BackTable MSK https://www.backtable.com/ en All rights reserved BackTable MSK is for all things Musculoskeletal and Interventional; covering tools, techniques, and expert guidance. It's the meeting after the meeting. https://megaphone.imgix.net/podcasts/1b360356-056f-11ee-964b-1f06086f4511/image/backtable-msk-favicon-square-3000.png?ixlib=rails-4.3.1&max-w=3000&max-h=3000&fit=crop&auto=format,compress BackTable MSK https://www.backtable.com/ episodic The BackTable MSK Podcast is a resource for Interventionalists to learn tips, techniques, and practical advice from their peers in the field. BackTable BackTable MSK is for all things Musculoskeletal and Interventional; covering tools, techniques, and expert guidance. It's the meeting after the meeting. BackTable MSK is for all things Musculoskeletal and Interventional; covering tools, techniques, and expert guidance. It's the meeting after the meeting.

]]> Backtable LLC aaron@backtable.com Ep. 98 MSK Hip Embolization: Patient Selection & Technique with Dr. Mateus Correa and Dr. Joaquim Filho Ready to shake up hip pain management? In this episode of BackTable MSK, we unpack how embolization is opening a new frontier for patients caught between conservative care and surgery. Interventional radiologist Dr. Kavi Krishnasamy hosts Brazilian interventionalists, Dr. Mateus Correa and Dr. Joaquim Filho, to discuss hip embolization for Greater Trochanteric Pain Syndrome (GTPS) and early hip Osteoarthritis (OA). The doctors highlight building multidisciplinary referrals, reimbursement, and the availability of embolic agents. They also address pre-procedure workup, including imaging and physical exam findings. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction 02:37 - Guest Background in MSK Embolization 08:14 - Availability of Embolics and Preferences in Brazil 10:31 - Reimbursement and Access Hurdles13:55 - Hip Etiologies Treated by Embolization 16:54 - Imaging Workup and the Role of MRI24:23 - Offering Conservative Treatment Options Prior to Embolization 26:52 - Scoring Systems and Physical Exam34:44 - Procedure Access Strategy39:16 - When to Utilize Temporary vs. Permanent Embolics46:34 - Post-Procedure and Follow-Up Guidelines58:05 - Discussion of Current Evidence --- More about this episode At the time of the procedure, Drs. Correa and Filho explain why they prefer certain vascular access points and specify arterial targets, favoring temporary embolic agents due to potential risk of Avascular Necrosis (AVN) of the femoral head. Furthermore, the doctors detail awake procedures with intraprocedural palpation and blush/pain-based endpoints, post-embolization pain flare management, follow-up schedules, and re-treatment criteria; all with consideration for current published evidence. ---Resources Dr. Mateus Correahttps://www.researchgate.net/profile/Mateus-Correa-4 Dr. Joaquim Filhohttps://www.researchgate.net/profile/Joaquim-Da-Motta-Leal-Filho --- BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons.Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app Tue, 28 Apr 2026 07:00:00 -0000 full BackTable Ready to shake up hip pain management? In this episode of BackTable MSK, we unpack how embolization is opening a new frontier for patients caught between conservative care and surgery. Interventional radiologist Dr. Kavi Krishnasamy hosts Brazilian interventionalists, Dr. Mateus Correa and Dr. Joaquim Filho, to discuss hip embolization for Greater Trochanteric Pain Syndrome (GTPS) and early hip Osteoarthritis (OA). The doctors highlight building multidisciplinary referrals, reimbursement, and the availability of embolic agents. They also address pre-procedure workup, including imaging and physical exam findings. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction 02:37 - Guest Background in MSK Embolization 08:14 - Availability of Embolics and Preferences in Brazil 10:31 - Reimbursement and Access Hurdles13:55 - Hip Etiologies Treated by Embolization 16:54 - Imaging Workup and the Role of MRI24:23 - Offering Conservative Treatment Options Prior to Embolization 26:52 - Scoring Systems and Physical Exam34:44 - Procedure Access Strategy39:16 - When to Utilize Temporary vs. Permanent Embolics46:34 - Post-Procedure and Follow-Up Guidelines58:05 - Discussion of Current Evidence --- More about this episode At the time of the procedure, Drs. Correa and Filho explain why they prefer certain vascular access points and specify arterial targets, favoring temporary embolic agents due to potential risk of Avascular Necrosis (AVN) of the femoral head. Furthermore, the doctors detail awake procedures with intraprocedural palpation and blush/pain-based endpoints, post-embolization pain flare management, follow-up schedules, and re-treatment criteria; all with consideration for current published evidence. ---Resources Dr. Mateus Correahttps://www.researchgate.net/profile/Mateus-Correa-4 Dr. Joaquim Filhohttps://www.researchgate.net/profile/Joaquim-Da-Motta-Leal-Filho --- BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons.Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app Ready to shake up hip pain management? In this episode of BackTable MSK, we unpack how embolization is opening a new frontier for patients caught between conservative care and surgery. Interventional radiologist Dr. Kavi Krishnasamy hosts Brazilian interventionalists, Dr. Mateus Correa and Dr. Joaquim Filho, to discuss hip embolization for Greater Trochanteric Pain Syndrome (GTPS) and early hip Osteoarthritis (OA). The doctors highlight building multidisciplinary referrals, reimbursement, and the availability of embolic agents. They also address pre-procedure workup, including imaging and physical exam findings.


---


Get the BackTable app
https://www.backtable.com/app


---


Timestamps


00:00 - Introduction
02:37 - Guest Background in MSK Embolization
08:14 - Availability of Embolics and Preferences in Brazil
10:31 - Reimbursement and Access Hurdles
13:55 - Hip Etiologies Treated by Embolization
16:54 - Imaging Workup and the Role of MRI
24:23 - Offering Conservative Treatment Options Prior to Embolization
26:52 - Scoring Systems and Physical Exam
34:44 - Procedure Access Strategy
39:16 - When to Utilize Temporary vs. Permanent Embolics
46:34 - Post-Procedure and Follow-Up Guidelines
58:05 - Discussion of Current Evidence


---


More about this episode


At the time of the procedure, Drs. Correa and Filho explain why they prefer certain vascular access points and specify arterial targets, favoring temporary embolic agents due to potential risk of Avascular Necrosis (AVN) of the femoral head. Furthermore, the doctors detail awake procedures with intraprocedural palpation and blush/pain-based endpoints, post-embolization pain flare management, follow-up schedules, and re-treatment criteria; all with consideration for current published evidence.


---
Resources


Dr. Mateus Correa
https://www.researchgate.net/profile/Mateus-Correa-4


Dr. Joaquim Filho
https://www.researchgate.net/profile/Joaquim-Da-Motta-Leal-Filho


---


BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons.
Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.


► https://www.backtable.com/app

]]> 4010 Ep. 97 Minimally Invasive Lumbar Decompression (MILD): Techniques & Outcomes with Dr. Denis Patterson Caught between conservative care and a large spine surgery, the MILD procedure offers potential as the in-between. On this episode of the BackTable MSK Podcast, Interventional Radiologist Dr. Dana Dunleavy welcomes pain specialist Dr. Denis Patterson to explore the evidence, technique, and evolving role of Minimally Invasive Lumbar Decompression (MILD) procedure for lumbar spinal stenosis with neurogenic claudication. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Strykerhttps://www.stryker.com/us/en/interventional-spine/products/mild-procedure.html --- Timestamps 00:00 - Introduction04:22 - What is the MILD procedure?09:55 - Comparing Discogenic Pain to Neurogenic Claudication 19:20 - MILD Procedure Technique 22:54 - Toolbox and Workflow36:59 - MILD Makes a Difference in the Pain Management Field41:53 - Objectifying Pain Measurements and Setting Patient Expectations46:26 - Driving Mutual Understanding in Surgical Cohorts 01:00:53 - Collaboration Over Competition01:05:32 - Final Takeaways --- More about this episode Dr. Patterson explains the pathophysiology and diagnostic process, highlighting key insights from patient history and MRI findings. The physicians review technique evolution from multiple paramedian incisions and epidurograms to streamlined single midline incision access, and cross lateral oblique (CLO) fluoroscopic safety landmarks. The discussion also references the MiDAS and Cleveland Clinic studies showing pain and functional improvement with a complication rate similar to epidural steroid injections, along with promising long-term outcomes and reduced need for surgical re-intervention. This episode also tackles practical considerations, including the impact of Category I CPT codes on reimbursement, challenges in radiology reporting, privileging politics, and pathways for physician training and proctoring. --- Resources Dr. Denis Pattersonhttps://www.linkedin.com/in/denis-patterson-50ba0485/ MiDAS I (Mild Decompression Alternative to Open Surgery): a preliminary report of a prospective, multi-center clinical studyhttps://pubmed.ncbi.nlm.nih.gov/20648206/ The durability of Minimally Invasive Lumbar Decompression procedure in patients with symptomatic lumbar spinal stenosis: Long-term follow-uphttps://pubmed.ncbi.nlm.nih.gov/33942964/ Pacific Spine and Pain Societyhttps://pacificspineandpainsociety.com/ --- BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app Tue, 21 Apr 2026 07:00:00 -0000 full BackTable Caught between conservative care and a large spine surgery, the MILD procedure offers potential as the in-between. On this episode of the BackTable MSK Podcast, Interventional Radiologist Dr. Dana Dunleavy welcomes pain specialist Dr. Denis Patterson to explore the evidence, technique, and evolving role of Minimally Invasive Lumbar Decompression (MILD) procedure for lumbar spinal stenosis with neurogenic claudication. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Strykerhttps://www.stryker.com/us/en/interventional-spine/products/mild-procedure.html --- Timestamps 00:00 - Introduction04:22 - What is the MILD procedure?09:55 - Comparing Discogenic Pain to Neurogenic Claudication 19:20 - MILD Procedure Technique 22:54 - Toolbox and Workflow36:59 - MILD Makes a Difference in the Pain Management Field41:53 - Objectifying Pain Measurements and Setting Patient Expectations46:26 - Driving Mutual Understanding in Surgical Cohorts 01:00:53 - Collaboration Over Competition01:05:32 - Final Takeaways --- More about this episode Dr. Patterson explains the pathophysiology and diagnostic process, highlighting key insights from patient history and MRI findings. The physicians review technique evolution from multiple paramedian incisions and epidurograms to streamlined single midline incision access, and cross lateral oblique (CLO) fluoroscopic safety landmarks. The discussion also references the MiDAS and Cleveland Clinic studies showing pain and functional improvement with a complication rate similar to epidural steroid injections, along with promising long-term outcomes and reduced need for surgical re-intervention. This episode also tackles practical considerations, including the impact of Category I CPT codes on reimbursement, challenges in radiology reporting, privileging politics, and pathways for physician training and proctoring. --- Resources Dr. Denis Pattersonhttps://www.linkedin.com/in/denis-patterson-50ba0485/ MiDAS I (Mild Decompression Alternative to Open Surgery): a preliminary report of a prospective, multi-center clinical studyhttps://pubmed.ncbi.nlm.nih.gov/20648206/ The durability of Minimally Invasive Lumbar Decompression procedure in patients with symptomatic lumbar spinal stenosis: Long-term follow-uphttps://pubmed.ncbi.nlm.nih.gov/33942964/ Pacific Spine and Pain Societyhttps://pacificspineandpainsociety.com/ --- BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app Caught between conservative care and a large spine surgery, the MILD procedure offers potential as the in-between. On this episode of the BackTable MSK Podcast, Interventional Radiologist Dr. Dana Dunleavy welcomes pain specialist Dr. Denis Patterson to explore the evidence, technique, and evolving role of Minimally Invasive Lumbar Decompression (MILD) procedure for lumbar spinal stenosis with neurogenic claudication.


---


Get the BackTable app
https://www.backtable.com/app


---


This podcast is supported by


Stryker
https://www.stryker.com/us/en/interventional-spine/products/mild-procedure.html


---


Timestamps


00:00 - Introduction
04:22 - What is the MILD procedure?
09:55 - Comparing Discogenic Pain to Neurogenic Claudication
19:20 - MILD Procedure Technique
22:54 - Toolbox and Workflow
36:59 - MILD Makes a Difference in the Pain Management Field
41:53 - Objectifying Pain Measurements and Setting Patient Expectations
46:26 - Driving Mutual Understanding in Surgical Cohorts
01:00:53 - Collaboration Over Competition
01:05:32 - Final Takeaways


---


More about this episode


Dr. Patterson explains the pathophysiology and diagnostic process, highlighting key insights from patient history and MRI findings. The physicians review technique evolution from multiple paramedian incisions and epidurograms to streamlined single midline incision access, and cross lateral oblique (CLO) fluoroscopic safety landmarks.


The discussion also references the MiDAS and Cleveland Clinic studies showing pain and functional improvement with a complication rate similar to epidural steroid injections, along with promising long-term outcomes and reduced need for surgical re-intervention. This episode also tackles practical considerations, including the impact of Category I CPT codes on reimbursement, challenges in radiology reporting, privileging politics, and pathways for physician training and proctoring.


---


Resources


Dr. Denis Patterson
https://www.linkedin.com/in/denis-patterson-50ba0485/


MiDAS I (Mild Decompression Alternative to Open Surgery): a preliminary report of a prospective, multi-center clinical study
https://pubmed.ncbi.nlm.nih.gov/20648206/


The durability of Minimally Invasive Lumbar Decompression procedure in patients with symptomatic lumbar spinal stenosis: Long-term follow-up
https://pubmed.ncbi.nlm.nih.gov/33942964/


Pacific Spine and Pain Society
https://pacificspineandpainsociety.com/


---


BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons.


Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.


► https://www.backtable.com/app

]]> 4047 Ep. 96 MSK Embolization Case Discussions with Dr. Os Ahmed and Dr. Mikin Patel The embolization playbook is expanding. The question is: are you ready to use it? In this episode of the BackTable MSK Podcast, host Dr. Ally Bahehi joins Dr. Mikin Patel and Dr. Osmad Ahmed from Joint and Vascular Institute in the greater Chicago area to discuss plantar fasciitis embolization; a newer MSK embolization technique, building from concepts and clinical pearls for genicular artery embolization (GAE). --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:18 - Ideal Patient for Plantar Fasciitis Embolization02:14 - Workup, Imaging Needs, and the Reality of Insurance Coverage 03:53 - Benefits And Expectations06:05 - Step By Step Procedure Walkthrough11:29 - Pain Relief and Follow-Up Timeline13:46 - GAE Case Setup14:54 - Debating Access Strategy 15:54 - Crash Course in Genicular Artery Anatomy19:08 - Minimalist GAE Toolkit Set-Up22:32 - Time to Inject! The Wrap Up --- Resources Dr. Mikin Patelhttps://jointvascular.com/team/mikin-v-patel-md-mba/ Dr. Osman Ahmedhttps://jointvascular.com/team/osman-ahmed-m-d-fcirse/ Tue, 31 Mar 2026 07:00:00 -0000 full BackTable The embolization playbook is expanding. The question is: are you ready to use it? In this episode of the BackTable MSK Podcast, host Dr. Ally Bahehi joins Dr. Mikin Patel and Dr. Osmad Ahmed from Joint and Vascular Institute in the greater Chicago area to discuss plantar fasciitis embolization; a newer MSK embolization technique, building from concepts and clinical pearls for genicular artery embolization (GAE). --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:18 - Ideal Patient for Plantar Fasciitis Embolization02:14 - Workup, Imaging Needs, and the Reality of Insurance Coverage 03:53 - Benefits And Expectations06:05 - Step By Step Procedure Walkthrough11:29 - Pain Relief and Follow-Up Timeline13:46 - GAE Case Setup14:54 - Debating Access Strategy 15:54 - Crash Course in Genicular Artery Anatomy19:08 - Minimalist GAE Toolkit Set-Up22:32 - Time to Inject! The Wrap Up --- Resources Dr. Mikin Patelhttps://jointvascular.com/team/mikin-v-patel-md-mba/ Dr. Osman Ahmedhttps://jointvascular.com/team/osman-ahmed-m-d-fcirse/ The embolization playbook is expanding. The question is: are you ready to use it? In this episode of the BackTable MSK Podcast, host Dr. Ally Bahehi joins Dr. Mikin Patel and Dr. Osmad Ahmed from Joint and Vascular Institute in the greater Chicago area to discuss plantar fasciitis embolization; a newer MSK embolization technique, building from concepts and clinical pearls for genicular artery embolization (GAE).


