Techniques and Pearls for Bipolar Lumbar RFA

[oneforfighting]

Doing my first one next week. Any pearls? Looked at the Chapman paper and it doesn't look too bad.

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[kstarm]

What is the reason/benefit of doing bipolar?

 

[Taus]

Incompatible pacer/defib?

 

[oneforfighting]

Yes I posted about a patient with a new micra pacemaker on this forum recently. Sent a clearance form to cardiology but didn’t receive any guidance. Lit search made it seem like a magnet wouldn’t help. So bipolar seems safest.

 

[epidural man]

Facet steroid injections seem the safest.

 

[lobelsteve]

Facet steroid injections seem the safest.

And least effective or ineffective.

 

[Ferrismonk]

For bipolar, I only make one skin wheal and insert both needles at the same location. Makes it less painful and separating the two needles at the target area isn't a problem. I usually try to place one against the SAP junction and one on the TP about 5-10mm apart.

Intraarticular facet injections are allowed if there is a medical reason someone can't have the RF and having a pacemaker counts. That being said, I agree with Steve. In most of my patients, intraarticular steroids give them about 2-3 months relief. I also don't like to use intraarticular steroids if I can avoid them after seeing that steroids in knees actually worsen arthritis over time.