Striker Venom cannula for cervical RF

[Timeoutofmind]

Do any of you guys deploy the tine in the neck?

I have access to this system and bigger lesion is tempting for better coverage but just want to be safe in that more delicate area vs lumbar…

Any experience with this out there?

---

Members don't see this ad.

 

[Taus]

Do any of you guys deploy the tine in the neck?

I have access to this system and bigger lesion is tempting for better coverage but just want to be safe in that more delicate area vs lumbar…

Any experience with this out there?

In the Asc, where they pay for it, yes. It does not extend any more ventral than a standard just more ceph/caudal. I rotate so both are laying flush to bone, only then making one burn, except 2 at ton. I have done it this way for years without issue.

 

[cowboydoc]

In the Asc, where they pay for it, yes. It does not extend any more ventral than a standard just more ceph/caudal. I rotate so both are laying flush to bone, only then making one burn, except 2 at ton. I have done it this way for years without issue.

Same, and to clarify, I'm using the 18 gauge typically.

 

[PainandGain]

Same. 18G Venoms for cervical RFs all day long. No issues.

 

[RoloTomassi]

Same but I use Sidekick. Cheaper, compatible with Stryker generator.

 

[Status Sciaticus]

have you all found it to be significantly better than standard RFA needles burning twice?

 

[Taus]

have you all found it to be significantly better than standard RFA needles burning twice?

No, just faster. I use standard 18g in my office suite due to cost.

 

[blokdoc]

 

[BobBarker]

it is a very nice system. Use it everywhere if someone else is paying for it.

 

[bedrock]

it is a very nice system. Use it everywhere if someone else is paying for it.

No, just faster. I use standard 18g in my office suite due to cost.

I appreciate the information. I get great cervical RFA results, but they take a long time.

Taus, no moderate changes in outcomes or safety /adverse outcomes of your cervical RFA with venom needles?

With venom cervical RFA do you still place the tip of those venom needles at the anterior border of the articular pillar or only just to the halfway point such as the cervical RFA image just posted by blockdoc (post #8).

 

[bedrock]

Anyone doing lateral approach cervical RFA?

I once had a fellow doc in the practice that did them lateral. His long term results were far worse than mine. However his procedures were quicker to do and much shorter duration of post procedural pain.

 

[lobelsteve]

Anyone doing lateral approach cervical RFA?

I once had a fellow doc in the practice that did them lateral. His long term results were far worse than mine. However his procedures were quicker to do and much shorter duration of post procedural pain.

Higher risk and lower reward. No thanks.

 

[Ronin1]

Anyone doing lateral approach cervical RFA?

I once had a fellow doc in the practice that did them lateral. His long term results were far worse than mine. However his procedures were quicker to do and much shorter duration of post procedural pain.

I do a lot of cervical RFA with the patient in the lateral position but kind of place probes from a posterior lateral kind of trajectory. Well tolerated great results

From a true lateral approach I did a few trials with the avanos trident and it was really a quick procedure $142 a pop though

 

[Taus]

I appreciate the information. I get great cervical RFA results, but they take a long time.

Taus, no moderate changes in outcomes or safety /adverse outcomes of your cervical RFA with venom needles?

With venom cervical RFA do you still place the tip of those venom needles at the anterior border of the articular pillar or only just to the halfway point such as the cervical RFA image just posted by blockdoc (post #8).

I used purely venom for the last 6 to 7 years, as all RFA was in Asc until recently. I never changed the approach from the way I was trained. Take it deep. To anterior pillar or at least until entire 10 mm tip is on lateral pillar, unless their bones are tiny.

I have gone back to standard 18 gauge for the last six months or so, as started doing RFA in office. Medtronic system. Can’t say that I have seen a change in the results or neuritis. I don’t always make a second burn now since switching to 90° for 120 seconds. I will sometimes still do second burn depending upon the anatomy.

 

[au bon pain]

I will sometimes still do second burn depending upon the anatomy.

What specific features lead you to do 2 burns?

Asking as I used to do 2 burns for everything, then started doing 85 for 120…and my outcomes seem the same.

 

[Ronin1]

I used purely venom for the last 6 to 7 years, as all RFA was in Asc until recently. I never changed the approach from the way I was trained. Take it deep. To anterior pillar or at least until entire 10 mm tip is on lateral pillar, unless their bones are tiny.

I have gone back to standard 18 gauge for the last six months or so, as started doing RFA in office. Medtronic system. Can’t say that I have seen a change in the results or neuritis. I don’t always make a second burn now since switching to 90° for 120 seconds. I will sometimes still do second burn depending upon the anatomy.