---


Get the BackTable app


https://www.backtable.com/app


---


Timestamps


00:00 - Introduction
01:18 - Ideal Patient for Plantar Fasciitis Embolization
02:14 - Workup, Imaging Needs, and the Reality of Insurance Coverage
03:53 - Benefits And Expectations
06:05 - Step By Step Procedure Walkthrough
11:29 - Pain Relief and Follow-Up Timeline
13:46 - GAE Case Setup
14:54 - Debating Access Strategy
15:54 - Crash Course in Genicular Artery Anatomy
19:08 - Minimalist GAE Toolkit Set-Up
22:32 - Time to Inject! The Wrap Up


---


Resources


Dr. Mikin Patel
https://jointvascular.com/team/mikin-v-patel-md-mba/


Dr. Osman Ahmed
https://jointvascular.com/team/osman-ahmed-m-d-fcirse/

]]> 1509 Backtable Brief: How to Prepare for Complex Pelvic MSK Interventions with Dr. Brandon Key Every new device and technique comes with a learning curve, ​​and in this BackTable MSK Brief we’re navigating pelvic curves. Host Dr. Kavi Krishnasamy joins Dr. Brandon Key to dissect pelvic and sacral fixation techniques. They discuss patient positioning and prep to needle-guidance software, with procedural pearls scattered throughout the conversation. Episode Outline 00:00 - Introduction 00:26 - Pelvic Positioning Strategy 04:00 - Need to Know: Needle Guidance  09:20 - Thermoablation in Pathologic Fracture Fixation 13:29 - The Photodynamic Nail by IlluminOss: An Overview 20:00 - Finding The Way with a Curved Trajectory 22:52 - Wrap Up Resources Dr. Brandon Key, MD https://www.linkedin.com/in/brandon-key-md-367a01310/  IlluminOss https://illuminoss.com/us Tue, 17 Mar 2026 07:00:00 -0000 full BackTable Every new device and technique comes with a learning curve, ​​and in this BackTable MSK Brief we’re navigating pelvic curves. Host Dr. Kavi Krishnasamy joins Dr. Brandon Key to dissect pelvic and sacral fixation techniques. They discuss patient positioning and prep to needle-guidance software, with procedural pearls scattered throughout the conversation. Episode Outline 00:00 - Introduction 00:26 - Pelvic Positioning Strategy 04:00 - Need to Know: Needle Guidance  09:20 - Thermoablation in Pathologic Fracture Fixation 13:29 - The Photodynamic Nail by IlluminOss: An Overview 20:00 - Finding The Way with a Curved Trajectory 22:52 - Wrap Up Resources Dr. Brandon Key, MD https://www.linkedin.com/in/brandon-key-md-367a01310/  IlluminOss https://illuminoss.com/us Every new device and technique comes with a learning curve, ​​and in this BackTable MSK Brief we’re navigating pelvic curves. Host Dr. Kavi Krishnasamy joins Dr. Brandon Key to dissect pelvic and sacral fixation techniques. They discuss patient positioning and prep to needle-guidance software, with procedural pearls scattered throughout the conversation.


Episode Outline


00:00 - Introduction

00:26 - Pelvic Positioning Strategy

04:00 - Need to Know: Needle Guidance 

09:20 - Thermoablation in Pathologic Fracture Fixation

13:29 - The Photodynamic Nail by IlluminOss: An Overview

20:00 - Finding The Way with a Curved Trajectory

22:52 - Wrap Up


Resources


Dr. Brandon Key, MD

https://www.linkedin.com/in/brandon-key-md-367a01310/ 


IlluminOss

https://illuminoss.com/us


]]> 1489 Ep. 95 Shoulder Embolization for Adhesive Capsulitis & Tendinopathy with Dr. Yan Epelboym For patients who have exhausted conservative management but aren’t ready for the knife, shoulder embolization offers a minimally invasive intermediary option. In this episode of BackTable MSK, host Kavi Krishnasamy welcomes Dr. Yan Epelboym, an interventional radiologist trailblazing the MSK IR space. The doctors discuss the rapid development of musculoskeletal embolization applications with an emphasis on shoulder embolization. --- SYNPOSIS The episode begins with Dr. Epelboym outlining how his interest in musculoskeletal embolization developed after exposure to Okuno’s early work, along with practical considerations for establishing referral pathways for these procedures. He also provides updates on the ongoing ELECTRC clinical trial at Brigham and Women’s Hospital evaluating shoulder embolization. The discussion then turns to outcome measurement, including pain scoring systems and approaches to standardized clinical follow-up. The conversation concludes with a review of the existing literature on adhesive capsulitis, including a meta-analysis demonstrating improvements in pain and range of motion with predominantly minor adverse events, while emphasizing the ongoing need for randomized trials and greater procedural standardization. --- TIMESTAMPS 00:00 - Introduction 01:42 - Dr. Yan Epelboym’s Origin Story in MSK03:02 - Building Referral Networks06:50 - Details on Clinic Workflow 10:08 - The Run Down on Shoulder Embolization Treatment Targets22:09 - Current Insights on Shoulder OA Embolization27:56 - Shoulder Embolization Setup and Access Choice34:28 - Shoulder Embolization Strategy and Endpoints36:38 - Post-Procedure Pain Control and Activity Limitations42:26 - Shoulder Surgery Status-Post Embolization44:17 - Discussing Existing Research Data on Shoulder Embolization01:00:32 - Key Shoulder Arterial Anatomy and Variants01:04:27 - Shoulder OA Case Discussion01:09:08 - Final Thoughts --- RESOURCES Dr. Yan Epelboym, MD, MPHhttps://www.linkedin.com/in/yan-epelboym-4a84991b/ Embolization Treatment of Chronic Refractory Shoulder Tendinopathy (ELECTRC)https://clinicaltrials.gov/study/NCT06095050 Tue, 10 Mar 2026 07:00:00 -0000 full BackTable For patients who have exhausted conservative management but aren’t ready for the knife, shoulder embolization offers a minimally invasive intermediary option. In this episode of BackTable MSK, host Kavi Krishnasamy welcomes Dr. Yan Epelboym, an interventional radiologist trailblazing the MSK IR space. The doctors discuss the rapid development of musculoskeletal embolization applications with an emphasis on shoulder embolization. --- SYNPOSIS The episode begins with Dr. Epelboym outlining how his interest in musculoskeletal embolization developed after exposure to Okuno’s early work, along with practical considerations for establishing referral pathways for these procedures. He also provides updates on the ongoing ELECTRC clinical trial at Brigham and Women’s Hospital evaluating shoulder embolization. The discussion then turns to outcome measurement, including pain scoring systems and approaches to standardized clinical follow-up. The conversation concludes with a review of the existing literature on adhesive capsulitis, including a meta-analysis demonstrating improvements in pain and range of motion with predominantly minor adverse events, while emphasizing the ongoing need for randomized trials and greater procedural standardization. --- TIMESTAMPS 00:00 - Introduction 01:42 - Dr. Yan Epelboym’s Origin Story in MSK03:02 - Building Referral Networks06:50 - Details on Clinic Workflow 10:08 - The Run Down on Shoulder Embolization Treatment Targets22:09 - Current Insights on Shoulder OA Embolization27:56 - Shoulder Embolization Setup and Access Choice34:28 - Shoulder Embolization Strategy and Endpoints36:38 - Post-Procedure Pain Control and Activity Limitations42:26 - Shoulder Surgery Status-Post Embolization44:17 - Discussing Existing Research Data on Shoulder Embolization01:00:32 - Key Shoulder Arterial Anatomy and Variants01:04:27 - Shoulder OA Case Discussion01:09:08 - Final Thoughts --- RESOURCES Dr. Yan Epelboym, MD, MPHhttps://www.linkedin.com/in/yan-epelboym-4a84991b/ Embolization Treatment of Chronic Refractory Shoulder Tendinopathy (ELECTRC)https://clinicaltrials.gov/study/NCT06095050 For patients who have exhausted conservative management but aren’t ready for the knife, shoulder embolization offers a minimally invasive intermediary option. In this episode of BackTable MSK, host Kavi Krishnasamy welcomes Dr. Yan Epelboym, an interventional radiologist trailblazing the MSK IR space. The doctors discuss the rapid development of musculoskeletal embolization applications with an emphasis on shoulder embolization.


---


SYNPOSIS


The episode begins with Dr. Epelboym outlining how his interest in musculoskeletal embolization developed after exposure to Okuno’s early work, along with practical considerations for establishing referral pathways for these procedures. He also provides updates on the ongoing ELECTRC clinical trial at Brigham and Women’s Hospital evaluating shoulder embolization. The discussion then turns to outcome measurement, including pain scoring systems and approaches to standardized clinical follow-up. The conversation concludes with a review of the existing literature on adhesive capsulitis, including a meta-analysis demonstrating improvements in pain and range of motion with predominantly minor adverse events, while emphasizing the ongoing need for randomized trials and greater procedural standardization.


---


TIMESTAMPS


00:00 - Introduction
01:42 - Dr. Yan Epelboym’s Origin Story in MSK
03:02 - Building Referral Networks
06:50 - Details on Clinic Workflow
10:08 - The Run Down on Shoulder Embolization Treatment Targets
22:09 - Current Insights on Shoulder OA Embolization
27:56 - Shoulder Embolization Setup and Access Choice
34:28 - Shoulder Embolization Strategy and Endpoints
36:38 - Post-Procedure Pain Control and Activity Limitations
42:26 - Shoulder Surgery Status-Post Embolization
44:17 - Discussing Existing Research Data on Shoulder Embolization
01:00:32 - Key Shoulder Arterial Anatomy and Variants
01:04:27 - Shoulder OA Case Discussion
01:09:08 - Final Thoughts


---


RESOURCES


Dr. Yan Epelboym, MD, MPH
https://www.linkedin.com/in/yan-epelboym-4a84991b/


Embolization Treatment of Chronic Refractory Shoulder Tendinopathy (ELECTRC)
https://clinicaltrials.gov/study/NCT06095050

]]> 4319 Backtable Brief: Multidisciplinary Approaches in Bone Stabilization with Dr. Brandon Key In orthopedic IR, confidence comes from exposure. It’s all about getting those reps in. In this BackTable MSK Brief, host Kavi Krishnasamy interviews Dr. Brandon Key from the Medical College of Wisconsin about implementing bone stabilization and fixation in interventional radiology for pathologic and non-pathologic fractures. The doctors discuss key barriers which include limited training exposure and operational inefficiencies that discourage adoption. However, they highlight the evolving technology, vendor toolsets, and growing multidisciplinary collaboration that are mitigating these barriers. The discussion expands to cover trauma-related consults from orthopedic surgery, indications and evolving applications of the IlluminOss device, screw types and preferences, and the capabilities of the Flow-FX cement-delivery device.  Episode Outline 00:00 - Introduction 00:57 - The Delay in Take-Off of Bony Fixation and Stabilization at the Trainee Level  03:10 - Meaningful Multidisciplinary Momentum 05:35 - Treatment of Pathologic Fractures in the Orthopedic IR Space 09:17 - Considerations for Trauma and Fragility Cases 16:09 - Patient Prep and Approach 18:05 - Final Thoughts Resources Dr. Brandon Key, MD https://www.linkedin.com/in/brandon-key-md-367a01310/  IlluminOss https://illuminoss.com/us  Flow-FXhttps://flow-fx.net/products/ Tue, 03 Mar 2026 08:00:00 -0000 full BackTable In orthopedic IR, confidence comes from exposure. It’s all about getting those reps in. In this BackTable MSK Brief, host Kavi Krishnasamy interviews Dr. Brandon Key from the Medical College of Wisconsin about implementing bone stabilization and fixation in interventional radiology for pathologic and non-pathologic fractures. The doctors discuss key barriers which include limited training exposure and operational inefficiencies that discourage adoption. However, they highlight the evolving technology, vendor toolsets, and growing multidisciplinary collaboration that are mitigating these barriers. The discussion expands to cover trauma-related consults from orthopedic surgery, indications and evolving applications of the IlluminOss device, screw types and preferences, and the capabilities of the Flow-FX cement-delivery device.  Episode Outline 00:00 - Introduction 00:57 - The Delay in Take-Off of Bony Fixation and Stabilization at the Trainee Level  03:10 - Meaningful Multidisciplinary Momentum 05:35 - Treatment of Pathologic Fractures in the Orthopedic IR Space 09:17 - Considerations for Trauma and Fragility Cases 16:09 - Patient Prep and Approach 18:05 - Final Thoughts Resources Dr. Brandon Key, MD https://www.linkedin.com/in/brandon-key-md-367a01310/  IlluminOss https://illuminoss.com/us  Flow-FXhttps://flow-fx.net/products/ In orthopedic IR, confidence comes from exposure. It’s all about getting those reps in. In this BackTable MSK Brief, host Kavi Krishnasamy interviews Dr. Brandon Key from the Medical College of Wisconsin about implementing bone stabilization and fixation in interventional radiology for pathologic and non-pathologic fractures.


The doctors discuss key barriers which include limited training exposure and operational inefficiencies that discourage adoption. However, they highlight the evolving technology, vendor toolsets, and growing multidisciplinary collaboration that are mitigating these barriers. The discussion expands to cover trauma-related consults from orthopedic surgery, indications and evolving applications of the IlluminOss device, screw types and preferences, and the capabilities of the Flow-FX cement-delivery device. 


