👍🏻 Search “pedicle shadow”. I
Yep. Add copd Precisely who I had to use the “pedicle shadow” technique on. On the rare occasions I did T mbb/rf I had always done classic corner TP. One patient in particular forced my hand to use MM’s technique when I couldn’t see jack for reliable landmarks despite every trick I know. I was convinced a pneumothorax was coming. I changed to pedicle shadow….. it worked great. Done a handful that way over last few years…. Easy and worked well. I’ve reviewed the anatomy of original descriptions Tmbb and the newer anatomical studies presented at SIS over last few years re articular branches. Then I just shrug and said well this has worked well…
Why can’t you just line the needles so they lay caudal to cranial with the tips in the same spot?
Yes, parallax occurs in every procedure.
Suggest staring at a skeleton for about 15 - 30 minutes then figuring out what would work best for you. I suspect that is what most people do. One thing that has always fascinated me is the difference in procedure times for different practitioners. Some docs want a very fast technique that is fast and usually works. Other docs want a technique that always works and do not care much for speed. Everyone wants safe, but what is a safe procedure technique for a doc that has been doing spine work for 10 years is very different from what is safe for a new doc. So my advice - Suggest staring at a skeleton for about 15 - 30 minutes then figuring out what would work best for you.
Right that's what I mean. Standard TP technique parallax less of an issue since distance from needle to target landmark, TP border, is less. Usually start with some caudal tilt to get flatter but was wondering if it was more ideal to square pedicles inside the vertebral body like kypho for this technique
That works too. This technique lays the needles more parallel to the nerve according to the SIS diagram of the thoracic medial branches. And there’s only one needle entry site even if the procedure is bilateral.
That’s how I do it too. Here’s onei did on a post kyphoplasty patient with continued axial mid back pain
This is how I do it
This is the approach I take as well.
Agree with Dr. Lobel. The risk of superficial burns would be higher with the cooled than conventional due the geometry of the burn. If you have concerns, you can do things to protect the skin. The classic technique is to inject small amounts of air subcutaneously to create an insulating barrier. You could also do ice in a sterile glove to cool the skin, but the injection technique is easier.
www.ncbi.nlm.nih.gov
I only have 20g 10cm with 10mm tip available. Think this would be okay?
This is really cool. Thanks!Agree with Dr. Lobel. The risk of superficial burns would be higher with the cooled than conventional due the geometry of the burn. If you have concerns, you can do things to protect the skin. The classic technique is to inject small amounts of air subcutaneously to create an insulating barrier. You could also do ice in a sterile glove to cool the skin, but the injection technique is easier.
Pneumodissection for Skin Protection in Image-Guided Cryoablation of Superficial Musculoskeletal Tumors - PMC
Pneumodissection is described as a simple method for preventing skin injury during cryoablation of superficial tumours. Superficial tumour cryoablations performed from 2009 to 2015 were retrospectively reviewed. Pneumodissection was performed in 13 ...
Yes, I figured I'd need to place fairly parallel. Both to avoid superficial burns but also to better catch the nerves.
Look at ct or mri axials. You can measure for the answer.
