I have done few cases for lower back, neck, and occipital and the results are disappointing even during the first 60 days. Would love to hear if someone is getting good results and what are they doing different?
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Sprint PNS
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My n = 2 and both failed.
Edit - I should clarify. I did multifidus on a pt that failed traditional spine care with PT, meds, RFA and an ESI. It was doomed to fail. Nice spondy at L4-5 and she didn't want surgery. According to industry, she now qualifies for a stimulator I guess...Won't be getting one from me.
Second case was probably similarly doomed to fail. Left shoulder arthroscopy followed by a total shoulder with resultant shoulder spasticity and severe neuropathic shoulder pain. Failed SSNB and a stellate. Tried SSN and axillary nerve with SPRINT. Failed.
Both cases were set up for failure probably.
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I did about 50 Sprint multifidus in fellowship. I didn’t keep exact success rate but seems like about 75% worked really well. Did probably 15 in other locations, the only other spot I had consistent success with was saphenous for knee pain. I didn’t do anything different, followed their procedure steps.
Wow. 75% is big number. Not sure what could be the reason. Was this the first line of treatment for these patients? Most of my patients have failed multiple interventions. I tend to use sprint with a similar treatment algorithm as SCS.
Fellowship: rose colored glasses and no medium or long term follow up. Adequate MOA does not exist.
Thanks, Zig.
How do you decide which levels to put the leads if they have bilateral facet arthropathy L4-L5 and L5-S1?
My understanding one can’t put in more than 2 leads
Have done ~30. Majority within the last year so longer term outcomes still pending, but above poster approximates my overall success rate for lumbar spondy. Probably 70% have at least 50% pain reduction at 6 months and have some with 80% reduction at 1 yr. Also had some success with cervical spondy and ilioinguinal neuralgia--only n of 4 but all have >50% relief at 6 months.
Biggest disappointment, by far, was one I did for residual+phantom limb pain-- 0 relief.
For back/neck, in my experience so far the ideal candidate is a younger patient (<50s) who has never had an RF, has a myofascial component to their pain (but facet still predominant), and + multifidus atrophy on MRI.
Biggest disappointment, by far, was one I did for residual+phantom limb pain-- 0 relief.
For back/neck, in my experience so far the ideal candidate is a younger patient (<50s) who has never had an RF, has a myofascial component to their pain (but facet still predominant), and + multifidus atrophy on MRI.
@mdo1738 @au bon pain
What commercial insurances cover PNS for axial spine pain?
What commercial insurances cover PNS for axial spine pain?
IIRC got it covered with united in the past. Not sure of present situation as don't have to worry about it at current gig.
I mean I would call going from q 6 month RFAs to having no need for further intervention and continued significant pain relief 9+ months out to be pretty good medium term follow up results.
Just means your RFA technique needs improvement. Your N at 9 months follow up is 10-15. Not enough to really make any useful clinical recommendations.
Steve would you say a common error on lumbar rfas is not going ventral enough? If not what would you say it is? Thanks
Not using 18G cannula is #1
Not being parallel to nerve is #2
Not ventral enough is # 3
Even in AP, if your tip is too medial you are on SAP and think you are at the junction. If you don't come inferior to superior, lateral to medial and can see the junction, you will get there. Lack of fluoroscopic visualization is the biggest problem.
Try this today on an MBB or RF:
Set up C-arm. Walk to screen. Point at target. Step back to 10 feet from screen. Is it same target? Turn overhead lights off. Still same target. Black and white has a thousand shades of grey. Visual contrast is everything.
This 100%….as I get older I need to either mag or bring the monitor closer. It’s amazing some of the things I don’t see until I look at the saved pics later on my computer screen
I want to get better
1. I use 18G
2. I try to avoid going perpendicular of course. Anyway to ensure parallel? I usually start one TP below midway point of the TP. I have trouble with higher BMI patients, though.