Episode Outline


00:00 - Introduction

00:57 - The Delay in Take-Off of Bony Fixation and Stabilization at the Trainee Level 

03:10 - Meaningful Multidisciplinary Momentum

05:35 - Treatment of Pathologic Fractures in the Orthopedic IR Space

09:17 - Considerations for Trauma and Fragility Cases

16:09 - Patient Prep and Approach

18:05 - Final Thoughts


Resources


Dr. Brandon Key, MD

https://www.linkedin.com/in/brandon-key-md-367a01310/ 


IlluminOss

https://illuminoss.com/us 


Flow-FX
https://flow-fx.net/products/

]]> 1276 Backtable Brief: Sedation and Anesthesia in Bone Cancer Ablation with Dr. Damian Dupuy From anesthesia decisions to ablation strategy, what really separates a good outcome from a great one in bone tumor ablation? This BackTable MSK Brief features an enlightening conversation between host Kavi Krishnasamy and bone ablation pioneer Dr. Damian Dupuy. They cover anesthesia choices for different patient scenarios, optimal procedural techniques and agent selection for bone ablations, and the combination of local and systemic therapies for oligometastatic and oligo-progressive diseases. The doctors also tackle myths and realities around thermal and cryoablation, examining both clinical trial data and real-world experiences.  Episode Outline 00:00 - Introduction 00:40 - Selecting General Anesthesia vs. MAC 03:30 - Approach to Multiple Bony Lesions in Metastatic Disease 07:27 - Ablation Confirmation and Techniques Utilized in Bone Ablation  09:00 - Research Insights Surrounding RFA in Bone 12:16 - Sclerotic vs. Lytic Lesions: Techniques and Considerations 14:47 - Skin Protection During Superficial Lesion Treatments 16:38 - Analyzing Clinical Trials: Motion and OPuS One 20:51 - Conclusion Resources Dr. Damian E. Dupuy, MD, FACR https://www.linkedin.com/in/damian-e-dupuy-md-facr-6b080b1b/  Radiofrequency Ablation Provides Rapid and Durable Pain Relief for the Palliative Treatment of Lytic Bone Metastases Independent of Radiation Therapy: Final Results from the OsteoCool Tumor Ablation Post-Market Study https://pmc.ncbi.nlm.nih.gov/articles/PMC10156864/  Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Study https://pmc.ncbi.nlm.nih.gov/articles/PMC8011449/ Tue, 24 Feb 2026 08:00:00 -0000 full BackTable From anesthesia decisions to ablation strategy, what really separates a good outcome from a great one in bone tumor ablation? This BackTable MSK Brief features an enlightening conversation between host Kavi Krishnasamy and bone ablation pioneer Dr. Damian Dupuy. They cover anesthesia choices for different patient scenarios, optimal procedural techniques and agent selection for bone ablations, and the combination of local and systemic therapies for oligometastatic and oligo-progressive diseases. The doctors also tackle myths and realities around thermal and cryoablation, examining both clinical trial data and real-world experiences.  Episode Outline 00:00 - Introduction 00:40 - Selecting General Anesthesia vs. MAC 03:30 - Approach to Multiple Bony Lesions in Metastatic Disease 07:27 - Ablation Confirmation and Techniques Utilized in Bone Ablation  09:00 - Research Insights Surrounding RFA in Bone 12:16 - Sclerotic vs. Lytic Lesions: Techniques and Considerations 14:47 - Skin Protection During Superficial Lesion Treatments 16:38 - Analyzing Clinical Trials: Motion and OPuS One 20:51 - Conclusion Resources Dr. Damian E. Dupuy, MD, FACR https://www.linkedin.com/in/damian-e-dupuy-md-facr-6b080b1b/  Radiofrequency Ablation Provides Rapid and Durable Pain Relief for the Palliative Treatment of Lytic Bone Metastases Independent of Radiation Therapy: Final Results from the OsteoCool Tumor Ablation Post-Market Study https://pmc.ncbi.nlm.nih.gov/articles/PMC10156864/  Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Study https://pmc.ncbi.nlm.nih.gov/articles/PMC8011449/ From anesthesia decisions to ablation strategy, what really separates a good outcome from a great one in bone tumor ablation? This BackTable MSK Brief features an enlightening conversation between host Kavi Krishnasamy and bone ablation pioneer Dr. Damian Dupuy. They cover anesthesia choices for different patient scenarios, optimal procedural techniques and agent selection for bone ablations, and the combination of local and systemic therapies for oligometastatic and oligo-progressive diseases. The doctors also tackle myths and realities around thermal and cryoablation, examining both clinical trial data and real-world experiences. 


Episode Outline


00:00 - Introduction

00:40 - Selecting General Anesthesia vs. MAC

03:30 - Approach to Multiple Bony Lesions in Metastatic Disease

07:27 - Ablation Confirmation and Techniques Utilized in Bone Ablation 

09:00 - Research Insights Surrounding RFA in Bone

12:16 - Sclerotic vs. Lytic Lesions: Techniques and Considerations

14:47 - Skin Protection During Superficial Lesion Treatments

16:38 - Analyzing Clinical Trials: Motion and OPuS One

20:51 - Conclusion


Resources


Dr. Damian E. Dupuy, MD, FACR

https://www.linkedin.com/in/damian-e-dupuy-md-facr-6b080b1b/ 


Radiofrequency Ablation Provides Rapid and Durable Pain Relief for the Palliative Treatment of Lytic Bone Metastases Independent of Radiation Therapy: Final Results from the OsteoCool Tumor Ablation Post-Market Study

https://pmc.ncbi.nlm.nih.gov/articles/PMC10156864/ 


Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Study


https://pmc.ncbi.nlm.nih.gov/articles/PMC8011449/

]]> 1416 Backtable Brief: Bone Tumor Interface & Treatment Techniques in Palliative Care with Dr. Damian Dupuy Bone tumor treatment: when do you burn it and when do you freeze it? In this BackTable MSK Brief, Dr. Damian Dupuy joins Host Dr. Kavi Krishnasamy to discuss the technical nuances of radiofrequency ablation (RFA) and cryoablation, patient selection criteria, procedural strategies, and the importance of setting appropriate patient expectations. Dr. Dupuy also shares insights on preventing complications like cryomyositis and myoglobinuria, underscoring the balance between aggressive treatment and patient safety. Episode Outline 00:00 - Introduction 00:40 - Bone Tumor Interface and Time Under Treatment 05:10 - Patient Selection and Treatment Considerations 07:57 - Approach to Large Bony Lesions 12:37 - Best Treatment Modality: Cryoablation vs. RFA 13:38 - Managing Collateral Damage 15:58 - Navigating Patient Expectations Resources Dr. Damian E. Dupuy, MD, FACR https://www.linkedin.com/in/damian-e-dupuy-md-facr-6b080b1b/  Solitary painful osseous metastases: correlation of imaging features with pain palliation after radiofrequency ablation--a multicenter american college of radiology imaging network study https://pubmed.ncbi.nlm.nih.gov/23657892/ Tue, 17 Feb 2026 08:00:00 -0000 full BackTable Bone tumor treatment: when do you burn it and when do you freeze it? In this BackTable MSK Brief, Dr. Damian Dupuy joins Host Dr. Kavi Krishnasamy to discuss the technical nuances of radiofrequency ablation (RFA) and cryoablation, patient selection criteria, procedural strategies, and the importance of setting appropriate patient expectations. Dr. Dupuy also shares insights on preventing complications like cryomyositis and myoglobinuria, underscoring the balance between aggressive treatment and patient safety. Episode Outline 00:00 - Introduction 00:40 - Bone Tumor Interface and Time Under Treatment 05:10 - Patient Selection and Treatment Considerations 07:57 - Approach to Large Bony Lesions 12:37 - Best Treatment Modality: Cryoablation vs. RFA 13:38 - Managing Collateral Damage 15:58 - Navigating Patient Expectations Resources Dr. Damian E. Dupuy, MD, FACR https://www.linkedin.com/in/damian-e-dupuy-md-facr-6b080b1b/  Solitary painful osseous metastases: correlation of imaging features with pain palliation after radiofrequency ablation--a multicenter american college of radiology imaging network study https://pubmed.ncbi.nlm.nih.gov/23657892/ Bone tumor treatment: when do you burn it and when do you freeze it? In this BackTable MSK Brief, Dr. Damian Dupuy joins Host Dr. Kavi Krishnasamy to discuss the technical nuances of radiofrequency ablation (RFA) and cryoablation, patient selection criteria, procedural strategies, and the importance of setting appropriate patient expectations. Dr. Dupuy also shares insights on preventing complications like cryomyositis and myoglobinuria, underscoring the balance between aggressive treatment and patient safety.


Episode Outline


00:00 - Introduction

00:40 - Bone Tumor Interface and Time Under Treatment

05:10 - Patient Selection and Treatment Considerations

07:57 - Approach to Large Bony Lesions

12:37 - Best Treatment Modality: Cryoablation vs. RFA

13:38 - Managing Collateral Damage

15:58 - Navigating Patient Expectations


Resources


Dr. Damian E. Dupuy, MD, FACR

https://www.linkedin.com/in/damian-e-dupuy-md-facr-6b080b1b/ 


Solitary painful osseous metastases: correlation of imaging features with pain palliation after radiofrequency ablation--a multicenter american college of radiology imaging network study


https://pubmed.ncbi.nlm.nih.gov/23657892/

]]> 1261 Ep. 94 Genicular Artery Embolization in Post-TKA Pain Management with Dr. Rene Viso Can genicular artery embolization (GAE) relieve chronic knee pain after total knee arthroplasty (TKA)? In this episode of BackTable MSK, Argentinian interventional radiologist Dr. Rene Viso joins host Dr. Kavi Krishnasamy to discuss the status of GAE in South America, patient selection criteria, procedural techniques, and the challenges of treating post-TKA patients with GAE. --- SYNPOSIS Dr. Viso also highlights the importance of multidisciplinary collaboration and adjunctive therapies like genicular nerve blocks to improve patient outcomes. The episode concludes with a discussion on Dr. Viso's recent research and case studies, emphasizing the potential and complexities of GAE in managing chronic knee pain. --- TIMESTAMPS 00:00 - Introduction02:02 - GAE in South America03:57 - Patient Selection for GAE13:18 - Procedure Techniques and Device Choices23:54 - Challenges and Tips for TKA Patients Undergoing GAE27:17 - Patient Follow-Up After Intervention29:41 - Handling Treatment Failures32:57 - Adjunctive Therapies for Post-TKA Patients with GAE34:46 - Research Update: Dr. Viso’s Recent Publication on GAE in Post-TKA Patients 39:44 - Case Studies and Discussion50:19 - Future Directions and Final Thoughts --- RESOURCES Dr. Rene Visohttps://www.linkedin.com/in/rene-viso-11a245132/ Genicular Artery Embolization for Persistent Pain after Total Knee Arthroplasty: Initial Clinical Experiencehttps://pubmed.ncbi.nlm.nih.gov/41320119/ Tue, 10 Feb 2026 08:00:00 -0000 full BackTable Can genicular artery embolization (GAE) relieve chronic knee pain after total knee arthroplasty (TKA)? In this episode of BackTable MSK, Argentinian interventional radiologist Dr. Rene Viso joins host Dr. Kavi Krishnasamy to discuss the status of GAE in South America, patient selection criteria, procedural techniques, and the challenges of treating post-TKA patients with GAE. --- SYNPOSIS Dr. Viso also highlights the importance of multidisciplinary collaboration and adjunctive therapies like genicular nerve blocks to improve patient outcomes. The episode concludes with a discussion on Dr. Viso's recent research and case studies, emphasizing the potential and complexities of GAE in managing chronic knee pain. --- TIMESTAMPS 00:00 - Introduction02:02 - GAE in South America03:57 - Patient Selection for GAE13:18 - Procedure Techniques and Device Choices23:54 - Challenges and Tips for TKA Patients Undergoing GAE27:17 - Patient Follow-Up After Intervention29:41 - Handling Treatment Failures32:57 - Adjunctive Therapies for Post-TKA Patients with GAE34:46 - Research Update: Dr. Viso’s Recent Publication on GAE in Post-TKA Patients 39:44 - Case Studies and Discussion50:19 - Future Directions and Final Thoughts --- RESOURCES Dr. Rene Visohttps://www.linkedin.com/in/rene-viso-11a245132/ Genicular Artery Embolization for Persistent Pain after Total Knee Arthroplasty: Initial Clinical Experiencehttps://pubmed.ncbi.nlm.nih.gov/41320119/ Can genicular artery embolization (GAE) relieve chronic knee pain after total knee arthroplasty (TKA)? In this episode of BackTable MSK, Argentinian interventional radiologist Dr. Rene Viso joins host Dr. Kavi Krishnasamy to discuss the status of GAE in South America, patient selection criteria, procedural techniques, and the challenges of treating post-TKA patients with GAE.


---


SYNPOSIS


Dr. Viso also highlights the importance of multidisciplinary collaboration and adjunctive therapies like genicular nerve blocks to improve patient outcomes. The episode concludes with a discussion on Dr. Viso's recent research and case studies, emphasizing the potential and complexities of GAE in managing chronic knee pain.


---


TIMESTAMPS


00:00 - Introduction
02:02 - GAE in South America
03:57 - Patient Selection for GAE
13:18 - Procedure Techniques and Device Choices
23:54 - Challenges and Tips for TKA Patients Undergoing GAE
27:17 - Patient Follow-Up After Intervention
29:41 - Handling Treatment Failures
32:57 - Adjunctive Therapies for Post-TKA Patients with GAE
34:46 - Research Update: Dr. Viso’s Recent Publication on GAE in Post-TKA Patients
39:44 - Case Studies and Discussion
50:19 - Future Directions and Final Thoughts


---


RESOURCES


Dr. Rene Viso
https://www.linkedin.com/in/rene-viso-11a245132/


Genicular Artery Embolization for Persistent Pain after Total Knee Arthroplasty: Initial Clinical Experience
https://pubmed.ncbi.nlm.nih.gov/41320119/

]]> 3498 Ep. 93 Genicular Artery Embolization: Insights & Techniques with Dr. Rachel Piechowiak and Dr. Faraz Khan How is genicular artery embolization reshaping our clinical approach to patients with chronic knee pain? Dr. Rachel Piechowiak and Dr. Faraz Khan, interventional radiologists at IR Centers join Dr. Don Garbett in a deep dive into the current state of Genicular Artery Embolization (GAE). --- SYNPOSIS Dr. Piechowiak and Dr. Khan provide a deep dive on the technical nuances of GAE, covering patient selection, access strategies, and key procedural techniques. The conversation also details complex case scenarios and how to tailor catheters and embolics to navigate challenging anatomy. The doctors then share their structured approach to post-procedure follow-up, underscoring the importance of setting realistic treatment expectations with patients. The episode closes with their perspective on the future of genicular artery embolization, emphasizing the need for robust long-term outcomes data to better define the role of GAE in chronic knee pain management. --- TIMESTAMPS 00:00 - Introduction05:54 - Patient Workup for GAE10:42 - Setting Patient Expectations for GAE16:24 - Procedure Approaches and Techniques30:41 - Understanding Artery Targeting Strategies34:56 - Approaches to Microcatheter Selection38:18 - Choosing the Right Embolic Agents47:43 - Managing Complications and Follow-Ups51:23 - Challenges with Post-TKA Patients54:16 - Future Directions Tue, 27 Jan 2026 08:00:00 -0000 full BackTable How is genicular artery embolization reshaping our clinical approach to patients with chronic knee pain? Dr. Rachel Piechowiak and Dr. Faraz Khan, interventional radiologists at IR Centers join Dr. Don Garbett in a deep dive into the current state of Genicular Artery Embolization (GAE). --- SYNPOSIS Dr. Piechowiak and Dr. Khan provide a deep dive on the technical nuances of GAE, covering patient selection, access strategies, and key procedural techniques. The conversation also details complex case scenarios and how to tailor catheters and embolics to navigate challenging anatomy. The doctors then share their structured approach to post-procedure follow-up, underscoring the importance of setting realistic treatment expectations with patients. The episode closes with their perspective on the future of genicular artery embolization, emphasizing the need for robust long-term outcomes data to better define the role of GAE in chronic knee pain management. --- TIMESTAMPS 00:00 - Introduction05:54 - Patient Workup for GAE10:42 - Setting Patient Expectations for GAE16:24 - Procedure Approaches and Techniques30:41 - Understanding Artery Targeting Strategies34:56 - Approaches to Microcatheter Selection38:18 - Choosing the Right Embolic Agents47:43 - Managing Complications and Follow-Ups51:23 - Challenges with Post-TKA Patients54:16 - Future Directions How is genicular artery embolization reshaping our clinical approach to patients with chronic knee pain? Dr. Rachel Piechowiak and Dr. Faraz Khan, interventional radiologists at IR Centers join Dr. Don Garbett in a deep dive into the current state of Genicular Artery Embolization (GAE).


---


SYNPOSIS


Dr. Piechowiak and Dr. Khan provide a deep dive on the technical nuances of GAE, covering patient selection, access strategies, and key procedural techniques. The conversation also details complex case scenarios and how to tailor catheters and embolics to navigate challenging anatomy. The doctors then share their structured approach to post-procedure follow-up, underscoring the importance of setting realistic treatment expectations with patients. The episode closes with their perspective on the future of genicular artery embolization, emphasizing the need for robust long-term outcomes data to better define the role of GAE in chronic knee pain management.


