MBB/facets that aren't going to go well?

6- What are the new rules about ESIs that aren't going to go well?

Check out the AE ratio on spacers. Almost up there with SCS.

 

[bedrock]

For the third time, I ask as an SIS dues paying member........
Why can't any of you folks take a couple minutes to answer these questions in a serious way?
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1- Is there no hope for anything injected intradiscal? What about combo of BMAC +PRP?

Or was this just negative reports on non autologous commercial products?

2-I'm actually very curious to hear what they said about spacers. I don't do them and don't plan to offer them, but I would be happy to send some of my old stenotic patients for them, if there are any patient subcategories that would actually benefit from spacers. I see quite a few spacer failures that show up at my clinic, so I don't want to send patients for this if the data isn't there.

3- what are the new rules about MBB/facets that aren't going to go well?

4- What are the new rules about ESIs that aren't going to go well?

 

[pmrmd]

For facets the limits and 2 week time period between blocks is not appreciated by patients and they look at you like it’s your fault they need to painfully wait no matter what you say.