Experience with Intracept.

IPSIS: Formerly the Spine Intervention Society
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lobelsteve said:
See Glade Roper's LinkedIn post. L3-S1 for Modic changes and axial LBP that failed PT and epidurals. (Hint: Imaging not very supportive for this).
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Epidurals for axial low back pain? Didn’t the holier than thou crowd poo poo for discogenic pain? But it’s being ruled out to support intracept?
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lobelsteve said:
See Glade Roper's LinkedIn post. L3-S1 for Modic changes and axial LBP that failed PT and epidurals. (Hint: Imaging not very supportive for this).
Click to expand...

Not signed up for linked in. What the gist about imaging?

That modic changes don’t predict Intracept success or that absence of modic changes doesn’t rule out successful intracept?
 
bedrock said:
Not signed up for linked in. What the gist about imaging?

That modic changes don’t predict Intracept success or that absence of modic changes doesn’t rule out successful intracept?
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IMG_3526.png
 
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Mod to severe spinal stenosis commonly hurts in the back and belt line and I commonly ILESI them with good results.
 
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im having trouble finding the spinal stenosis on the MRI he posted. mild at best.

and the ligamentum flavum is borderline enough to do the MILD.
from his linkedin:
roper mild.GIF


this is a typical MILD candidate and one that i did recently, after surgery refused (cardiac history):

mild pre pic 2.GIF



his and other "doctors" use of this procedure outside of the clear indications will lead to its ultimate demise, as has been done with all of our shiny new toys...
 
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Ducttape said:
im having trouble finding the spinal stenosis on the MRI he posted. mild at best.

and the ligamentum flavum is borderline enough to do the MILD.
from his linkedin:
View attachment 375505

this is a typical MILD candidate and one that i did recently, after surgery refused (cardiac history):

View attachment 375508


his and other "doctors" use of this procedure outside of the clear indications will lead to its ultimate demise, as has been done with all of our shiny new toys...
Click to expand...

This is exactly why I posted.
 
Did 2 cases today, overall not too bad, thanks for the helps and encouragements.
 
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ragnathor said:
The training/reps will call anything Modic changes. I've done 3 cases so far. One seems to be doing pretty good not a slam dunk, one nothing, and one some mild-moderate relief. The one doing the best I actually had to abort a level - bone was too sclerotic and the stylet bent, just couldn't advance.

Supposedly pain relief keeps going til 3 months out so we'll see. I've got 2 more booked this week. 4 of the 5 total so far are Medicare. Several do have mixed pain. I can't make anything of my n=3 so far. All had anterior column pain but mixed presentation. If I'm not getting great results I may limit to those middle age with more isolated anterior column pain.


We've been doing TIVA starting 2nd case and I'm slow with fellow. We may try true MAC as I get faster.
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My 4th and 5th patients are one month out and 50% relief, very please so far.
 
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ragnathor said:
My 4th and 5th patients are one month out and 50% relief, very please so far.
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I’ve done about 70 cases. Results mirror literature.

I have only had a handful that were slamdunks at the two week incision check. Most are partially better at that point, some no better, truly does take up to three months. I have had many patient report the biggest change was somewhere in month two.
 
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Taus said:
I’ve done about 70 cases. Results mirror literature.

I have only had a handful that were slamdunks at the two week incision check. Most are partially better at that point, some no better, truly does take up to three months. I have had many patient report the biggest change was somewhere in month two.
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Do you use 75 degrees for 7 minutes?
 
Taus said:
I’ve done about 70 cases. Results mirror literature.

I have only had a handful that were slamdunks at the two week incision check. Most are partially better at that point, some no better, truly does take up to three months. I have had many patient report the biggest change was somewhere in month two.
Click to expand...

What is your average percentage of pain relief at 3 months with your patients?
 
I like to ask once in a while; how do you not loose money doing this procedure? You need to book in the OR, takes a long time, pro fee is very low.
 
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Ronin1 said:
Anyone have any Cigna patients approved yet with the psych required visits. I just sent someone for the CBT today?
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Do they require psych therapy? Or do they require a “clearance” like SCS?
 
Taus said:
Available via telehealth. Several companies out there, have used a few for my stim psych clearances. Much better insurance coverage and faster turnaround than local psychologists
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Taus,
What telehealth companies have you used for CBT? I’ve seen my first cigna Intracept candidate and she needs CBT
 
Just reviving this thread a bit. I did 2 Intracept cases this am with local/sedation with no issues. Big time saver. HOPD procedure suite. 14 cases so far with 3 failures 5 good responses and the others to soon to tell
 
Ronin1 said:
Just reviving this thread a bit. I did 2 Intracept cases this am with local/sedation with no issues. Big time saver. HOPD procedure suite. 14 cases so far with 3 failures 5 good responses and the others to soon to tell
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Nice, I've done some this way as well. How many VBs, and how much fentanyl/Versed did you use?
 
Taus said:
Nice. Definitely a huge timesaver without GA.

I’ve done over 100 cases at this point. 4 or 5 failures.
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Taus, have you done extra-pedicular access for fusion levels? I have several patients with big screws obstructing access.

Have done for BKP but Relievant reps tell me they don't officially sanction this approach for BVN.

Any tips/tricks for fusion levels would be appreciated given your experience.

Thanks
 
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I am nowhere near what the literature claims. For axial back pain I will block/RF facets first then look for Intracept if patient localizes pain to the area of Modic change. But I’ve had too many failures with ideal placement.
 
For those non hospital employees..you guys actually find this procedure worth your while? I can’t imagine taking time out to go to a hospital, deal with their inefficiencies to do this procedure. I also just don’t see a lot of vertebrogenic back pain. Some people have mixed anterior/posterior column pain but there imaging is just straight up disc disease and facet arthropathy
 
It’s a low revenue to time ratio unfortunately. I was going to stop doing it due to OR inefficiency but now that I switched to the procedure room, it’s about a 45 minute block of time. About 11 wrvus so it’s not terrible for me. Facility does very well
 
I’m now actively looking into Intracept.
I’m also now a partner and part owner of our ASC. The ASC does very well on Intracept which is a motivating factor. ( I sent these out previously). And our commercial contracts pay more than 2x Medicare rate for the pro fee.

So I’m looking to get trained and offer intracept. It really helps people, and the pay is more reasonable if you’re RVU based or you have ASC shares.
 
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Taus said:
I do them in Asc. not bad now with more commercial insurance approvals and increased efficiency on procedure.



This is specific to each individual Asc and their own contracts.
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Agree with all of the above.
 
I can't line up 5 pts who are ready and waiting on the procedure. How do yall do that?
 
I've been looking for months.

How do you plan on forming your line?

Tell the pt you have to go get trained in a procedure and to get in line?
 
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