---


TIMESTAMPS


00:00 - Introduction
05:54 - Patient Workup for GAE
10:42 - Setting Patient Expectations for GAE
16:24 - Procedure Approaches and Techniques
30:41 - Understanding Artery Targeting Strategies
34:56 - Approaches to Microcatheter Selection
38:18 - Choosing the Right Embolic Agents
47:43 - Managing Complications and Follow-Ups
51:23 - Challenges with Post-TKA Patients
54:16 - Future Directions

]]> 3500 Ep. 92 Understanding Frozen Shoulder: Causes, Symptoms, & Treatment Options with Dr. Sameer Nagda Frozen shoulder is characterized by progressive motion loss, distinct disease stages, and new treatment opportunities; raising important questions about timing, patient selection, and new interventional strategies. In this episode of the BackTable MSK Podcast, guest host Osman Ahmed welcomes orthopedic surgeon and upper extremity specialist Dr. Sameer Nagda to discuss the intricacies of adhesive capsulitis of the shoulder (“frozen shoulder”). --- SYNPOSIS Dr. Nagda shares his expertise on diagnosing and treating frozen shoulder, including the evaluation process, treatment options, and the role of early intervention. He emphasizes the importance of recognizing the stages of frozen shoulder and the potential benefits of embolization, particularly in the inflammatory stage. Dr. Nagda also shares his journey into shoulder specialization and his collaborative efforts with IR specialists to improve patient outcomes. --- TIMESTAMPS 00:00 - Introduction 04:29 - The Run Down: What is Frozen Shoulder?08:37 - Approaching the Diagnosis of Frozen Shoulder13:51 - Treatment Paradigms 22:48 - Comparing Traditional Treatments vs. Embolization26:39 - An Orthopedic Surgeon’s Perspective on Embolization for Frozen Shoulder35:36 - Surgical Options and When to Consider Them 37:55 - Final Thoughts --- RESOURCES Dr. Sameer Nagda, MDhttps://www.sameernagdamd.com/sameer-nagda-md-sports-medicine-specialist-arlington-va.html Adhesive Capsulitis of the Shoulderhttps://journals.lww.com/jaaos/abstract/2011/09000/adhesive_capsulitis_of_the_shoulder.4.aspx Treatment of Adhesive Capsulitis of the Shoulderhttps://journals.lww.com/jaaos/abstract/2019/06150/treatment_of_adhesive_capsulitis_of_the_shoulder.3.aspx Tue, 20 Jan 2026 08:00:00 -0000 full BackTable Frozen shoulder is characterized by progressive motion loss, distinct disease stages, and new treatment opportunities; raising important questions about timing, patient selection, and new interventional strategies. In this episode of the BackTable MSK Podcast, guest host Osman Ahmed welcomes orthopedic surgeon and upper extremity specialist Dr. Sameer Nagda to discuss the intricacies of adhesive capsulitis of the shoulder (“frozen shoulder”). --- SYNPOSIS Dr. Nagda shares his expertise on diagnosing and treating frozen shoulder, including the evaluation process, treatment options, and the role of early intervention. He emphasizes the importance of recognizing the stages of frozen shoulder and the potential benefits of embolization, particularly in the inflammatory stage. Dr. Nagda also shares his journey into shoulder specialization and his collaborative efforts with IR specialists to improve patient outcomes. --- TIMESTAMPS 00:00 - Introduction 04:29 - The Run Down: What is Frozen Shoulder?08:37 - Approaching the Diagnosis of Frozen Shoulder13:51 - Treatment Paradigms 22:48 - Comparing Traditional Treatments vs. Embolization26:39 - An Orthopedic Surgeon’s Perspective on Embolization for Frozen Shoulder35:36 - Surgical Options and When to Consider Them 37:55 - Final Thoughts --- RESOURCES Dr. Sameer Nagda, MDhttps://www.sameernagdamd.com/sameer-nagda-md-sports-medicine-specialist-arlington-va.html Adhesive Capsulitis of the Shoulderhttps://journals.lww.com/jaaos/abstract/2011/09000/adhesive_capsulitis_of_the_shoulder.4.aspx Treatment of Adhesive Capsulitis of the Shoulderhttps://journals.lww.com/jaaos/abstract/2019/06150/treatment_of_adhesive_capsulitis_of_the_shoulder.3.aspx Frozen shoulder is characterized by progressive motion loss, distinct disease stages, and new treatment opportunities; raising important questions about timing, patient selection, and new interventional strategies. In this episode of the BackTable MSK Podcast, guest host Osman Ahmed welcomes orthopedic surgeon and upper extremity specialist Dr. Sameer Nagda to discuss the intricacies of adhesive capsulitis of the shoulder (“frozen shoulder”).


---


SYNPOSIS


Dr. Nagda shares his expertise on diagnosing and treating frozen shoulder, including the evaluation process, treatment options, and the role of early intervention. He emphasizes the importance of recognizing the stages of frozen shoulder and the potential benefits of embolization, particularly in the inflammatory stage. Dr. Nagda also shares his journey into shoulder specialization and his collaborative efforts with IR specialists to improve patient outcomes.


---


TIMESTAMPS


00:00 - Introduction
04:29 - The Run Down: What is Frozen Shoulder?
08:37 - Approaching the Diagnosis of Frozen Shoulder
13:51 - Treatment Paradigms
22:48 - Comparing Traditional Treatments vs. Embolization
26:39 - An Orthopedic Surgeon’s Perspective on Embolization for Frozen Shoulder
35:36 - Surgical Options and When to Consider Them
37:55 - Final Thoughts


---


RESOURCES


Dr. Sameer Nagda, MD
https://www.sameernagdamd.com/sameer-nagda-md-sports-medicine-specialist-arlington-va.html


Adhesive Capsulitis of the Shoulder
https://journals.lww.com/jaaos/abstract/2011/09000/adhesive_capsulitis_of_the_shoulder.4.aspx


Treatment of Adhesive Capsulitis of the Shoulder
https://journals.lww.com/jaaos/abstract/2019/06150/treatment_of_adhesive_capsulitis_of_the_shoulder.3.aspx

]]> 2572 Ep. 91 Pathologic Fracture Fixation: Pelvic & Sacral Bone Stabilization Techniques with Dr. Brandon Key Your bony fixation technique can make (or break) a complex fracture case. In this episode of the BackTable MSK Podcast, host Kavi Krishnasamy welcomes Dr. Brandon Key, interventional radiologist at Medical College of Wisconsin (MCW) in Milwaukee, to discuss bone stabilization techniques in treating pathologic and non-pathologic fractures. --- SYNPOSIS Dr. Key shares insights into his practice, highlighting the importance of multidisciplinary collaboration with orthopedic surgery, the challenges of training in bony fixation, and the evolving technology that aids in these procedures, including the use of IlluminOss Photodynamic nails in complex bone interventions. Several detailed case studies illustrate the practical application and benefits of these advanced techniques, emphasizing their impact on patient outcomes and functionality. --- TIMESTAMPS 00:00 - Introduction02:06 - A Run Down of Bone Stabilization in the IR Space12:54 - What’s in the Toolbox?17:51 - Patient Preparation and Procedure Setup29:47 - Combining Fixation with Thermal Ablation34:12 - Introducing the Photodynamic Nail by IlluminOss40:22 - “The Learning Curve” of the Photodynamic Nail47:48 - Dr. Key’s Guidance for Practice Building 52:01 - Literature Highlights on IlluminOss 55:01 - Case 1: Anterior Column Disease 01:01:27 - Case 2: Isolated Posterior Column Disease 01:05:37 - Case 3: Non-healing Pathologic Fracture of Pubic Ramus01:09:37 - Case 4: Iliac Wing Fixation with Orthopedic Surgery01:15:40 - Case 5: Sacral Defects01:19:45 - Case 6: Reconstruction of Posterior Iliac Wing 01:23:50 - Post-Procedure Outcomes and Reflections01:29:02 - Final Thoughts: Encouragement for Collaboration and Innovation --- RESOURCES Dr. Brandon Key, MDhttps://www.linkedin.com/in/brandon-key-md-367a01310/ A Prospective Study of the IlluminOss Photodynamic Nail System for Pelvic Stabilization: Treatment of Impending and Actual Fractures from Metastatic Bone Disease, Multiple Myeloma, and Primary Bone Lymphomahttps://pubmed.ncbi.nlm.nih.gov/39281295/ Minimally Invasive Stabilization Using Screws and Cement for Pelvic Metastases: Technical Considerations for the Pelvic "Screw and Glue" Techniquehttps://pubmed.ncbi.nlm.nih.gov/31435131/ IlluminOsshttps://illuminoss.com/us Flow-FXhttps://flow-fx.net/products/ Tue, 06 Jan 2026 08:00:00 -0000 full BackTable Your bony fixation technique can make (or break) a complex fracture case. In this episode of the BackTable MSK Podcast, host Kavi Krishnasamy welcomes Dr. Brandon Key, interventional radiologist at Medical College of Wisconsin (MCW) in Milwaukee, to discuss bone stabilization techniques in treating pathologic and non-pathologic fractures. --- SYNPOSIS Dr. Key shares insights into his practice, highlighting the importance of multidisciplinary collaboration with orthopedic surgery, the challenges of training in bony fixation, and the evolving technology that aids in these procedures, including the use of IlluminOss Photodynamic nails in complex bone interventions. Several detailed case studies illustrate the practical application and benefits of these advanced techniques, emphasizing their impact on patient outcomes and functionality. --- TIMESTAMPS 00:00 - Introduction02:06 - A Run Down of Bone Stabilization in the IR Space12:54 - What’s in the Toolbox?17:51 - Patient Preparation and Procedure Setup29:47 - Combining Fixation with Thermal Ablation34:12 - Introducing the Photodynamic Nail by IlluminOss40:22 - “The Learning Curve” of the Photodynamic Nail47:48 - Dr. Key’s Guidance for Practice Building 52:01 - Literature Highlights on IlluminOss 55:01 - Case 1: Anterior Column Disease 01:01:27 - Case 2: Isolated Posterior Column Disease 01:05:37 - Case 3: Non-healing Pathologic Fracture of Pubic Ramus01:09:37 - Case 4: Iliac Wing Fixation with Orthopedic Surgery01:15:40 - Case 5: Sacral Defects01:19:45 - Case 6: Reconstruction of Posterior Iliac Wing 01:23:50 - Post-Procedure Outcomes and Reflections01:29:02 - Final Thoughts: Encouragement for Collaboration and Innovation --- RESOURCES Dr. Brandon Key, MDhttps://www.linkedin.com/in/brandon-key-md-367a01310/ A Prospective Study of the IlluminOss Photodynamic Nail System for Pelvic Stabilization: Treatment of Impending and Actual Fractures from Metastatic Bone Disease, Multiple Myeloma, and Primary Bone Lymphomahttps://pubmed.ncbi.nlm.nih.gov/39281295/ Minimally Invasive Stabilization Using Screws and Cement for Pelvic Metastases: Technical Considerations for the Pelvic "Screw and Glue" Techniquehttps://pubmed.ncbi.nlm.nih.gov/31435131/ IlluminOsshttps://illuminoss.com/us Flow-FXhttps://flow-fx.net/products/ Your bony fixation technique can make (or break) a complex fracture case. In this episode of the BackTable MSK Podcast, host Kavi Krishnasamy welcomes Dr. Brandon Key, interventional radiologist at Medical College of Wisconsin (MCW) in Milwaukee, to discuss bone stabilization techniques in treating pathologic and non-pathologic fractures.


---


SYNPOSIS


Dr. Key shares insights into his practice, highlighting the importance of multidisciplinary collaboration with orthopedic surgery, the challenges of training in bony fixation, and the evolving technology that aids in these procedures, including the use of IlluminOss Photodynamic nails in complex bone interventions. Several detailed case studies illustrate the practical application and benefits of these advanced techniques, emphasizing their impact on patient outcomes and functionality.


---


TIMESTAMPS


00:00 - Introduction
02:06 - A Run Down of Bone Stabilization in the IR Space
12:54 - What’s in the Toolbox?
17:51 - Patient Preparation and Procedure Setup
29:47 - Combining Fixation with Thermal Ablation
34:12 - Introducing the Photodynamic Nail by IlluminOss
40:22 - “The Learning Curve” of the Photodynamic Nail
47:48 - Dr. Key’s Guidance for Practice Building
52:01 - Literature Highlights on IlluminOss
55:01 - Case 1: Anterior Column Disease
01:01:27 - Case 2: Isolated Posterior Column Disease
01:05:37 - Case 3: Non-healing Pathologic Fracture of Pubic Ramus
01:09:37 - Case 4: Iliac Wing Fixation with Orthopedic Surgery
01:15:40 - Case 5: Sacral Defects
01:19:45 - Case 6: Reconstruction of Posterior Iliac Wing
01:23:50 - Post-Procedure Outcomes and Reflections
01:29:02 - Final Thoughts: Encouragement for Collaboration and Innovation


---


RESOURCES


Dr. Brandon Key, MD
https://www.linkedin.com/in/brandon-key-md-367a01310/


A Prospective Study of the IlluminOss Photodynamic Nail System for Pelvic Stabilization: Treatment of Impending and Actual Fractures from Metastatic Bone Disease, Multiple Myeloma, and Primary Bone Lymphoma
https://pubmed.ncbi.nlm.nih.gov/39281295/


Minimally Invasive Stabilization Using Screws and Cement for Pelvic Metastases: Technical Considerations for the Pelvic "Screw and Glue" Technique
https://pubmed.ncbi.nlm.nih.gov/31435131/


IlluminOss
https://illuminoss.com/us


Flow-FX
https://flow-fx.net/products/

]]> 5669 Ep. 90 Thermoprotection Techniques in Musculoskeletal Ablations Part II with Dr. Alan Sag How to stay cool when a thermal ablation case gets complicated? Your toolbox can make all the difference. In this episode of the BackTable MSK Podcast, Dr. Alan Sag returns with host Dr. Jacob Fleming to continue the discussion on thermal protection in musculoskeletal ablation procedures. Part 2 focuses on real-world cases to provide practical insights and illustrate decision-making in complex thermal ablation cases. --- SYNPOSIS Dr. Sag and Dr. Fleming discuss thermoprotection strategies in real-world cases, such as radiofrequency ablation (RFA) of inoperable rectal cancer and sacral metastases near nerve roots. They also discuss the importance of interdisciplinary collaboration, emerging technologies in the field, and the role of intraoperative neuromonitoring. --- TIMESTAMPS 00:00 - Introduction00:55 - Ganglion Impar and Pelvic Pain Strategies09:08 - The Active Thaw Phenomenon18:20 - Nerve Protection During Ablations23:16 - Motor and Sensory Neuromonitoring34:06 - Temperature Management in Ablative Procedures40:28 - Dosing Strategies for Gabapentin and Lyrica in Nerve Injuries42:33 - Future Directions --- RESOURCES Dr. Alan Alper Sag, M.D., FSIRhttps://med.miami.edu/faculty/alan-alper-sag-md-fsir Thermal Protection: Heightened Safety for Minimally Invasive Percutaneous Ablation of Musculoskeletal Tumorshttps://pubs.rsna.org/doi/10.1148/rg.240238 Intraoperative Neuromonitoring for Peripheral Nerve Surgeryhttps://mayoclinic.elsevierpure.com/en/publications/intraoperative-neuromonitoring-for-peripheral-nerve-surgery/ Tue, 30 Dec 2025 08:00:00 -0000 full BackTable How to stay cool when a thermal ablation case gets complicated? Your toolbox can make all the difference. In this episode of the BackTable MSK Podcast, Dr. Alan Sag returns with host Dr. Jacob Fleming to continue the discussion on thermal protection in musculoskeletal ablation procedures. Part 2 focuses on real-world cases to provide practical insights and illustrate decision-making in complex thermal ablation cases. --- SYNPOSIS Dr. Sag and Dr. Fleming discuss thermoprotection strategies in real-world cases, such as radiofrequency ablation (RFA) of inoperable rectal cancer and sacral metastases near nerve roots. They also discuss the importance of interdisciplinary collaboration, emerging technologies in the field, and the role of intraoperative neuromonitoring. --- TIMESTAMPS 00:00 - Introduction00:55 - Ganglion Impar and Pelvic Pain Strategies09:08 - The Active Thaw Phenomenon18:20 - Nerve Protection During Ablations23:16 - Motor and Sensory Neuromonitoring34:06 - Temperature Management in Ablative Procedures40:28 - Dosing Strategies for Gabapentin and Lyrica in Nerve Injuries42:33 - Future Directions --- RESOURCES Dr. Alan Alper Sag, M.D., FSIRhttps://med.miami.edu/faculty/alan-alper-sag-md-fsir Thermal Protection: Heightened Safety for Minimally Invasive Percutaneous Ablation of Musculoskeletal Tumorshttps://pubs.rsna.org/doi/10.1148/rg.240238 Intraoperative Neuromonitoring for Peripheral Nerve Surgeryhttps://mayoclinic.elsevierpure.com/en/publications/intraoperative-neuromonitoring-for-peripheral-nerve-surgery/ How to stay cool when a thermal ablation case gets complicated? Your toolbox can make all the difference. In this episode of the BackTable MSK Podcast, Dr. Alan Sag returns with host Dr. Jacob Fleming to continue the discussion on thermal protection in musculoskeletal ablation procedures. Part 2 focuses on real-world cases to provide practical insights and illustrate decision-making in complex thermal ablation cases.

