Why is that? I feel like my patient have true thoracic facet mediated pain (adjacent segment disease given mid-thoracic fusion)
Doesn't matter what you think.
Most of my cases have been Medicare. no payment issues that I’m aware of. Do a few a year. Half are repeats that get 1-2 years relief. Done a couple for cash on bcbs who won’t cover.
Yeah, bc there was a language barrier.
Which CPT code do you request for a T12-L1 facet block? 64490 or 64493 (assuming first level)?
I didn't know this was a proper published technique, but have been doing mine this way for years. Patients get good relief. Again, I do this all the time.
It’s not published. I’m currently working on it.
If you put the needle perpendicular to the nerve in the lumbar then just the tip of the needle is touching it. The technique above places the nerve, ideally, across the center of the active tip. Should still ablate several mm of nerve, and covers a lot more superior/inferior territory which is a good idea with the reputedly variable location of the thoracic nerves.
still the more you deviate from parallel to the nerve the shorter the length of ablation. how parallel to you believe the probe is to the nerve using this technique? 30 degrees? 45, 60?
The approach I use is posted up above - as parallel as I can make it. However, I was pointing out that in the thoracic spine it is possible to have the needle perpendicular to the nerve but centered on it, therefore getting an effective ablation, whereas in the lumbar if the needle is perpendicular to the nerve in the groove, only the tip can touch.
Still not following your logic? why do you think being perpendicular to the nerve is adequate even if the needle is centered on it? Makes no sense to me. If you’re perpendicular you’re going to get a much shorter ablation regardless of how “centered” you are.
Where are you placing for cooled RF? Pics? Thinking about doing this for a current patient.
Would have to dig for a bit to find pics but basically still placing the probe over the superolateral TP
Are you using 2mm active tip?
lol wut?
No. Smaller burn is great on gasserian, but really nowhere else.
Curious, what part do you think took too long? How would a shorter cannula and or active tip help this? Keep in mind, Shorter cannula equals buying new set of shorter electrodes.
Pedicle shadow is over the spine. Lung field more than an inch laterally. Man up.
Entry and trajectory is over lung fields. At least according to all the pics posted here.
Do it the way callmeanesthesia's graphic illustrated. You avoid the lung fields entirely and end up parallel to the course of the nerve. Sometimes I put just a couple degrees of contralateral oblique as well to help obtain a more shallow trajectory.
Still doesn't make sense. Needle length doesn't affect anything re lung fields. Trajectory is the same, just more needle sticking out of the skin with longer needle
You are not doing it correctly.
Medial to lateral? Even Ferrismonk's post above has it lateral to medial. Same as Mister Mxyzptlk's.
This is good. I'll just stay above spine the whole time in the future. What gauge needle are you using?
Definitely considering this now. Just concerned that by going parallel it would miss the nerve altogether given variability.
You're right. Trajectory matters more. I just find it harder to maneuver longer needle in delicate areas.
Stryker Venom probe makes 6cm^3 lesion, 1.8cm in any direction. Measure just how big that is on a radiograph and you'll realize that it's basically impossible not to get the nerve if you are somewhat close.