What evidence is there to do 120 seconds. I thought 80 degrees for 90 was shown to be the most effective combo

 

[Taus]

What evidence is there to do 120 seconds. I thought 80 degrees for 90 was shown to be the most effective combo

Factors That Affect Radiofrequency Heat Lesion Size

AbstractObjective. This study aims to compare radiofrequency (RF) heat lesion size across electrodes and generator settings available for interventional pa

academic.oup.com

 

[bedrock]

Ха

In the Asc, where they pay for it, yes. It does not extend any more ventral than a standard just more ceph/caudal. I rotate so both are laying flush to bone, only then making one burn, except 2 at ton. I have done it this way for years without issue.

When using venom cannulae for TON are you doing two lesions from different angles per the recommended IPSIS technique with standard RF cannulae or just moving cranially/caudal for those two TON lesions with Venom?

If just moving cranially caudally, any decrease in TON outcomes compared with doing a sagittal and a second angle at TON?

 

[Taus]

Ха

When using venom cannulae for TON are you doing two lesions from different angles per the recommended IPSIS technique with standard RF cannulae or just moving cranially/caudal for those two TON lesions with Venom?

If just moving cranially caudally, any decrease in TON outcomes compared with doing a sagittal and a second angle at TON?

Just cranial/caudal, no noted difference

Would move up both to yellow lines for lesion 2

 

[Dr. Ice]

I used purely venom for the last 6 to 7 years, as all RFA was in Asc until recently. I never changed the approach from the way I was trained. Take it deep. To anterior pillar or at least until entire 10 mm tip is on lateral pillar, unless their bones are tiny.

I have gone back to standard 18 gauge for the last six months or so, as started doing RFA in office. Medtronic system. Can’t say that I have seen a change in the results or neuritis. I don’t always make a second burn now since switching to 90° for 120 seconds. I will sometimes still do second burn depending upon the anatomy.

I was asking your practice to switch rfa to in office almost 15 years ago as a 30 year old brand new attending as no pain docs had any financial access to ascs. I must have looked too young for them to have taken me seriously. Glad to hear someone was able to finally get through…

 

[bedrock]

Just cranial/caudal, no noted difference

Would move up both to yellow lines for lesion 2

Thank you. Yellow lines make sense as do the current position of the upper C2 cannula.

However I don’t think the current position of the C3 cannula is lesioning much of anything.

 

[Taus]

Thank you. Yellow lines make sense as do the current position of the upper C2 cannula.

However I don’t think the current position of the C3 cannula is lesioning much of anything.

Agreed

 

[SpineandWine]

I've had more incidence of post-procedural neuritis with stryker venom 18 G.
I do not deploy the venom needles.

 

[BobBarker]

I would probably pull back the c2/3 needle to the depth of the C3 needle. C3 might be a little low but the lesion size is big enough to get the nerve. This is just splitting hairs. If the patient twitch’s a minuscule amount the needles move much more than you would expect. I had a thin lady kinda shrug her shoulders. Sounds like more than it was. All of the needles had moved posterior at least 1cm. I had to redo my placement.

On neuritis, it is just a function of how much you get the nerve. I tell every patient to expect to have neuritis and some numbness after a cervical RFA.

 

[Taus]

I would probably pull back the c2/3 needle to the depth of the C3 needle. C3 might be a little low but the lesion size is big enough to get the nerve. This is just splitting hairs. If the patient twitch’s a minuscule amount the needles move much more than you would expect. I had a thin lady kinda shrug her shoulders. Sounds like more than it was. All of the needles had moved posterior at least 1cm. I had to redo my placement.

On neuritis, it is just a function of how much you get the nerve. I tell every patient to expect to have neuritis and some numbness after a cervical RFA.

Agreed C3 first burn is a little low here, not my best example. 90x120 should get it, but also moved for 2nd burn up to yellow line for more classic c3 and bottom of ton zone.

However, why do you think C23 needle needs to be pulled back? What’s your concern? I confirm in CLO also well behind foramen. That is essentially my goal depth on all cervical RFA.

 

[Taus]

What specific features lead you to do 2 burns?

Asking as I used to do 2 burns for everything, then started doing 85 for 120…and my outcomes seem the same.

Subjective, but generally:
- in lumbar with fubar anatomy
-in cervical, besides ton, its usually when I have to rely on pure clo for lower levels ceph/caudal location on pillar and can’t get a lateral with good wig/way for confirmation of perfect ceph/caudal location on pillar for mbb target zone.

 

[BobBarker]

Just personal preference. I have gotten a motor twitch before there at c5 a couple times.