---

SYNPOSIS

Dr. Sag and Dr. Fleming discuss thermoprotection strategies in real-world cases, such as radiofrequency ablation (RFA) of inoperable rectal cancer and sacral metastases near nerve roots. They also discuss the importance of interdisciplinary collaboration, emerging technologies in the field, and the role of intraoperative neuromonitoring.

---

TIMESTAMPS

00:00 - Introduction
00:55 - Ganglion Impar and Pelvic Pain Strategies
09:08 - The Active Thaw Phenomenon
18:20 - Nerve Protection During Ablations
23:16 - Motor and Sensory Neuromonitoring
34:06 - Temperature Management in Ablative Procedures
40:28 - Dosing Strategies for Gabapentin and Lyrica in Nerve Injuries
42:33 - Future Directions

---

RESOURCES

Dr. Alan Alper Sag, M.D., FSIR
https://med.miami.edu/faculty/alan-alper-sag-md-fsir

Thermal Protection: Heightened Safety for Minimally Invasive Percutaneous Ablation of Musculoskeletal Tumors
https://pubs.rsna.org/doi/10.1148/rg.240238

Intraoperative Neuromonitoring for Peripheral Nerve Surgery
https://mayoclinic.elsevierpure.com/en/publications/intraoperative-neuromonitoring-for-peripheral-nerve-surgery/

]]> 2942 Ep. 89 Thermoprotection Techniques in Musculoskeletal Ablations Part I with Dr. Alan Sag Burns = big consequences. Let’s talk thermoprotection. In this episode of the BackTable MSK Podcast, host Jacob Fleming welcomes longtime friend and colleague Dr. Alan Sag to discuss thermoprotection in musculoskeletal ablation procedures over this two-part episode series. Part 1 focuses on established strategies and new techniques for protecting critical structures during ablation. --- SYNPOSIS Dr. Sag shares how he approaches thermoprotection in complex MSK ablation cases. The discussion covers hydro-dissection techniques, hydro convection needle strategies, pump and tubing set up, troubleshooting, and visualization of the protective layer. --- TIMESTAMPS 00:00 - Introduction02:49 - Thermoprotection 10112:37 - Skin Injury and Mitigation Strategies18:57 - Avoiding Bottlenecks with Hydrodissection23:49 - Practical Recommendations for Cold Skin Protection 29:36 - Managing Complications and Wound Care38:12 - Heating up with RFA and Microwave Ablations --- RESOURCES Dr. Alan Alper Sag, M.D., FSIRhttps://med.miami.edu/faculty/alan-alper-sag-md-fsir Thermal Protection: Heightened Safety for Minimally Invasive Percutaneous Ablation of Musculoskeletal Tumorshttps://pubs.rsna.org/doi/10.1148/rg.240238 Intraoperative Neuromonitoring for Peripheral Nerve Surgeryhttps://mayoclinic.elsevierpure.com/en/publications/intraoperative-neuromonitoring-for-peripheral-nerve-surgery/ Tue, 16 Dec 2025 08:00:00 -0000 full BackTable Burns = big consequences. Let’s talk thermoprotection. In this episode of the BackTable MSK Podcast, host Jacob Fleming welcomes longtime friend and colleague Dr. Alan Sag to discuss thermoprotection in musculoskeletal ablation procedures over this two-part episode series. Part 1 focuses on established strategies and new techniques for protecting critical structures during ablation. --- SYNPOSIS Dr. Sag shares how he approaches thermoprotection in complex MSK ablation cases. The discussion covers hydro-dissection techniques, hydro convection needle strategies, pump and tubing set up, troubleshooting, and visualization of the protective layer. --- TIMESTAMPS 00:00 - Introduction02:49 - Thermoprotection 10112:37 - Skin Injury and Mitigation Strategies18:57 - Avoiding Bottlenecks with Hydrodissection23:49 - Practical Recommendations for Cold Skin Protection 29:36 - Managing Complications and Wound Care38:12 - Heating up with RFA and Microwave Ablations --- RESOURCES Dr. Alan Alper Sag, M.D., FSIRhttps://med.miami.edu/faculty/alan-alper-sag-md-fsir Thermal Protection: Heightened Safety for Minimally Invasive Percutaneous Ablation of Musculoskeletal Tumorshttps://pubs.rsna.org/doi/10.1148/rg.240238 Intraoperative Neuromonitoring for Peripheral Nerve Surgeryhttps://mayoclinic.elsevierpure.com/en/publications/intraoperative-neuromonitoring-for-peripheral-nerve-surgery/ Burns = big consequences. Let’s talk thermoprotection. In this episode of the BackTable MSK Podcast, host Jacob Fleming welcomes longtime friend and colleague Dr. Alan Sag to discuss thermoprotection in musculoskeletal ablation procedures over this two-part episode series. Part 1 focuses on established strategies and new techniques for protecting critical structures during ablation.


---


SYNPOSIS


Dr. Sag shares how he approaches thermoprotection in complex MSK ablation cases. The discussion covers hydro-dissection techniques, hydro convection needle strategies, pump and tubing set up, troubleshooting, and visualization of the protective layer.


---


TIMESTAMPS


00:00 - Introduction
02:49 - Thermoprotection 101
12:37 - Skin Injury and Mitigation Strategies
18:57 - Avoiding Bottlenecks with Hydrodissection
23:49 - Practical Recommendations for Cold Skin Protection
29:36 - Managing Complications and Wound Care
38:12 - Heating up with RFA and Microwave Ablations


---


RESOURCES


Dr. Alan Alper Sag, M.D., FSIR
https://med.miami.edu/faculty/alan-alper-sag-md-fsir


Thermal Protection: Heightened Safety for Minimally Invasive Percutaneous Ablation of Musculoskeletal Tumors
https://pubs.rsna.org/doi/10.1148/rg.240238


Intraoperative Neuromonitoring for Peripheral Nerve Surgery
https://mayoclinic.elsevierpure.com/en/publications/intraoperative-neuromonitoring-for-peripheral-nerve-surgery/

]]> 2629 Ep. 88 Bone Tumor Ablation: Techniques & Outcomes with Dr. Damian Dupuy Ablate before you radiate. Success with bone tumor ablation may have as much to do with your procedure technique as it does with your ability to collaborate. In this episode of BackTable MSK, interventional oncologist Dr. Damian Dupuy shares his approach to bone tumor ablation with host Dr. Kavi Krishnasamy, and offers practical advice on how to partner with your cancer care team to make ablation a viable treatment option. --- This podcast is supported by: Medtronic Osteocool https://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-2-0-bone-tumor-ablation-system.html --- SYNPOSIS The doctors review the history of bone ablation techniques, including radiofrequency and cryoablation modalities. They discuss the significance of targeting the bone-tumor interface for pain palliation and highlight several case studies to illustrate various techniques and successful outcomes. The conversation also touches upon the synergistic benefits of combining ablation with radiation therapy and emphasizes the importance of multidisciplinary collaboration in treating cancer patients. --- TIMESTAMPS 00:00 - Introduction02:07 - Dr. Dupuy’s Start in Bone Ablation06:29 - Cryo vs. Microwave Therapies08:25 - Dr. Dupuy’s Clinical Trial and Research Involvement 12:49 - Patient Selection and Treatment Strategies25:54 - Sedation and Anesthesia Practices in Bone Ablation28:46 - Treatment Approach: Oligometastases vs. Progressive Disease36:22 - Microwave Ablation in Bone: Future Prospects37:30 - Techniques for Treating Sclerotic and Lytic Lesions40:01 - Skin Protection Methods in Superficial Lesion Treatments41:49 - Reviewing Recent Clinical Trials: MOTION, OPuS One, and More52:35 - Case Studies: Achieving Effective Ablation Techniques01:08:08 - Final Thoughts and Recommendations --- RESOURCES Dr. Damian E. Dupuy, MD, FACRhttps://www.linkedin.com/in/damian-e-dupuy-md-facr-6b080b1b/ Solitary painful osseous metastases: correlation of imaging features with pain palliation after radiofrequency ablation--a multicenter american college of radiology imaging network studyhttps://pubmed.ncbi.nlm.nih.gov/23657892/ Radiofrequency Ablation Provides Rapid and Durable Pain Relief for the Palliative Treatment of Lytic Bone Metastases Independent of Radiation Therapy: Final Results from the OsteoCool Tumor Ablation Post-Market Studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC10156864/ Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC8011449/ A Multi-Center Observational Trial of Symptomatic, High-Risk Bone Metastases Treated with Percutaneous Ablation and Palliative Radiation Therapy (TRIBUTE)https://clinicaltrials.gov/study/NCT06859801 Tue, 02 Dec 2025 08:00:00 -0000 full BackTable Ablate before you radiate. Success with bone tumor ablation may have as much to do with your procedure technique as it does with your ability to collaborate. In this episode of BackTable MSK, interventional oncologist Dr. Damian Dupuy shares his approach to bone tumor ablation with host Dr. Kavi Krishnasamy, and offers practical advice on how to partner with your cancer care team to make ablation a viable treatment option. --- This podcast is supported by: Medtronic Osteocool https://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-2-0-bone-tumor-ablation-system.html --- SYNPOSIS The doctors review the history of bone ablation techniques, including radiofrequency and cryoablation modalities. They discuss the significance of targeting the bone-tumor interface for pain palliation and highlight several case studies to illustrate various techniques and successful outcomes. The conversation also touches upon the synergistic benefits of combining ablation with radiation therapy and emphasizes the importance of multidisciplinary collaboration in treating cancer patients. --- TIMESTAMPS 00:00 - Introduction02:07 - Dr. Dupuy’s Start in Bone Ablation06:29 - Cryo vs. Microwave Therapies08:25 - Dr. Dupuy’s Clinical Trial and Research Involvement 12:49 - Patient Selection and Treatment Strategies25:54 - Sedation and Anesthesia Practices in Bone Ablation28:46 - Treatment Approach: Oligometastases vs. Progressive Disease36:22 - Microwave Ablation in Bone: Future Prospects37:30 - Techniques for Treating Sclerotic and Lytic Lesions40:01 - Skin Protection Methods in Superficial Lesion Treatments41:49 - Reviewing Recent Clinical Trials: MOTION, OPuS One, and More52:35 - Case Studies: Achieving Effective Ablation Techniques01:08:08 - Final Thoughts and Recommendations --- RESOURCES Dr. Damian E. Dupuy, MD, FACRhttps://www.linkedin.com/in/damian-e-dupuy-md-facr-6b080b1b/ Solitary painful osseous metastases: correlation of imaging features with pain palliation after radiofrequency ablation--a multicenter american college of radiology imaging network studyhttps://pubmed.ncbi.nlm.nih.gov/23657892/ Radiofrequency Ablation Provides Rapid and Durable Pain Relief for the Palliative Treatment of Lytic Bone Metastases Independent of Radiation Therapy: Final Results from the OsteoCool Tumor Ablation Post-Market Studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC10156864/ Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC8011449/ A Multi-Center Observational Trial of Symptomatic, High-Risk Bone Metastases Treated with Percutaneous Ablation and Palliative Radiation Therapy (TRIBUTE)https://clinicaltrials.gov/study/NCT06859801 Ablate before you radiate. Success with bone tumor ablation may have as much to do with your procedure technique as it does with your ability to collaborate. In this episode of BackTable MSK, interventional oncologist Dr. Damian Dupuy shares his approach to bone tumor ablation with host Dr. Kavi Krishnasamy, and offers practical advice on how to partner with your cancer care team to make ablation a viable treatment option.


---


This podcast is supported by:


Medtronic Osteocool


https://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-2-0-bone-tumor-ablation-system.html


---


SYNPOSIS


The doctors review the history of bone ablation techniques, including radiofrequency and cryoablation modalities. They discuss the significance of targeting the bone-tumor interface for pain palliation and highlight several case studies to illustrate various techniques and successful outcomes. The conversation also touches upon the synergistic benefits of combining ablation with radiation therapy and emphasizes the importance of multidisciplinary collaboration in treating cancer patients.


