Compression fx FJI vs RFA for post element tx

[schmee90]

Is there any dif in doing a FJI vs Mbb/RFA in treating posterior elements for chronic compression fractures. I did a mbb and RFA on a patient with T11, T12 old comp fractures. Did pretty well with first RFA, 2nd RFA with less benefit. Saw a surgeon who said of course it didnt work do a facet injection instead. Not sure if there is any data on one being superior to the other specfically for treating posterior comp for chronic compression fx.

I havent found anything other then case series, non randomized studies for both, however my thought is that doing a FJI when an RFA has failed for treating posterior compression fracture doesnt make a whole lot of sense.

I do have other reaons I go after FJI>mbb ie be young healthy person done want to denervate multifidus, But to just say oh the pt's RFA didnt work for the comp fx, you should do a FJI doesnt make sense to me.

Any input is always appreciated .

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[SSdoc33]

Is there any dif in doing a FJI vs Mbb/RFA in treating posterior elements for chronic compression fractures. I did a mbb and RFA on a patient with T11, T12 old comp fractures. Did pretty well with first RFA, 2nd RFA with less benefit. Saw a surgeon who said of course it didnt work do a facet injection instead. Not sure if there is any data on one being superior to the other specfically for treating posterior comp for chronic compression fx.

I havent found anything other then case series, non randomized studies for both, however my thought is that doing a FJI when an RFA has failed for treating posterior compression fracture doesnt make a whole lot of sense.

I do have other reaons I go after FJI>mbb ie be young healthy person done want to denervate multifidus, But to just say oh the pt's RFA didnt work for the comp fx, you should do a FJI doesnt make sense to me.

Any input is always appreciated .

nothing different.

the surgeon is wrong (shocker). we do the shots, they do the surgery. we dont tell them to do a TLIF vs. ALIF, they shouldnt tell us which shots to so

 

[bedrock]

nothing different.

the surgeon is wrong (shocker). we do the shots, they do the surgery. we dont tell them to do a TLIF vs. ALIF, they shouldnt tell us which shots to so

Agree. Surgeon is an idiot that doesn’t understand.

RFA is definitely superior to facet injections for this.

The reason they likely hurt more after the 2nd RFA than the 1st is that their altered bony anatomy causing more disc issues.

 

[schmee90]

thanks all for input

 

[manowar rules]

The one time that I can find facet steroid injections helpful is when I have a patient with a significant degenerative scoliosis. Like initial MBBs will help, but the RFA will often produce lukewarm results. Then I go back with intraarticular facet steroid that gives better results, albeit only for 3-4 months at a time. I figure the pain is much more multifocal with the scoliosis that the steroid can hit. Or maybe I just suck at RFA in real curvy spines.