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Has anyone tried the Nimbus Expandable Electrode yet? Interesting concept.
Perhaps you can run some tap water over the electrode and simply reuse it on the next patient....
The cost seems too high for me, when we have something that works well already. Maybe for the lateral branch's
Are most of you using 18G 10mm tips and doing two burns?
Just curious to see what others are doing we do 2 burns at 90 degrees for 90 to 120 sconds
I agree with what Steve has said.
Water cooled RF and the like are claiming 'big' lesions are better. But is there really any science to it?
If you tk the regular RF needle and do a few lesions and 'burn' the nerve at a few places, wont it burn the nerve? What is the need to 'burn' the nerve at every point.
For example, if you have a nerve:
A----------------------B---------C---------D
and you burn at B. wont it kill the transmission from A to D ? What is the need to burn at B and C, as long as you have burned point B very well. I know this is quite simplistic, but it makes sense to me...
Anyone using the nimbus? Experiences? Suggestions?
I am thinking of starting to use them for cervical RFA's using the lateral approach.
If I was an out of network doc I would probably market coolief much more. If I had an rf machine in my office I would also be more inclined to market it more. Doing it in an asc at Medicare rates is not cost effective at all.
OTOH if a patient is in agony and is not surgical I would consider it or if some douche joint surgeon jacked someone up and doesn't want to do a revision and instead insisted that the patient's residual knee pain "is coming from their spine"...oh yeah cause that has happened...I would do it..
Are we all convinced that Cooled RF or Nimbus needles are necessary to get optimal results? I don't personally have a large enough N in my own practice to know. But, with all of these patients calling for Coolief I want to be honest and tell them if the procedure with standard 16 needles is equivalent.
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Cosman first released 16g RF canulas in 2013. If you are doing one SI RF a week, you are diagnosing way more SIJ dysfunction than the published literature
I've done 3-4 SIJ with 18ga using palisade technique and 2 Simplicity in the last 12 months or so. I did 2 Coolief SI a few years back. I think my best results are the palisade technique and that is the easiest for me and the patient. I got ZIP results with Coolief but it could have been my poor technique and crappy landmarks in old patients. Simplicity is a trauma case in my hands. I've tried to get support/training/preceptorship from St Jude but they don't give a rat's --- about that product line.
I'm more interested if I can legitimately claim that 16 ga conventional RF and Coolief are equivalent for genicular.
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Cosman first released 16g RF canulas in 2013. If you are doing one SI RF a week, you are diagnosing way more SIJ dysfunction than the published literature
I had some amazing results with cooled RF of the SIJ back in the day. Haven't done one in awhile though. I've also used standard 18g needles with a very steep approach "lying" the standard RF needle on the sacrum. Works ok but not quite as well as my cooled RF's. I usually got 80%+ relief for 12-18 months with those, better than my standard lumbar RF results
Key is being able to visualize the posterior sacral foramen and making sure you burn close to the foramen. The nerve path varies the farther you get from the source. I've probably done 50+ over the last 8 years. Very good results. And patient selection is key! Patient usually has a positive Fortin finger sign (60% ppv), 2-3/5 positive provocative SIJ maneuvers and + response to at least 2 SIJ injections.interesting that yours turned out so well and not for NJpain. I guess this is fairly technique sensitive. I have a chronic SIJ issue for which I'm thinking about having cooled RF, but these different responses to the same procedure do worry me.
Anybody know a pain physician skilled with cooled RF in the San Diego area? Will go to LA if I need to. Will pay cash if needed.
interesting that yours turned out so well and not for NJpain. I guess this is fairly technique sensitive. I have a chronic SIJ issue for which I'm thinking about having cooled RF, but these different responses to the same procedure do worry me.
Anybody know a pain physician skilled with cooled RF in the San Diego area? Will go to LA if I need to. Will pay cash if needed.
Appreciate deacs comments on technique.
Anybody know a pain doc doing cooled SIJ RFA in San Diego/LA?