---


TIMESTAMPS


00:00 - Introduction
02:07 - Dr. Dupuy’s Start in Bone Ablation
06:29 - Cryo vs. Microwave Therapies
08:25 - Dr. Dupuy’s Clinical Trial and Research Involvement
12:49 - Patient Selection and Treatment Strategies
25:54 - Sedation and Anesthesia Practices in Bone Ablation
28:46 - Treatment Approach: Oligometastases vs. Progressive Disease
36:22 - Microwave Ablation in Bone: Future Prospects
37:30 - Techniques for Treating Sclerotic and Lytic Lesions
40:01 - Skin Protection Methods in Superficial Lesion Treatments
41:49 - Reviewing Recent Clinical Trials: MOTION, OPuS One, and More
52:35 - Case Studies: Achieving Effective Ablation Techniques
01:08:08 - Final Thoughts and Recommendations


---


RESOURCES


Dr. Damian E. Dupuy, MD, FACR
https://www.linkedin.com/in/damian-e-dupuy-md-facr-6b080b1b/


Solitary painful osseous metastases: correlation of imaging features with pain palliation after radiofrequency ablation--a multicenter american college of radiology imaging network study
https://pubmed.ncbi.nlm.nih.gov/23657892/


Radiofrequency Ablation Provides Rapid and Durable Pain Relief for the Palliative Treatment of Lytic Bone Metastases Independent of Radiation Therapy: Final Results from the OsteoCool Tumor Ablation Post-Market Study
https://pmc.ncbi.nlm.nih.gov/articles/PMC10156864/


Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Study
https://pmc.ncbi.nlm.nih.gov/articles/PMC8011449/


A Multi-Center Observational Trial of Symptomatic, High-Risk Bone Metastases Treated with Percutaneous Ablation and Palliative Radiation Therapy (TRIBUTE)
https://clinicaltrials.gov/study/NCT06859801

]]> 4329 Ep. 87 Advanced Techniques in Orthopedic Oncology: Bone Ablation for Skeletal Metastases with Dr. Francis Lee “We learn traditionally that bone metastasis is terminal.” 一 Or is it? In this episode of the BackTable MSK podcast, host Dr. Jacob Fleming welcomes Dr. Francis Lee, a leading figure in orthopedic oncology, to discuss advancements in treating skeletal metastasis. Dr. Lee, the Wayne O. Southwick Professor from Yale and President-elect of the Musculoskeletal Tumor Society, shares his innovative AORIF (Ablation, Osteoplasty, Reinforcement and Internal Fixation) technique, which emphasizes collaboration between orthopedic oncologists and interventional radiologists. --- This podcast is supported by an educational grant from Medtronic. --- SYNPOSIS The conversation covers the complexities of bone metastasis, the biomechanics of skeletal ablation, and the importance of understanding bone-cancer interactions. Dr. Lee also shares insights from his translational research on cancer and bone dynamics, and emphasizes the need for continued interdisciplinary collaboration to drive forward minimally invasive treatments. --- TIMESTAMPS 00:00 - Introduction 01:39 - Crash Course: Orthopedic Oncology 10113:24 - The Important Role of Biomechanics20:10 - Dr Lee’s Training and Interdisciplinary Collaboration28:13 - Intraoperative Imaging and Techniques in AORIF40:15 - Cannulated Screws for Access and Fixation 42:24 - Case Study: Sacral Insufficiency Fracture and Cement Injection44:17 - Understanding Cement Properties and Application46:45 - Case Study Series: Approach to Reconstruction57:58 - Decision Making in Complex Procedures01:08:40 - The Power of Bone Regeneration01:12:31 - Final Thoughts --- RESOURCES Dr. Francis Lee, MD, PhD, FAAOS, MBAhttps://medicine.yale.edu/profile/francis-lee/ Minimally Invasive Image-Guided Ablation, Osteoplasty, Reinforcement, and Internal Fixation (AORIF) for Osteolytic Lesions in the Pelvis and Periarticular Regions of Weight-Bearing Boneshttps://pubmed.ncbi.nlm.nih.gov/32139256/ Tue, 11 Nov 2025 08:00:00 -0000 full BackTable “We learn traditionally that bone metastasis is terminal.” 一 Or is it? In this episode of the BackTable MSK podcast, host Dr. Jacob Fleming welcomes Dr. Francis Lee, a leading figure in orthopedic oncology, to discuss advancements in treating skeletal metastasis. Dr. Lee, the Wayne O. Southwick Professor from Yale and President-elect of the Musculoskeletal Tumor Society, shares his innovative AORIF (Ablation, Osteoplasty, Reinforcement and Internal Fixation) technique, which emphasizes collaboration between orthopedic oncologists and interventional radiologists. --- This podcast is supported by an educational grant from Medtronic. --- SYNPOSIS The conversation covers the complexities of bone metastasis, the biomechanics of skeletal ablation, and the importance of understanding bone-cancer interactions. Dr. Lee also shares insights from his translational research on cancer and bone dynamics, and emphasizes the need for continued interdisciplinary collaboration to drive forward minimally invasive treatments. --- TIMESTAMPS 00:00 - Introduction 01:39 - Crash Course: Orthopedic Oncology 10113:24 - The Important Role of Biomechanics20:10 - Dr Lee’s Training and Interdisciplinary Collaboration28:13 - Intraoperative Imaging and Techniques in AORIF40:15 - Cannulated Screws for Access and Fixation 42:24 - Case Study: Sacral Insufficiency Fracture and Cement Injection44:17 - Understanding Cement Properties and Application46:45 - Case Study Series: Approach to Reconstruction57:58 - Decision Making in Complex Procedures01:08:40 - The Power of Bone Regeneration01:12:31 - Final Thoughts --- RESOURCES Dr. Francis Lee, MD, PhD, FAAOS, MBAhttps://medicine.yale.edu/profile/francis-lee/ Minimally Invasive Image-Guided Ablation, Osteoplasty, Reinforcement, and Internal Fixation (AORIF) for Osteolytic Lesions in the Pelvis and Periarticular Regions of Weight-Bearing Boneshttps://pubmed.ncbi.nlm.nih.gov/32139256/ “We learn traditionally that bone metastasis is terminal.” 一 Or is it? In this episode of the BackTable MSK podcast, host Dr. Jacob Fleming welcomes Dr. Francis Lee, a leading figure in orthopedic oncology, to discuss advancements in treating skeletal metastasis. Dr. Lee, the Wayne O. Southwick Professor from Yale and President-elect of the Musculoskeletal Tumor Society, shares his innovative AORIF (Ablation, Osteoplasty, Reinforcement and Internal Fixation) technique, which emphasizes collaboration between orthopedic oncologists and interventional radiologists.


---


This podcast is supported by an educational grant from Medtronic.


---


SYNPOSIS


The conversation covers the complexities of bone metastasis, the biomechanics of skeletal ablation, and the importance of understanding bone-cancer interactions. Dr. Lee also shares insights from his translational research on cancer and bone dynamics, and emphasizes the need for continued interdisciplinary collaboration to drive forward minimally invasive treatments.


---


TIMESTAMPS


00:00 - Introduction
01:39 - Crash Course: Orthopedic Oncology 101
13:24 - The Important Role of Biomechanics
20:10 - Dr Lee’s Training and Interdisciplinary Collaboration
28:13 - Intraoperative Imaging and Techniques in AORIF
40:15 - Cannulated Screws for Access and Fixation
42:24 - Case Study: Sacral Insufficiency Fracture and Cement Injection
44:17 - Understanding Cement Properties and Application
46:45 - Case Study Series: Approach to Reconstruction
57:58 - Decision Making in Complex Procedures
01:08:40 - The Power of Bone Regeneration
01:12:31 - Final Thoughts


---


RESOURCES


Dr. Francis Lee, MD, PhD, FAAOS, MBA
https://medicine.yale.edu/profile/francis-lee/


Minimally Invasive Image-Guided Ablation, Osteoplasty, Reinforcement, and Internal Fixation (AORIF) for Osteolytic Lesions in the Pelvis and Periarticular Regions of Weight-Bearing Bones
https://pubmed.ncbi.nlm.nih.gov/32139256/

]]> 4644 Backtable Brief: Pain Management Strategies in Spine Oncology with Dr. Ran Lador and Dr. Mark Amsbaugh Living in the best of both worlds: balancing pain management and quality of life. In this BackTable MSK Brief, Dr. Mark Amsbaugh and Dr. Ran Lador discuss multidisciplinary approaches to treating spinal tumors with a particular focus on pain management. They explore the complexities of defining and treating pain related to spinal tumors, differentiating between mechanical instability, tumor burden, and neuropathic pain.  The conversation delves into the roles of various treatments including opioids, radiation, nerve blocks, cryoablation, and surgical interventions. They highlight the evolving landscape of spine oncology, emphasizing the need for holistic approaches and the promising future of integrating advanced technologies for better patient outcomes. Episode Outline 00:00 - Introduction  00:53 - Approach to Pain Management in Spine Oncology 02:54 - Multimodal Analgesia 04:25 - What is a Safe Radiation Dose that Spares Spinal Nerves? 07:59 - The Balance Between Quality of Life and Pain Management  09:58 - Final Remarks Resources Dr. Mark Amsbaugh, MD https://med.uth.edu/neurosciences/dr-mark-j-amsbaugh-md/  Dr. Ran Lador, MD https://med.uth.edu/ortho/2022/11/02/ran-lador-md/  Dr. Alexa Levey, MD https://medicine.yale.edu/profile/alexa-levey/ Tue, 04 Nov 2025 08:00:00 -0000 full BackTable Living in the best of both worlds: balancing pain management and quality of life. In this BackTable MSK Brief, Dr. Mark Amsbaugh and Dr. Ran Lador discuss multidisciplinary approaches to treating spinal tumors with a particular focus on pain management. They explore the complexities of defining and treating pain related to spinal tumors, differentiating between mechanical instability, tumor burden, and neuropathic pain.  The conversation delves into the roles of various treatments including opioids, radiation, nerve blocks, cryoablation, and surgical interventions. They highlight the evolving landscape of spine oncology, emphasizing the need for holistic approaches and the promising future of integrating advanced technologies for better patient outcomes. Episode Outline 00:00 - Introduction  00:53 - Approach to Pain Management in Spine Oncology 02:54 - Multimodal Analgesia 04:25 - What is a Safe Radiation Dose that Spares Spinal Nerves? 07:59 - The Balance Between Quality of Life and Pain Management  09:58 - Final Remarks Resources Dr. Mark Amsbaugh, MD https://med.uth.edu/neurosciences/dr-mark-j-amsbaugh-md/  Dr. Ran Lador, MD https://med.uth.edu/ortho/2022/11/02/ran-lador-md/  Dr. Alexa Levey, MD https://medicine.yale.edu/profile/alexa-levey/ Living in the best of both worlds: balancing pain management and quality of life. In this BackTable MSK Brief, Dr. Mark Amsbaugh and Dr. Ran Lador discuss multidisciplinary approaches to treating spinal tumors with a particular focus on pain management. They explore the complexities of defining and treating pain related to spinal tumors, differentiating between mechanical instability, tumor burden, and neuropathic pain. 

The conversation delves into the roles of various treatments including opioids, radiation, nerve blocks, cryoablation, and surgical interventions. They highlight the evolving landscape of spine oncology, emphasizing the need for holistic approaches and the promising future of integrating advanced technologies for better patient outcomes.

Episode Outline

00:00 - Introduction 

00:53 - Approach to Pain Management in Spine Oncology

02:54 - Multimodal Analgesia

04:25 - What is a Safe Radiation Dose that Spares Spinal Nerves?

07:59 - The Balance Between Quality of Life and Pain Management 

09:58 - Final Remarks

Resources


Dr. Mark Amsbaugh, MD

https://med.uth.edu/neurosciences/dr-mark-j-amsbaugh-md/ 


Dr. Ran Lador, MD

https://med.uth.edu/ortho/2022/11/02/ran-lador-md/ 


Dr. Alexa Levey, MD

https://medicine.yale.edu/profile/alexa-levey/

]]> 773 Ep. 86 Neuromodulation: Past, Present & Future with Dr. Timothy Deer As our understanding of pain physiology evolves, neuromodulation continues to offer new treatment possibilities in MSK pain management. In this episode of the BackTable MSK, host Jacob Fleming discusses the evolving world of neuromodulation with Dr. Timothy Deer, a leading expert in the field. Dr. Deer shares insights from his extensive career and his innovative contributions in neuromodulation.---This podcast is supported by:Medtronic Osteocoolhttps://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-2-0-bone-tumor-ablation-system.html---SYNPOSISThe conversation covers the development of spinal cord and dorsal root ganglion (DRG) stimulation, the significance of patient selection and challenges facing neuromodulation therapies, and exciting developments in the field, including AI. Dr. Deer and Dr. Fleming also discuss the importance of advanced training and the pioneering work by the American Society of Pain and Neuroscience (ASPN) to improve procedural education through its innovative MIS Certification Program.---TIMESTAMPS00:00 - Introduction02:52 - What is Neuromodulation?06:03 - Evolution of Neuromodulation08:49 - Use of Closed Loop and AI 13:58 - DRG Stimulation Explained19:58 - Progression of Peripheral Nerve Stimulation26:26 - Handheld Navigation and Reducing Radiation Exposure 30:18 - The Umbrella of Specialties within ASPN35:15 - Obtaining MIS Certification and Fellowship Program Outlook44:07 - Future Directions of Neuromodulation48:09 - Concluding Thoughts---RESOURCESDr. Timothy Deer, MDhttps://centerforpainrelief.com/doctor-timothy-deer/ American Society of Pain and Neuroscience (ASPN)https://aspnpain.com/ Tue, 28 Oct 2025 07:00:00 -0000 full BackTable As our understanding of pain physiology evolves, neuromodulation continues to offer new treatment possibilities in MSK pain management. In this episode of the BackTable MSK, host Jacob Fleming discusses the evolving world of neuromodulation with Dr. Timothy Deer, a leading expert in the field. Dr. Deer shares insights from his extensive career and his innovative contributions in neuromodulation.---This podcast is supported by:Medtronic Osteocoolhttps://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-2-0-bone-tumor-ablation-system.html---SYNPOSISThe conversation covers the development of spinal cord and dorsal root ganglion (DRG) stimulation, the significance of patient selection and challenges facing neuromodulation therapies, and exciting developments in the field, including AI. Dr. Deer and Dr. Fleming also discuss the importance of advanced training and the pioneering work by the American Society of Pain and Neuroscience (ASPN) to improve procedural education through its innovative MIS Certification Program.---TIMESTAMPS00:00 - Introduction02:52 - What is Neuromodulation?06:03 - Evolution of Neuromodulation08:49 - Use of Closed Loop and AI 13:58 - DRG Stimulation Explained19:58 - Progression of Peripheral Nerve Stimulation26:26 - Handheld Navigation and Reducing Radiation Exposure 30:18 - The Umbrella of Specialties within ASPN35:15 - Obtaining MIS Certification and Fellowship Program Outlook44:07 - Future Directions of Neuromodulation48:09 - Concluding Thoughts---RESOURCESDr. Timothy Deer, MDhttps://centerforpainrelief.com/doctor-timothy-deer/ American Society of Pain and Neuroscience (ASPN)https://aspnpain.com/ As our understanding of pain physiology evolves, neuromodulation continues to offer new treatment possibilities in MSK pain management. In this episode of the BackTable MSK, host Jacob Fleming discusses the evolving world of neuromodulation with Dr. Timothy Deer, a leading expert in the field. Dr. Deer shares insights from his extensive career and his innovative contributions in neuromodulation.
---
This podcast is supported by:
Medtronic Osteocool
https://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-2-0-bone-tumor-ablation-system.html
---
SYNPOSIS
The conversation covers the development of spinal cord and dorsal root ganglion (DRG) stimulation, the significance of patient selection and challenges facing neuromodulation therapies, and exciting developments in the field, including AI. Dr. Deer and Dr. Fleming also discuss the importance of advanced training and the pioneering work by the American Society of Pain and Neuroscience (ASPN) to improve procedural education through its innovative MIS Certification Program.
---
TIMESTAMPS
00:00 - Introduction
02:52 - What is Neuromodulation?
06:03 - Evolution of Neuromodulation
08:49 - Use of Closed Loop and AI
13:58 - DRG Stimulation Explained
19:58 - Progression of Peripheral Nerve Stimulation
26:26 - Handheld Navigation and Reducing Radiation Exposure
30:18 - The Umbrella of Specialties within ASPN
35:15 - Obtaining MIS Certification and Fellowship Program Outlook
44:07 - Future Directions of Neuromodulation
48:09 - Concluding Thoughts
---
RESOURCES
Dr. Timothy Deer, MD
https://centerforpainrelief.com/doctor-timothy-deer/
American Society of Pain and Neuroscience (ASPN)
https://aspnpain.com/

]]> 3129 Backtable Brief: Surgical and Radiation Strategies in Spine Oncology with Dr. Ran Lador and Dr. Mark Amsbaugh “There is always constant review and constant learning”. In this BackTable MSK Brief, Dr. Mark Amsbaugh and Dr. Ran Lador discuss comprehensive treatment strategies for spinal tumors, highlighting the critical interplay between surgical and radiation oncology.  The doctors explain the complex planning required based on tumor characteristics, including surgical options like en bloc resection and minimally invasive techniques, as well as the advancements in radiation therapy. The conversation emphasizes the importance of collaboration across disciplines to optimize patient outcomes, improve quality of life, and adapt to new medical advancements. Episode Outline 00:00 - Introduction 00:21 - Collaboration Between Surgeons and Interventionalists 05:42 - Intertwined Approach of Radiation and Surgical Treatment 07:37 - Advancements in Radiation Techniques 14:15 - Advancements in Surgical Approach  16:20 - Final Thoughts Resources Dr. Mark Amsbaugh, MD https://med.uth.edu/neurosciences/dr-mark-j-amsbaugh-md/  Dr. Ran Lador, MD https://med.uth.edu/ortho/2022/11/02/ran-lador-md/  Dr. Alexa Levey, MD https://medicine.yale.edu/profile/alexa-levey/ Tue, 21 Oct 2025 07:00:00 -0000 full BackTable “There is always constant review and constant learning”. In this BackTable MSK Brief, Dr. Mark Amsbaugh and Dr. Ran Lador discuss comprehensive treatment strategies for spinal tumors, highlighting the critical interplay between surgical and radiation oncology.  The doctors explain the complex planning required based on tumor characteristics, including surgical options like en bloc resection and minimally invasive techniques, as well as the advancements in radiation therapy. The conversation emphasizes the importance of collaboration across disciplines to optimize patient outcomes, improve quality of life, and adapt to new medical advancements. Episode Outline 00:00 - Introduction 00:21 - Collaboration Between Surgeons and Interventionalists 05:42 - Intertwined Approach of Radiation and Surgical Treatment 07:37 - Advancements in Radiation Techniques 14:15 - Advancements in Surgical Approach  16:20 - Final Thoughts Resources Dr. Mark Amsbaugh, MD https://med.uth.edu/neurosciences/dr-mark-j-amsbaugh-md/  Dr. Ran Lador, MD https://med.uth.edu/ortho/2022/11/02/ran-lador-md/  Dr. Alexa Levey, MD https://medicine.yale.edu/profile/alexa-levey/ “There is always constant review and constant learning”. In this BackTable MSK Brief, Dr. Mark Amsbaugh and Dr. Ran Lador discuss comprehensive treatment strategies for spinal tumors, highlighting the critical interplay between surgical and radiation oncology. 

