The Ultimate Overkill In RF Neurotomy

[Aether2000]

Recently I had the displeasure of witnessing an orthopedic spine surgeon using a tube discectomy portal over 6 different facet joints in the low back, then use an electrocautery to destroy not only the medial branches but the back of the facet capsule itself posteriorly and laterally. This procedure took 2 hours and of course would only be covered through an auto insurance injury claim since there is no code for this procedure other than our RF codes. The prior RF he did (he hasn't a clue where to place the needles) did not work, so he effectively did an open destruction of everything in sight through the tube portals. It does make me wonder the long term outcome when the facet capsule is partially destroyed and on the much higher wattage (used 50W continuous) power than we use in traditional RF neurotomy (typically 10 watts then falls quickly to 2-5 watts), especially since he was using monopolar. See the interesting article below on monopolar cautery and spinal ganglia denervation when using monopolar cautery. Electrocautery also uses 200-500 volts typically. Neurodegenerative effects of monopolar electrocauterization on spinal ganglia in lumbar disc surgery. - PubMed - NCBI

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[lobelsteve]

Loves the smell of napalm in the morning.

 

[Ducttape]

did he pour down some 100 proof alcohol (that he uses in his coffee) down that tube too?

 

[willabeast]

Never heard of this. If it works well long term , please report back to us.

 

[Timeoutofmind]

Recently I had the displeasure of witnessing an orthopedic spine surgeon using a tube discectomy portal over 6 different facet joints in the low back, then use an electrocautery to destroy not only the medial branches but the back of the facet capsule itself posteriorly and laterally. This procedure took 2 hours and of course would only be covered through an auto insurance injury claim since there is no code for this procedure other than our RF codes. The prior RF he did (he hasn't a clue where to place the needles) did not work, so he effectively did an open destruction of everything in sight through the tube portals. It does make me wonder the long term outcome when the facet capsule is partially destroyed and on the much higher wattage (used 50W continuous) power than we use in traditional RF neurotomy (typically 10 watts then falls quickly to 2-5 watts), especially since he was using monopolar. See the interesting article below on monopolar cautery and spinal ganglia denervation when using monopolar cautery. Electrocautery also uses 200-500 volts typically. Neurodegenerative effects of monopolar electrocauterization on spinal ganglia in lumbar disc surgery. - PubMed - NCBI

How could this not work!

 

[MaximusD]

I'll look for the review article in the JOURNAL OF SOVIET RUSSIA PAIN MEDICINE!

 

[clubdeac]

Isn't this kinda what they do at Laser Spine Institute when they say they do a laser rhizotomy at the same time as a microdiskectomy?

 

[Aether2000]

Some of the surgeons here in Florida routinely do the following all on the same patient, same day:
1. Lumbar discogram
2. Lumbar 2-3 level discectomy/laminectomy
3. Lumbar radio frequency neurotomy
4. Intradiscal "stem cell" treatment, not using any stem cells (amniotic cryopreserved homogenized allograft)
These are auto accident patients. Gigantic scams in Florida.

 

[NOSfan]

Never heard of this.

Previous local orthopedist would perform multi-level fusion and additionally charge for facet rhizotomy at each level.

 

[Taus]

Saw my first one of these today in PA. snow bird w chronic axial back pain. Pre op MRI w 3 level mild stenosis. Got 3 level lami in Florida over winter. Said surgeon also "drilled into and burned the joints". I'd love to see the op report. Now has new neuropathic pain in legs and worse axial back. Pending new MRI with contrast....


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[bedrock]

Some of the surgeons here in Florida routinely do the following all on the same patient, same day:
1. Lumbar discogram
2. Lumbar 2-3 level discectomy/laminectomy
3. Lumbar radio frequency neurotomy
4. Intradiscal "stem cell" treatment, not using any stem cells (amniotic cryopreserved homogenized allograft)
These are auto accident patients. Gigantic scams in Florida.

That is terrible. They should be sent to prison.

 

[Aether2000]

It is how medicine is practiced in the late-fee-for-service era as everyone scrambles to extract the maximum number of dollars from insurers and unwitting patients before the door closes forever.

 

[painfree23]

Saw my first one of these today in PA. snow bird w chronic axial back pain. Pre op MRI w 3 level mild stenosis. Got 3 level lami in Florida over winter. Said surgeon also "drilled into and burned the joints". I'd love to see the op report. Now has new neuropathic pain in legs and worse axial back. Pending new MRI with contrast....


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Stim?

 

[jesspt]

Some of the surgeons here in Florida routinely do the following all on the same patient, same day:
1. Lumbar discogram
2. Lumbar 2-3 level discectomy/laminectomy
3. Lumbar radio frequency neurotomy
4. Intradiscal "stem cell" treatment, not using any stem cells (amniotic cryopreserved homogenized allograft)
These are auto accident patients. Gigantic scams in Florida.

Perfect set-up for the fusion they are inevitably going to recommend down the road.

 

[Taus]

Stim?

Maybe. First need to rule out badness on MRI.


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[ampaphb]

It is how medicine is practiced in the late-fee-for-service era as everyone scrambles to extract the maximum number of dollars from insurers and unwitting patients before the door closes forever.

Insurance won't pay for this. Purely medicolegal

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[ampaphb]

Some of the surgeons here in Florida routinely do the following all on the same patient, same day:
1. Lumbar discogram
2. Lumbar 2-3 level discectomy/laminectomy
3. Lumbar radio frequency neurotomy
4. Intradiscal "stem cell" treatment, not using any stem cells (amniotic cryopreserved homogenized allograft)
These are auto accident patients. Gigantic scams in Florida.

We have a very reputable, Aprill-trained pain guy in Baton Rouge who pitches amniotic allograft as stem cells. Has done it on members of the LSU football team, coaching staff, and athletic director, as well as several Olympic track athletes. Cash only business, from what I understand.