3. I try to start lateral and go medial and avoid being posterior resting on the pedicle. When in doubt I go from lateral back to AP and move the needle superolateral then take a lateral shot to see if I advanced the needle ventral.
4. When in doubt I go more ventral until motor stim.
5. I don’t want patients up to do sensory testing. I wonder if I did more sensory testing my results would improve?
What code is ur partner billing ?
Base code is 64555
I work in a HOPD but we bill privately. There is some interest in my group for bringing in Sprint, but I'm not sure if it's worth the hassle. Payment is around 3-400 I believe, but it looks like a PITA for the patient with all the changing dressings, etc and I believe it has a 90 day global.
For those who do Sprint, do you think it's worth the hassle?
For those who do Sprint, do you think it's worth the hassle?
I do, but I’m picky about who I offer this to.
Any whisp of patient non-compliance, shaky social situation, questionable cognitive abilities/life skills, etc are non-starters.
Regarding dressing changes, best way to prevent downstream hassle is to only offer to patients who have very reliable help from somebody to assist with them (spouse, friend, etc) and ideally that person is there for implant day so rep can them both how to dress. Dressing changes are pretty simple but I tell patients this is an absolute requirement and there’s no negotiation.
As with most devices, quality of rep is inversely proportional to hassle factor. My local sprint reps are excellent and stay in close contact with patients.
Speaking of Sprint reps, mine has dropped off the map. During fellowship, I'd connected with the rep in the region I'd be moving to. They even had even invited me to a training session.
Since opening my practice, I've been ghosted after reaching out multiple times. Thinking there might be a new rep, I've also requested to connect with a rep on the company's website at least twice with no response.
I'm wondering if this is the kind of thing that happens with reps or if there may be something going on behind the scenes with Sprint.
Since opening my practice, I've been ghosted after reaching out multiple times. Thinking there might be a new rep, I've also requested to connect with a rep on the company's website at least twice with no response.
I'm wondering if this is the kind of thing that happens with reps or if there may be something going on behind the scenes with Sprint.
Trying to revive this thread. Thinking about looking more into Sprint PNS
Any updated impressions?
I watched the video above on YouTube. The woman physician says she is placing a medial branch nerve location, but it looks to me like she’s almost doing an interlaminer so either I am really confused or she has some real issues with anatomy and skills
I've added it this year and have been really impressed with pain control for occipital nerve and lumbar facet. Haven't been doing long enough to judge the "70% get relief x 12 months" claim though. The lumbar facet technique is bizarre and it isn't targeting the MB per se. Mainly the multifidus muscle so they want you to drop needle essentially in place to just inferior and barely medial to facet joint.
Reps in my area are very good and doing procedure is incredibly easy so starting to do more - will probably stop (or be very selective with it) if there is not consistent long term relief though.
I work multi-specialty ortho so I'm hopeful for good results since it gives more options than ablations for shoulders, etc.
Reps in my area are very good and doing procedure is incredibly easy so starting to do more - will probably stop (or be very selective with it) if there is not consistent long term relief though.
I work multi-specialty ortho so I'm hopeful for good results since it gives more options than ablations for shoulders, etc.
Anecdote: just saw a patient I did b/l L4mb placement on ~16 month ago and no PT or other interventions since. States lumbar pain is still 40% below baseline (was 75% reduced at lead pull visit)
Can someone explain to me why they get relief that is prolonged with this for months after, trying to learn as I have not done these
No.
I’ve been doing these. Decent results. Some home runs and some that didn’t like it. It’s super easy but yeah the technique is weird. You place it at the 7 o clock position on the pedicle if on the right side and 5 o clock position on the pedicle if on the left side
For axial targets, my suspicion is that the regular stimulation and subsequent contraction of the multifidus plays a big role. Company talks about the basic science theories, but most of my longer-term responders are the ones who had multifidus atrophy on MRI or components of concomitant myofascial pain...so face validity...