The doctors explain the complex planning required based on tumor characteristics, including surgical options like en bloc resection and minimally invasive techniques, as well as the advancements in radiation therapy. The conversation emphasizes the importance of collaboration across disciplines to optimize patient outcomes, improve quality of life, and adapt to new medical advancements.

Episode Outline

00:00 - Introduction

00:21 - Collaboration Between Surgeons and Interventionalists

05:42 - Intertwined Approach of Radiation and Surgical Treatment

07:37 - Advancements in Radiation Techniques

14:15 - Advancements in Surgical Approach 

16:20 - Final Thoughts

Resources


Dr. Mark Amsbaugh, MD

https://med.uth.edu/neurosciences/dr-mark-j-amsbaugh-md/ 


Dr. Ran Lador, MD

https://med.uth.edu/ortho/2022/11/02/ran-lador-md/ 


Dr. Alexa Levey, MD


https://medicine.yale.edu/profile/alexa-levey/

]]> 1157 Backtable Brief: Multidisciplinary Care Approaches for Spinal Tumors with Dr. Ran Lador and Dr. Mark Amsbaugh Check your ego at the door! In this BackTable MSK Brief, Dr. Mark Amsbaugh and Dr. Ran Lador share their multidisciplinary approach to the treatment of spinal tumors at the University of Texas and Memorial Hermann in Houston. They highlight the distinctive aspects of their practice, including their extensive collaboration and support system for patients, the intricate process of managing spinal tumors, and the unique challenges and solutions they encounter. The doctors emphasize the importance of teamwork, minimally invasive techniques, and comprehensive patient-centered care to improve treatment outcomes for patients with spinal tumors. Episode Outline 00:00 - Introduction  03:18 - Addressing Potential Barriers in Receiving Spinal Tumor Treatment 04:32 - The Multidisciplinary Approach in Action 07:46 - Minimally Invasive Techniques and Their Impact 09:49 - Navigating Patient Care and Referrals 14:29 - Final Thoughts  Resources Dr. Mark Amsbaugh, MD https://med.uth.edu/neurosciences/dr-mark-j-amsbaugh-md/  Dr. Ran Lador, MD https://med.uth.edu/ortho/2022/11/02/ran-lador-md/  Dr. Alexa Levey, MD https://medicine.yale.edu/profile/alexa-levey/ Tue, 14 Oct 2025 07:00:00 -0000 full BackTable Check your ego at the door! In this BackTable MSK Brief, Dr. Mark Amsbaugh and Dr. Ran Lador share their multidisciplinary approach to the treatment of spinal tumors at the University of Texas and Memorial Hermann in Houston. They highlight the distinctive aspects of their practice, including their extensive collaboration and support system for patients, the intricate process of managing spinal tumors, and the unique challenges and solutions they encounter. The doctors emphasize the importance of teamwork, minimally invasive techniques, and comprehensive patient-centered care to improve treatment outcomes for patients with spinal tumors. Episode Outline 00:00 - Introduction  03:18 - Addressing Potential Barriers in Receiving Spinal Tumor Treatment 04:32 - The Multidisciplinary Approach in Action 07:46 - Minimally Invasive Techniques and Their Impact 09:49 - Navigating Patient Care and Referrals 14:29 - Final Thoughts  Resources Dr. Mark Amsbaugh, MD https://med.uth.edu/neurosciences/dr-mark-j-amsbaugh-md/  Dr. Ran Lador, MD https://med.uth.edu/ortho/2022/11/02/ran-lador-md/  Dr. Alexa Levey, MD https://medicine.yale.edu/profile/alexa-levey/ Check your ego at the door! In this BackTable MSK Brief, Dr. Mark Amsbaugh and Dr. Ran Lador share their multidisciplinary approach to the treatment of spinal tumors at the University of Texas and Memorial Hermann in Houston.

They highlight the distinctive aspects of their practice, including their extensive collaboration and support system for patients, the intricate process of managing spinal tumors, and the unique challenges and solutions they encounter. The doctors emphasize the importance of teamwork, minimally invasive techniques, and comprehensive patient-centered care to improve treatment outcomes for patients with spinal tumors.

Episode Outline

00:00 - Introduction 

03:18 - Addressing Potential Barriers in Receiving Spinal Tumor Treatment

04:32 - The Multidisciplinary Approach in Action

07:46 - Minimally Invasive Techniques and Their Impact

09:49 - Navigating Patient Care and Referrals

14:29 - Final Thoughts 

Resources


Dr. Mark Amsbaugh, MD

https://med.uth.edu/neurosciences/dr-mark-j-amsbaugh-md/ 


Dr. Ran Lador, MD

https://med.uth.edu/ortho/2022/11/02/ran-lador-md/ 


Dr. Alexa Levey, MD


https://medicine.yale.edu/profile/alexa-levey/

]]> 1065 Ep. 85 Cryoneurolysis & MSK Pain Management Techniques with Dr. Junjian Huang Are you considering expanding your IR practice into pain management services? Get the download from someone who’s done it already. In this episode of BackTable MSK, Dr. Sean Maratto from Philadelphia's Jefferson Health Network is joined by guest Dr. Junjian Huang from Emory University School of Medicine to discuss the intricacies of building a pain management practice within the interventional radiology space. ---This podcast is supported by an educational grant from Medtronic.---SYNPOSISDr. Huang shares his career journey, highlighting his shift towards pain palliation. The conversation covers a range of topics including procedural insights, patient management strategies, navigating institutional politics, and future trends in orthopedic IR. Dr. Huang emphasizes the importance of balancing patient care with building robust referral networks, and shares valuable advice for budding interventional radiologists.---TIMESTAMPS00:00 - Introduction02:20 - What’s Your Why? Why Pain Intervention? 12:52 - Building a Complex Pain Management Practice24:47 - Marketing a Service Line30:57 - Patient Impact from Pain Management Services39:53 - Recommendations and Indications for Cryoneurolysis and BVNA 45:36 - Post-Procedure Follow-up and Psychosomatic Pain Guidance52:35 - Insight to the Future of Interventional Pain and Final Thoughts---RESOURCESDr. Junjian Huang, MDhttps://med.emory.edu/directory/profile/?u=JHUAN22 Dr. Sean Maratto, MDhttps://www.jeffersonhealth.org/find-a-doctor/m/maratto-sean-a Tue, 30 Sep 2025 07:00:00 -0000 full BackTable Are you considering expanding your IR practice into pain management services? Get the download from someone who’s done it already. In this episode of BackTable MSK, Dr. Sean Maratto from Philadelphia's Jefferson Health Network is joined by guest Dr. Junjian Huang from Emory University School of Medicine to discuss the intricacies of building a pain management practice within the interventional radiology space. ---This podcast is supported by an educational grant from Medtronic.---SYNPOSISDr. Huang shares his career journey, highlighting his shift towards pain palliation. The conversation covers a range of topics including procedural insights, patient management strategies, navigating institutional politics, and future trends in orthopedic IR. Dr. Huang emphasizes the importance of balancing patient care with building robust referral networks, and shares valuable advice for budding interventional radiologists.---TIMESTAMPS00:00 - Introduction02:20 - What’s Your Why? Why Pain Intervention? 12:52 - Building a Complex Pain Management Practice24:47 - Marketing a Service Line30:57 - Patient Impact from Pain Management Services39:53 - Recommendations and Indications for Cryoneurolysis and BVNA 45:36 - Post-Procedure Follow-up and Psychosomatic Pain Guidance52:35 - Insight to the Future of Interventional Pain and Final Thoughts---RESOURCESDr. Junjian Huang, MDhttps://med.emory.edu/directory/profile/?u=JHUAN22 Dr. Sean Maratto, MDhttps://www.jeffersonhealth.org/find-a-doctor/m/maratto-sean-a Are you considering expanding your IR practice into pain management services? Get the download from someone who’s done it already. In this episode of BackTable MSK, Dr. Sean Maratto from Philadelphia's Jefferson Health Network is joined by guest Dr. Junjian Huang from Emory University School of Medicine to discuss the intricacies of building a pain management practice within the interventional radiology space.
---
This podcast is supported by an educational grant from Medtronic.
---
SYNPOSIS
Dr. Huang shares his career journey, highlighting his shift towards pain palliation. The conversation covers a range of topics including procedural insights, patient management strategies, navigating institutional politics, and future trends in orthopedic IR. Dr. Huang emphasizes the importance of balancing patient care with building robust referral networks, and shares valuable advice for budding interventional radiologists.
---
TIMESTAMPS
00:00 - Introduction
02:20 - What’s Your Why? Why Pain Intervention?
12:52 - Building a Complex Pain Management Practice
24:47 - Marketing a Service Line
30:57 - Patient Impact from Pain Management Services
39:53 - Recommendations and Indications for Cryoneurolysis and BVNA
45:36 - Post-Procedure Follow-up and Psychosomatic Pain Guidance
52:35 - Insight to the Future of Interventional Pain and Final Thoughts
---
RESOURCES
Dr. Junjian Huang, MD
https://med.emory.edu/directory/profile/?u=JHUAN22
Dr. Sean Maratto, MD
https://www.jeffersonhealth.org/find-a-doctor/m/maratto-sean-a

]]> 3311 Ep. 84 Approaches in Complex Kyphoplasty Cases with Dr. Asad Baig To ablate or not to ablate? That is the question. Learn how to tackle complex and unique cases of kyphoplasty and spinal ablation in part two of our discussion with Dr. Asad Baig and host Dr. Michael Barrazza.---This podcast is supported by an educational grant from Medtronic.---SYNPOSISThis episode looks at the ins and outs of real-world kyphoplasty and spinal ablation cases, including detailed patient histories, diagnostic techniques like the Oswestry Disability Index and Roland-Morris Disability Questionnaire, and the challenges of treating patients with extensive spinal hardware, osteoporosis, and other complicating factors.---TIMESTAMPS00:00 - Introduction01:38 - Hx of Osteoporosis and Previous Kyphoplasty04:06 - Challenges in Identifying Fractures05:29 - Tool Selection and Technique10:35 - Post-Kyphoplasty Follow-Up and Patient Outcomes13:29 - Importance of Timely Treatment18:13 - Weight Loss and Cancer Concerns28:26 - Final Thoughts and Takeaway---RESOURCESDr. Asad Baig, MDhttps://doctors.columbia.edu/us/ny/new-york/asad-baig-md-51-west-51st-street OsteoCool RF Ablation System by Medtronichttps://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-radiofrequency-ablation-system.html Tue, 16 Sep 2025 07:00:00 -0000 full BackTable To ablate or not to ablate? That is the question. Learn how to tackle complex and unique cases of kyphoplasty and spinal ablation in part two of our discussion with Dr. Asad Baig and host Dr. Michael Barrazza.---This podcast is supported by an educational grant from Medtronic.---SYNPOSISThis episode looks at the ins and outs of real-world kyphoplasty and spinal ablation cases, including detailed patient histories, diagnostic techniques like the Oswestry Disability Index and Roland-Morris Disability Questionnaire, and the challenges of treating patients with extensive spinal hardware, osteoporosis, and other complicating factors.---TIMESTAMPS00:00 - Introduction01:38 - Hx of Osteoporosis and Previous Kyphoplasty04:06 - Challenges in Identifying Fractures05:29 - Tool Selection and Technique10:35 - Post-Kyphoplasty Follow-Up and Patient Outcomes13:29 - Importance of Timely Treatment18:13 - Weight Loss and Cancer Concerns28:26 - Final Thoughts and Takeaway---RESOURCESDr. Asad Baig, MDhttps://doctors.columbia.edu/us/ny/new-york/asad-baig-md-51-west-51st-street OsteoCool RF Ablation System by Medtronichttps://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-radiofrequency-ablation-system.html To ablate or not to ablate? That is the question. Learn how to tackle complex and unique cases of kyphoplasty and spinal ablation in part two of our discussion with Dr. Asad Baig and host Dr. Michael Barrazza.
---
This podcast is supported by an educational grant from Medtronic.
---
SYNPOSIS
This episode looks at the ins and outs of real-world kyphoplasty and spinal ablation cases, including detailed patient histories, diagnostic techniques like the Oswestry Disability Index and Roland-Morris Disability Questionnaire, and the challenges of treating patients with extensive spinal hardware, osteoporosis, and other complicating factors.
---
TIMESTAMPS
00:00 - Introduction
01:38 - Hx of Osteoporosis and Previous Kyphoplasty
04:06 - Challenges in Identifying Fractures
05:29 - Tool Selection and Technique
10:35 - Post-Kyphoplasty Follow-Up and Patient Outcomes
13:29 - Importance of Timely Treatment
18:13 - Weight Loss and Cancer Concerns
28:26 - Final Thoughts and Takeaway
---
RESOURCES
Dr. Asad Baig, MD
https://doctors.columbia.edu/us/ny/new-york/asad-baig-md-51-west-51st-street
OsteoCool RF Ablation System by Medtronic
https://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-radiofrequency-ablation-system.html

