Outpatient Surgery Magazine

Snuffing Out Surgical Smoke - December 2019 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 89 of 156

mine if the medial branch nerves surrounding the facet joints — small joints between the vertebrae at the back of the spine — are the source of the patient's pain. "The medial branch block is a diagnostic test to see if the nerve that innervates the joint is the cause of the pain," says Dr. Shaparin. Generally, the procedure or "test" is done twice, and if that test is pos- itive, you proceed with an ablation. "Ablation gives the patient months if not years of relief. But it's not forever because the nerves do grow back," says Dr. Shaparin, adding that ideal candidates are patients who suffer from serious joint pain, whether it's from the facet joints in the back of the neck or the sacroiliac joint. From a cost perspective, there's some heavy upfront investment, says Dr. Cohen. The radiofrequency generator needed for the proce- dure can run you more than $30,000. Plus, the time for the radiology tech is costly. "They're very expensive. They bill at over $20 a minute," says Dr. Cohen. But again, there's the effectiveness factor. "Some patients see a tremendous response to this intervention," says Dr. Shaparin. "I've had patients who've seen relief for more than 2 years." 3. Spinal cord stimulators. The most intensive intervention on this list, spinal cord stimulators (SCSs) — also known as dorsal column stimulators (DCSs) — are for patients who haven't found relief from major surgery or who have undergone multiple back sur- geries, have a diagnosis of failed back surgery syndrome or have a major dependence on opioids for their chronic pain. The SCS inter- vention involves placing an implantable neuromodulation device into the patient that sends mild electrical signals to select areas of the spinal cord to reduce pain. Like radiofrequency ablation, SCSs involve a 2-step process. The first step is a trial where the surgeon places the lead wire into the 9 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • D E C E M B E R 2 0 1 9

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