Spondylolisthesis treatment

[MD87]

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I frequently RF next to pedicle screws (usually under an L4-5 fusion). Often requires a little more oblique, and it’s as much by feel as by fluoro, but I’d say at least 2/3 of the time I get a motor response. My partner often just does the L5 DR and I’ve repeated a few of his that failed, but with both nerves and had success with some (maybe half).

Question - how is your partner procedurally? Are you confident that he has truly burned the L5 DR in these patients? Not trying to be a jerk. Obviously, we've all seen patients who have had injections/procedures that were not done properly.

 

[callmeanesthesia]

Question - how is your partner procedurally? Are you confident that he has truly burned the L5 DR in these patients? Not trying to be a jerk. Obviously, we've all seen patients who have had injections/procedures that were not done properly.

He does a good job. He does a very limited scope of procedures (lumbar epidurals/caudals, and RFs/MBB/facet injections, and SIJ injections, but generally I approve of his needle placement when I’m looking at a mutual patient.

 

[Doctodd]

Brace....PT....1-2 steroid shots and/or RF if long term benefit. Since steroids cause ligamentous laxity often, PRP and or msc for some. If still fails.....NS.

 

[painfree23]

Brace....PT....1-2 steroid shots and/or RF if long term benefit. Since steroids cause ligamentous laxity often, PRP and or msc for some. If still fails.....NS.

Prp where??

 

[SommeRiver]

Interspinous ligaments, multifidi, LF.

 

[Doctodd]

Prp where??

The facet capsules, the pars defects if they have any, epidural space. It depends on the patient.

 

[painfree23]

The facet capsules, the pars defects if they have any, epidural space. It depends on the patient.

Wats the goal here with prp in these places for a spondylolisthesis?

 

[avalon10]

Re rf at a fused level... I generally don’t. ie rf for adjacent to L45 fusion I’d only rf at L3 mb or L5 dr. How do I know that’s all I’d need to do (ie skip the L4mb) ? .... response to the mbb. If I get 100% relief with mbb x 2 at the L5 dr or L3 mb then why would I expect more benefit from RF at the L4 mb where there’s a pedicle screw? Perhaps if suboptimal response to mbb and the target appears intact and has a little space between sap/tp junction and pedicle I’d consider it.

RF at fused level makes no sense.

 

[ED50]

Jumping in on this thread so I don't start a new one. Question - at what number for dynamic cervical listhesis do you refer to neurosurgery?

 

[jonnylingo]

symptomatic and >3mm