Spine-Pain

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SIJ Palisade

Treat Sacroiliac Joint Pain For Cost Two RF Cannulae

The PalisadeTM technique makes treatment of pain from sacroiliac joint (SIJ) dysfunction easier, faster, and less expensive than ever before. It employs recent discoveries in Bipolar radiofrequency (RF) technology to create larger lesions than in cooled RF SIJ treatments, using smaller, less expensive RF cannulae and electrodes. Scientific evaluation of the technique predicts a more complete SI Joint lesion zone that conforms to patient anatomy and is less likely to leave gaps between adjacent lesions that could allow painful nerves to remain.1

Bipolar RF Creates Larger Lesions that Cooled RF

The Palisade approach employs overlapping bipolar RF lesions to create an aggregate lesion zone that traverses the entire region that sacral lateral branch nerves travel to the SI Joint.  Since bipolar lesions have an elongated “brick like” rectangular shape that is robust to parallel cannulae spacings of 8-12 mm (Figure 2), a lesion zone with substantially consistent thickness and height can be created using by lowering relatively few standard cannulae straight to the sacral surface.  In contrast, cooled RF methods use multiple, smaller spherical lesions that produce a total lesion zone with variable height and thickness, and which will have gaps that could spare painful nerves (see Figure 1).1,3

Cosman-2011-Bipolar-vs-Cooled-RF-w675

Figure 1 (A) Cooled monopolar lesion geometry for 10 and 12 mm tip-to-tip spacings, 2 mm tip-to-sacrum distance, 60°C set temperature, and 3.25-minute lesion time (0.75 pre-cooling + 2.5 heating).2,3,4 Gaps between and around adjacent lesions situated near the sacral surface can arise from small increases in tip-to-tip and tip-to-sacrum distances. (B) Bipolar lesion geometry for 10 mm and 12 mm tip-to-tip spacings, 0 mm tip-to-sacrum distance, 90°C set temperature, and 3-minute lesion time. Individually, bipolar lesions can be larger than both cooled and noncooled monopolar lesions. When arranged in a palisade on the sacral surface, bipolar lesions can collectively produce a lesion zone of consistent height, width, and depth that has fewer gaps than the lesion zone produced by the reported cooled RF SIJ method. (C) Three monopolar lesions, created using 90°C set temperature and 3-minute lesion time, are required to approximate a single bipolar lesion for 10 mm tip spacing and the same RF parameters (shown by the dotted outline). (A–C) Each panel shows a set of thermal lesions in both lateral (top) and needle (bottom) views.1

Straight-Line Ease and Efficiency

In the Palisade procedure1, cannulae are placed in a straight line between the sacral foramina and the ipsilateral SIJ line.  The line can be chosen using an AP x-ray image without additional measurement equipement, even in the presence of bowel gas.  In contrast, for periforaminal techniques like that used with cooled RF, each sacral foramina must be accurately identified and electrodes placed at specific positions and distances relative to each foramina2,3,4.  Use of additional reference needles2,3 and an epsilon rulers3 are advocated by some for these placements.

Multi-Bipolar for Even Faster Procedures

With standard reusable electrodes, the Palisade procedure can be performed efficiently and at very low cost using only two standard disposable RF cannulae.  Using up to six cannulae and the G4 four-electrode generator reduces procedure time even more, since multiple bipolar lesions are generated at the same time.  The Palisade Kit includes disposable cannulae and disposable electrodes to perform the Palisade procedure as described in the literature1.

The Confidence of Bony Contact

Since Palisade Cannulae remain in contact with the sacral surface through placement and lesioning, you can ensure that placements conform to patient anatomy over the length of the sacrum.  And, you can avoid placements within the sacral foramina which could pose a risk to the sacral nerve roots.

Compare to Cooled RF Point by Point

Compare the SIJ pain treatment using the Cosman Palisade kit with that using the Kimberly-Clark/Baylis SInergy® kit in terms of ease of use, effectiveness, treatment time, equipment requirements, patient trauma, and cost.  The following table is dervived from peer-reviewed scientific literature on the subject1,2,3,4, published specifications, promotional material, and bench testing.  As shown below, procedure time can be even further reduced by energizing multiple bipolar pairs at once using the Cosman G4 four-electrode radiofrequency generator.

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