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Struggling to get medial flow on my TFESI lately. Square SEP, oblique 25 degree IPL, but still tend to be lateral. Thoughts/recommendations?
Struggling to get medial flow on my TFESI lately. Square SEP, oblique 25 degree IPL, but still tend to be lateral. Thoughts/recommendations?
several hundred TFESI under supervision during their year long fellowship
Agree with all of this with the addition of saying that an infraneural approach one level above is also a viable option.I think most people are too shallow with their needle placement, both in TFESI and/especially RFA.
The 6 oclock needle position on the pedicle is a requirement IMO, and another thing is the level you're choosing to inject. If they're super tight go one level below. I've had very stenotic people try to push my contrast back out.
SIS is living in a dream world where money and time must not matter.SIS: 5 saved images. Ap/Lat with and without contrast, washout. Live fluoro to assess contrast flow as well.
agree. AP and oblique only as long as the flow looks goodSIS is living in a dream world where money and time must not matter.
agree. AP and oblique only as long as the flow looks good
to fix this depends on the level.Struggling to get medial flow on my TFESI lately. Square SEP, oblique 25 degree IPL, but still tend to be lateral. Thoughts/recommendations?
No offense but based on your username, I assume you did not do a pain fellowship?
If you can’t do a TFESI, you should likely leave all pain procedures to pain physicians, who perform a minimum of several hundred TFESI under close supervision during their year long fellowship.
Annoyingly, I can think of several ACGME fellowships where TFESI is avoided as much as possible and interlaminar/caudal is used preferentially resulting in only a handful of TFESI being performed each year…
Yes, just rotate the C-arm back to show you were at 6 for final image. Know where the sac is and avoid it.Do you guys ever notice sometimes you have to advance past 6 o'clock on the pedicle to get medial contrast flow?
thank youYes, just rotate the C-arm back to show you were at 6 for final image. Know where the sac is and avoid it.
What about the other 4 views?Yes, just rotate the C-arm back to show you were at 6 for final image. Know where the sac is and avoid it.
Doesn’t have to be perfect every time. Maybe there’s a lot of foraminal stenosis, a big foraminal disc or big facets. Sometimes as my illustrious mentor would say, the enemy of good, is your hubris that you can make it betterDo you guys ever notice sometimes you have to advance past 6 o'clock on the pedicle to get medial contrast flow?
Save them too. There may come a day when I retire and Medicare hires me to do nothing but look at pictures and payments will stop if the pictures aren’t there or aren’t right.What about the other 4 views?