I had the privilege of being on faculty to teach a large group of Consultants and Trainees techniques for interventional spinal pain management.
As always at course you learn from the teachers and students.
New learnings from the Course were:
A slightly adapted approach to the basic medial branch block for facet diagnostics. When added to the new Nimbus probe this will make facet radiofrequency denervation a simpler, more efficient, patient-friendly and probably effective technique.
Reintroduced to cryo-RF. Possibly a simpler way of doing a very similar job to heat nerve lesioning.
VBN ablation for Modic Pain (https://en.wikipedia.org/wiki/Modic_changes)
Modic related spinal pain can be very severe and hard to treat. I have used Modic Antibiotic Spinal Therapy (MAST) but it’s a hard course of antibiotic treatment.
I have been watching the vertbro-basal ablation technique since I first chaired a session at an IPSIS meeting in Munich where some of the first clinical data was presented, perhaps in 2017. It has now been developed by Relevant in the US and is FDA approved with randomised clinical trial data to prove potential efficacy. Similar technology is now available in the UK and is coming into practice.
The principle is the same as facet RF denervation: if you can isolate the nerve which carries pain sensation back to the brain and coagulate it by heat you effectively ‘cut the wire” conducting pain and the pain is controlled. Surprisingly, the principle works inside the vertebrae affected by Modic change.
The approach is similar to that used for vertebroplasty, a treatment I have used at times over the years, so it is not unfamiliar. I had the opportunity to practice at the Leeds Cadaver Course with skilled colleagues to offer tips and guidance.
I will be receiving further training with Robert Rapcan at his course in Warsaw in November and will be able to offer the treatment in the near future.
Alternative treatments for Modic pain exist including injection of antibiotics and steroid, injection of leucocyte rich concentrated platelet rich plasma (lrPRP) and Modic Antibiotic Therapy (MAST). I have published a small series of cases treated with MAST in the past but at this time I think lrPRP and VBN ablation would be preferred.
Given that Modic pain is among the most severe forms of back pain, these are highly significant new options for previously untreatable or very difficult to treat patients.