Pictures of the Week

[Ligament]

Good to know patient does not require Ketamine. Great doc.

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[melancholy]

Good thing the patient did not require ketamine in the prone position!

 

[lobelsteve]

CT reconstruction. Shows off the fusion and my wires.

 

[unchockey21]

Good thing the patient did not require ketamine in the prone position!

Well, duh. You save the ketamine for the bradycardia and the proning to increase oxygenation during the ensuing CPR.

 

[lobelsteve]

 

[Green Grass]

Cool earrings, bro


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[lobelsteve]

Long standing patient. FBSS since 1975. 5 rounds of lung cancer. Last round took her away as a patient in December. MSContin 30- 60 tid than would change to Fentanyl 50-100 for a few months a year. MSIR/Dilaudid/Oxy for breakthrough, rotating every 6 mo. Begged for years to have her old Medtronic unit, offered her $100 and free removal in office. It was placed in 1979, lasted under 6 mo, never really helped. Family dropped it off today, the funeral home took it for me. She made sure in her will. Sweet lady. Nice person.

Here is a pic of it implanted:

 

[epidural man]

quick f/u.

All my patients get a quick f/u, but only after they leave and never to their face. I find the f/u to the face doesn't work well.

 

[lobelsteve]

All my patients get a quick f/u, but only after they leave and never to their face. I find the f/u to the face doesn't work well.

Ahh, the reach around f/u.

 

[Taus]

Horrible neck, great RFA outcome. remote major trauma w c1-2 fx, paralysis, emergency surgery, recovered most neuro function aside from minor balance deficits. Severe refractory unilateral neck pain. Now 95% better, off all meds, after RFA.

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[unchockey21]

Horrible neck, great RFA outcome. remote major trauma w c1-2 fx, paralysis, emergency surgery, recovered most neuro function aside from minor balance deficits. Severe refractory unilateral neck pain. Now 95% better, off all meds, after RFA.
View attachment 214279


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Nice win. Which levels did you end up doing? How far out from RF/how long did it last?

 

[Taus]

Nice win. Which levels did you end up doing? How far out from RF/how long did it last?

Initial block right c34, 45, 56. Had 80% overall relief and complete relief of upper/mid neck pain, but some persistent pain lower neck. I had never done 4 levels before but was willing to make this my first case (especially as unilateral- ie not as concerned about head drop). Added c67 on repeat block. Had compete relief of pain. Therefore did RFA at 4 levels. Now 2 months out.


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[lobelsteve]

 

[Green Grass]

Aseptic loosening vs chronic infection. Assuming it's painful, needs a revision.


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[lobelsteve]

Aseptic loosening vs chronic infection. Assuming it's painful, needs a revision.


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Aseptic loosening vs chronic infection. Assuming it's painful, needs a revision.


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OK, sucker punch. 5 revisions. Now in chrono order. I offered to sawzall the leg off AKA style.

7-7-11



6-30-14


11-6-15



3-1-17

 

[Green Grass]

OK, sucker punch. 5 revisions. Now in chrono order. I offered to sawzall the leg off AKA style.

7-7-11



6-30-14


11-6-15



3-1-17

Look at all that bone loss and now he's lost his ligaments so he's got a constrained prosthesis. Same surgeon? Would love to see what the original X-rays looked like before he got his first surgery...this folks is what happens when joint surgery goes bad.

 

[geauxg8rs]

Look at all that bone loss and now he's lost his ligaments so he's got a constrained prosthesis. Same surgeon? Would love to see what the original X-rays looked like before he got his first surgery...this folks is what happens when joint surgery goes bad.

Joint surgery never goes bad. It must be crps. At least that's what orthos in my area say

 

[painfree23]

Joint surgery never goes bad. It must be crps. At least that's what orthos in my area say

Lolol same. Get the most ridiculous crps consults. Any advice on how to avoid these? Worth educating ortho or waste of time? Got a crps referral from primary after a car accident, bc lady had some joint swelling and mild redness on her joints, I diagnosed her with RA. Ridiculous.

 

[cowboydoc]

37 yo male, runs half marathons, 4 years of foot numbness, sounded like chronic right S1 radic. MRI spine normal, except "incidental" tarlov cyst at S2. I did a S1 TFESI, no benefit.

"I can push right here" (mid-hamstrings) and reproduce symptoms in the foot on eval after injection. We decided to go "fishing" and did MRI of the thigh w/ and w/o contrast.

2.3 cm lesion, perineural, thought to be schwannoma, sent to neurosurg to evaluate.

 

[epidural man]

First time in my career seeing the very rare Ferret Kidney. I can't tell but I think this one is giving the radiologist a smirk.

 

[freddydpt]

First time in my career seeing the very rare Ferret Kidney. I can't tell but I think this one is giving the radiologist a smirk.


View attachment 218350

I'm printing that out and hanging in my office.

 

[chibadriver]

First time in my career seeing the very rare Ferret Kidney. I can't tell but I think this one is giving the radiologist a smirk.


View attachment 218350

Once you see it, it can't (won't) be unseen.

 

[lobelsteve]

Asymptomatic.

 

[Green Grass]

Asymptomatic.

Chronic pain and cognitive decline. It's real.


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[lobelsteve]

Chronic pain and cognitive decline. It's real.


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A touch of MS

 

[lobelsteve]

Is this what I think it is? Why is it hooked up to a paddle?

 

[lobelsteve]

https://www.dropbox.com/s/wul1gvwb6f2bd6v/Radionics.mov?dl=0

Anyone still using?

 

[SSdoc33]

Dropbox - Radionics.mov

Anyone still using?

wow, that thing is a dinosaur. lost i saw that relic was in fellowship - a decade ago

 

[Ducttape]

I have one in my office as we speak.

it sits next to the cryoablation "machine".

 

[lobelsteve]

Photobucket changes terms of service and destroys links unless you pay them $399 per year. And they are going to go out of business. Plus, they suck. Lots of popups and videos that autoplay. So now, I am changing to imgur for hosting. Oh, the thing in the picture. It fell off a guys back with an 11 blade. Too close to my injection site.

 

[lobelsteve]

I wound up doing T3-8 ICNB, will RF when pain returns.

 

[lobelsteve]

T9 yes.
T12 no.

 

[lobelsteve]

Largest facets this side of the mighty Mississip?

 

[lobelsteve]

L3 TFESI. Just on way in to foramen and turned past lamina. Shot this spot film before 6 o'clock under pedicle.
Contrast rapidly dispersed in a tube like structure across the midline. I removed needle and took different angle.

Here is lateral, but I did advance 2-3mm before getting spot above.

 

[cbest]

Retrodural space of Okada?


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[lobelsteve]

Retrodural space of Okada?


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It was vascular. Flash and gone. Hard to get on spot film, put 1cc contrast in slow to make sure I got it.

 

[myrandom2003]

I wound up doing T3-8 ICNB, will RF when pain returns.

What's going on here?
Tumor? mets to ribs and fracture?

 

[lobelsteve]

What's going on here?
Tumor? mets to ribs and fracture?

Osteosarcoma of distal femur s/p resection, mets to lung/ribs s/p resection. It makes Xrays look like crap. I thought it was her bowel s/p prep through a hernia. But some cancers go black on C-arm.

 

[lobelsteve]

Normal MRI 2011. Zoster neck to ear at that time. New MRI this month. CRPS symptoms right arm only.

 

[SSdoc33]

Normal MRI 2011. Zoster neck to ear at that time. New MRI this month. CRPS symptoms right arm only.

what?

arm?

 

[lobelsteve]

what?

arm?

IMGUR loaded wrong picture.

Here:

 

[SSdoc33]

IMGUR loaded wrong picture.

Here:

View attachment 223464

? MS ?

Also, why is there a baby bird right below the cerebellum?

 

[lobelsteve]

? MS ?

Also, why is there a baby bird right below the cerebellum?

Started after zoster in 2011. Will get brain and T-spine completed to rule out MS via Neurology.
Nevro?

 

[NOSfan]

Started after zoster in 2011. Will get brain and T-spine completed to rule out MS via Neurology.
Nevro?

Interesting case - Zoster myelitis. Primarily DCML. Yes, MS needs to be ruled out. Also, would check B12 level.

Nevro -- wonder where the cervical 'sweet spot' is?

Let us know how the trial goes.

 

[lobelsteve]

Interesting case - Zoster myelitis. Primarily DCML. Yes, MS needs to be ruled out. Also, would check B12 level.

Nevro -- wonder where the cervical 'sweet spot' is?

Let us know how the trial goes.

Spoke with Neurology. No MRI change since 2014. Not MS.
If successful will post results and lead location as well as programming notes. Well defined lesion makes gathering data easier.

 

[clubdeac]

what are the patient's symptoms? NMO?

 

[lobelsteve]

what are the patient's symptoms? NMO?

CRPS like right arm. But had Ramsay Hunt in right ear 8 years ago at onset.

 

[lobelsteve]

She thought I was a Psychiatrist.
I actually walked out of exam room while she was still talking. Nurses said she was still talking when they went in.
Meds included Adderal, Klonopin, Oxy

 

[SSdoc33]

She thought I was a Psychiatrist.
I actually walked out of exam room while she was still talking. Nurses said she was still talking when they went in.
Meds included Adderal, Klonopin, Oxy

terrifying. like the notebook in the movie "seven"

 

[painfree23]

so what'd u do for her? lol