]]> 1952 Ep. 83 Spine Ablation & Kyphoplasty: Handling Complex Cases with Dr. Asad Baig From patient selection to procedure technique–learn the key insights that shape a successful kyphoplasty and spine ablation practice. In this episode of the BackTable MSK Podcast, host Dr. Michael Barraza welcomes back Dr. Asad Baig, an Interventional Radiologist and director of the Interventional Spine Center at Columbia University. They discuss the latest developments at Columbia, focusing on exciting expansions in the interventional radiology and spine realms. The primary focus of their conversation is on advanced techniques in spine ablation and kyphoplasty, and the ideal patient profile for these treatments.---This podcast is supported by:Medtronic OsteoCoolhttps://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-2-0-bone-tumor-ablation-system.html---SYNPOSISDr. Baig begins the episode by explaining the importance of collaborating with radiation oncologists and spine surgeons to optimize patient outcomes and emphasizes considerations, such as bone quality, prior to a spinal ablation. The episode also features Dr. Baig’s approach to treating sclerotic versus lytic lesions with his insights on navigating complex cases involving post-radiation fractures and internal fixation complications. This first episode of a two-part series emphasizes a multi-disciplinary approach and the need for precise imaging and patient communication when treating patients with spinal ablation.---TIMESTAMPS00:00 - Introduction 01:31 - Evaluating Patients Prior to Spine Ablation 09:02 - Who is the Ideal Candidate for Ablation Kyphoplasty?14:24 - Approaching Lesions Within the Vertebral Body21:26 - When is it Appropriate to Use Balloons After an OsteoCool Ablation?27:58 - Approach to Patients with Significant Vertebral Height Loss35:33 - Challenging Cases with Kyphoplasty39:02 - Sclerotic versus Lytic Lesions---RESOURCESDr. Asad Baig, MDhttps://doctors.columbia.edu/us/ny/new-york/asad-baig-md-51-west-51st-street OsteoCool RF Ablation System by Medtronic https://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-radiofrequency-ablation-system.html Tue, 02 Sep 2025 07:00:00 -0000 full BackTable From patient selection to procedure technique–learn the key insights that shape a successful kyphoplasty and spine ablation practice. In this episode of the BackTable MSK Podcast, host Dr. Michael Barraza welcomes back Dr. Asad Baig, an Interventional Radiologist and director of the Interventional Spine Center at Columbia University. They discuss the latest developments at Columbia, focusing on exciting expansions in the interventional radiology and spine realms. The primary focus of their conversation is on advanced techniques in spine ablation and kyphoplasty, and the ideal patient profile for these treatments.---This podcast is supported by:Medtronic OsteoCoolhttps://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-2-0-bone-tumor-ablation-system.html---SYNPOSISDr. Baig begins the episode by explaining the importance of collaborating with radiation oncologists and spine surgeons to optimize patient outcomes and emphasizes considerations, such as bone quality, prior to a spinal ablation. The episode also features Dr. Baig’s approach to treating sclerotic versus lytic lesions with his insights on navigating complex cases involving post-radiation fractures and internal fixation complications. This first episode of a two-part series emphasizes a multi-disciplinary approach and the need for precise imaging and patient communication when treating patients with spinal ablation.---TIMESTAMPS00:00 - Introduction 01:31 - Evaluating Patients Prior to Spine Ablation 09:02 - Who is the Ideal Candidate for Ablation Kyphoplasty?14:24 - Approaching Lesions Within the Vertebral Body21:26 - When is it Appropriate to Use Balloons After an OsteoCool Ablation?27:58 - Approach to Patients with Significant Vertebral Height Loss35:33 - Challenging Cases with Kyphoplasty39:02 - Sclerotic versus Lytic Lesions---RESOURCESDr. Asad Baig, MDhttps://doctors.columbia.edu/us/ny/new-york/asad-baig-md-51-west-51st-street OsteoCool RF Ablation System by Medtronic https://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-radiofrequency-ablation-system.html From patient selection to procedure technique–learn the key insights that shape a successful kyphoplasty and spine ablation practice. In this episode of the BackTable MSK Podcast, host Dr. Michael Barraza welcomes back Dr. Asad Baig, an Interventional Radiologist and director of the Interventional Spine Center at Columbia University. They discuss the latest developments at Columbia, focusing on exciting expansions in the interventional radiology and spine realms. The primary focus of their conversation is on advanced techniques in spine ablation and kyphoplasty, and the ideal patient profile for these treatments.
---
This podcast is supported by:
Medtronic OsteoCool
https://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-2-0-bone-tumor-ablation-system.html
---
SYNPOSIS
Dr. Baig begins the episode by explaining the importance of collaborating with radiation oncologists and spine surgeons to optimize patient outcomes and emphasizes considerations, such as bone quality, prior to a spinal ablation. The episode also features Dr. Baig’s approach to treating sclerotic versus lytic lesions with his insights on navigating complex cases involving post-radiation fractures and internal fixation complications. This first episode of a two-part series emphasizes a multi-disciplinary approach and the need for precise imaging and patient communication when treating patients with spinal ablation.
---
TIMESTAMPS
00:00 - Introduction
01:31 - Evaluating Patients Prior to Spine Ablation
09:02 - Who is the Ideal Candidate for Ablation Kyphoplasty?
14:24 - Approaching Lesions Within the Vertebral Body
21:26 - When is it Appropriate to Use Balloons After an OsteoCool Ablation?
27:58 - Approach to Patients with Significant Vertebral Height Loss
35:33 - Challenging Cases with Kyphoplasty
39:02 - Sclerotic versus Lytic Lesions
---
RESOURCES
Dr. Asad Baig, MD
https://doctors.columbia.edu/us/ny/new-york/asad-baig-md-51-west-51st-street
OsteoCool RF Ablation System by Medtronic


https://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-radiofrequency-ablation-system.html

]]> 2385 Ep. 82 Resorbable Embolics in MSK Embolizations with Dr. Keerthi Prasad Resorbable embolics are gaining traction in musculoskeletal interventions, but what are the key technical considerations? Dr. Keerthi Prasad, interventional radiologist at the Centers for Pain Control and Vein Care joins host Dr. Ally Baheti to share practical insights when using resorbable embolics in MSK interventions.---This podcast is supported by:Medtronic OsteoCoolhttps://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-2-0-bone-tumor-ablation-system.html---SYNPOSISDr. Prasad opens the conversation with an overview of embolic agents used in MSK interventions—including Imipenem, Lipiodol, and Nexsphere-F—and shares practical insights into technique selection. He explores the nuances of working with various resorbable embolics, highlighting clinical cases from his personal experience. The discussion also highlights Dr. Prasad’s innovative approach to establishing an outpatient-based lab (OBL) focused on musculoskeletal interventions. Additionally, Dr. Prasad also offers insight into the expanding role of resorbable embolics in treating conditions such as knee arthritis, plantar fasciitis, and adhesive capsulitis. The episode ends with a call to broaden access to this evolving treatment.---TIMESTAMPS00:00 - Introduction01:55 - Outpatient Embolization and MSK Procedures04:20 - Resorbable Embolics in Joint Embolization04:52 - Available Resorbable Embolics in the US07:57 - Technical Insights on Using Resorbable Embolics15:18 - Patient Outcomes and Long-Term Durability22:24 - Future of MSK Embolization Techniques24:05 - Exploring New Applications for Resorbable Embolics27:30 - Innovative Procedures and Techniques37:00 - Final Thoughts and Advice for Practitioners Tue, 19 Aug 2025 07:00:00 -0000 full BackTable Resorbable embolics are gaining traction in musculoskeletal interventions, but what are the key technical considerations? Dr. Keerthi Prasad, interventional radiologist at the Centers for Pain Control and Vein Care joins host Dr. Ally Baheti to share practical insights when using resorbable embolics in MSK interventions.---This podcast is supported by:Medtronic OsteoCoolhttps://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-2-0-bone-tumor-ablation-system.html---SYNPOSISDr. Prasad opens the conversation with an overview of embolic agents used in MSK interventions—including Imipenem, Lipiodol, and Nexsphere-F—and shares practical insights into technique selection. He explores the nuances of working with various resorbable embolics, highlighting clinical cases from his personal experience. The discussion also highlights Dr. Prasad’s innovative approach to establishing an outpatient-based lab (OBL) focused on musculoskeletal interventions. Additionally, Dr. Prasad also offers insight into the expanding role of resorbable embolics in treating conditions such as knee arthritis, plantar fasciitis, and adhesive capsulitis. The episode ends with a call to broaden access to this evolving treatment.---TIMESTAMPS00:00 - Introduction01:55 - Outpatient Embolization and MSK Procedures04:20 - Resorbable Embolics in Joint Embolization04:52 - Available Resorbable Embolics in the US07:57 - Technical Insights on Using Resorbable Embolics15:18 - Patient Outcomes and Long-Term Durability22:24 - Future of MSK Embolization Techniques24:05 - Exploring New Applications for Resorbable Embolics27:30 - Innovative Procedures and Techniques37:00 - Final Thoughts and Advice for Practitioners Resorbable embolics are gaining traction in musculoskeletal interventions, but what are the key technical considerations? Dr. Keerthi Prasad, interventional radiologist at the Centers for Pain Control and Vein Care joins host Dr. Ally Baheti to share practical insights when using resorbable embolics in MSK interventions.
---
This podcast is supported by:
Medtronic OsteoCool
https://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-2-0-bone-tumor-ablation-system.html
---
SYNPOSIS
Dr. Prasad opens the conversation with an overview of embolic agents used in MSK interventions—including Imipenem, Lipiodol, and Nexsphere-F—and shares practical insights into technique selection. He explores the nuances of working with various resorbable embolics, highlighting clinical cases from his personal experience. The discussion also highlights Dr. Prasad’s innovative approach to establishing an outpatient-based lab (OBL) focused on musculoskeletal interventions. Additionally, Dr. Prasad also offers insight into the expanding role of resorbable embolics in treating conditions such as knee arthritis, plantar fasciitis, and adhesive capsulitis. The episode ends with a call to broaden access to this evolving treatment.
---
TIMESTAMPS
00:00 - Introduction
01:55 - Outpatient Embolization and MSK Procedures
04:20 - Resorbable Embolics in Joint Embolization
04:52 - Available Resorbable Embolics in the US
07:57 - Technical Insights on Using Resorbable Embolics
15:18 - Patient Outcomes and Long-Term Durability
22:24 - Future of MSK Embolization Techniques
24:05 - Exploring New Applications for Resorbable Embolics
27:30 - Innovative Procedures and Techniques
37:00 - Final Thoughts and Advice for Practitioners

]]> 2466 Backtable Brief: Embolic Choice for Genicular Artery Embolization with Dr. Sid Padia and Dr. Osman Ahmed What is the optimal embolization technique in GAE? In this BackTable Brief, Dr. Osman Ahmed and Dr. Sid Padia, MD discuss the embolization of abnormal vessels, debating between targeting any abnormal vessel versus only the painful side. They reference studies and papers, including the Landers 2023 paper, to explore best practices.  They consider the use of temporary resorbable embolics compared to permanent embolics, examining safety profiles, efficacy, and potential complications. The conversation then shifts towards the size of embolic particles and endpoints for different embolization materials. They discuss specific techniques and their impacts, highlighting the reproducibility of certain methods and preparing for the future of resorbable embolics in various medical applications. Episode Outline 00:00 - Introduction 00:13 - Embolization of Abnormal Vessels 02:34 - Permanent vs. Resorbable Embolics 06:21 - Debating Particle Size  11:06 - Technique When Using Permanent Spheres  12:42 - Technique When Using Resorbable Spheres  Resources Dr. Venkatesh, “Kavi”, Krishnasamy, MD https://www.uab.edu/medicine/radiology/faculty/intervent-radiology/profile/krishnasamy Dr. Osman Ahmed, MD https://bucksbauminstitute.uchicago.edu/bio/osman-ahmed-md/ Dr. Siddarth, “Sid”, Padia, MD https://www.uclahealth.org/providers/siddharth-padia Genicular artery embolization for early-stage knee osteoarthritis: results from a triple-blind single-centre randomized controlled trial https://pmc.ncbi.nlm.nih.gov/articles/PMC10032233/ Multicenter Randomized Sham Controlled Study of Genicular Artery Embolization for Knee Pain Secondary to Osteoarthritis https://pubmed.ncbi.nlm.nih.gov/34610422/ Tue, 12 Aug 2025 07:00:00 -0000 full BackTable What is the optimal embolization technique in GAE? In this BackTable Brief, Dr. Osman Ahmed and Dr. Sid Padia, MD discuss the embolization of abnormal vessels, debating between targeting any abnormal vessel versus only the painful side. They reference studies and papers, including the Landers 2023 paper, to explore best practices.  They consider the use of temporary resorbable embolics compared to permanent embolics, examining safety profiles, efficacy, and potential complications. The conversation then shifts towards the size of embolic particles and endpoints for different embolization materials. They discuss specific techniques and their impacts, highlighting the reproducibility of certain methods and preparing for the future of resorbable embolics in various medical applications. Episode Outline 00:00 - Introduction 00:13 - Embolization of Abnormal Vessels 02:34 - Permanent vs. Resorbable Embolics 06:21 - Debating Particle Size  11:06 - Technique When Using Permanent Spheres  12:42 - Technique When Using Resorbable Spheres  Resources Dr. Venkatesh, “Kavi”, Krishnasamy, MD https://www.uab.edu/medicine/radiology/faculty/intervent-radiology/profile/krishnasamy Dr. Osman Ahmed, MD https://bucksbauminstitute.uchicago.edu/bio/osman-ahmed-md/ Dr. Siddarth, “Sid”, Padia, MD https://www.uclahealth.org/providers/siddharth-padia Genicular artery embolization for early-stage knee osteoarthritis: results from a triple-blind single-centre randomized controlled trial https://pmc.ncbi.nlm.nih.gov/articles/PMC10032233/ Multicenter Randomized Sham Controlled Study of Genicular Artery Embolization for Knee Pain Secondary to Osteoarthritis https://pubmed.ncbi.nlm.nih.gov/34610422/

What is the optimal embolization technique in GAE? In this BackTable Brief, Dr. Osman Ahmed and Dr. Sid Padia, MD discuss the embolization of abnormal vessels, debating between targeting any abnormal vessel versus only the painful side. They reference studies and papers, including the Landers 2023 paper, to explore best practices. 


They consider the use of temporary resorbable embolics compared to permanent embolics, examining safety profiles, efficacy, and potential complications. The conversation then shifts towards the size of embolic particles and endpoints for different embolization materials. They discuss specific techniques and their impacts, highlighting the reproducibility of certain methods and preparing for the future of resorbable embolics in various medical applications.


Episode Outline


00:00 - Introduction

00:13 - Embolization of Abnormal Vessels

02:34 - Permanent vs. Resorbable Embolics

06:21 - Debating Particle Size 

11:06 - Technique When Using Permanent Spheres 

12:42 - Technique When Using Resorbable Spheres 


Resources


Dr. Venkatesh, “Kavi”, Krishnasamy, MD

https://www.uab.edu/medicine/radiology/faculty/intervent-radiology/profile/krishnasamy


Dr. Osman Ahmed, MD

https://bucksbauminstitute.uchicago.edu/bio/osman-ahmed-md/


Dr. Siddarth, “Sid”, Padia, MD

https://www.uclahealth.org/providers/siddharth-padia


Genicular artery embolization for early-stage knee osteoarthritis: results from a triple-blind single-centre randomized controlled trial

https://pmc.ncbi.nlm.nih.gov/articles/PMC10032233/


Multicenter Randomized Sham Controlled Study of Genicular Artery Embolization for Knee Pain Secondary to Osteoarthritis

https://pubmed.ncbi.nlm.nih.gov/34610422/


]]> 1102 Backtable Brief: Catheter Selection for Genicular Artery Embolization in the OBL with Dr. Sid Padia and Dr. Osman Ahmed Which imaging and treatment techniques are optimal for GAE in the OBL? In this BackTable Brief, Dr. Osman Ahmed and Dr. Sid Padia explore instrument selection and CT techniques in the OBL for genicular artery embolization (GAE).  Dr. Ahmed and Dr. Padia discuss the importance of not compromising on patient safety, and the careful selection of their approach to treatment. They further elaborate on the use of cone beam CT for more precise treatment planning, sharing insights on catheter selection, contrast solutions, and best practices for ensuring high-quality patient care, especially in the OBL (office-based lab) setting. Episode Outline 00:00 - Introduction  00:53 - Discussion on Catheter Selection and Preference  03:37 - Use of Cone Beam CT in the OBL 10:42 - Cone Beam CT Protocols and Technique: Selective or Non-Selective? 12:38 - Contrast Solutions and Techniques Resources Dr. Venkatesh, “Kavi”, Krishnasamy, MD https://www.uab.edu/medicine/radiology/faculty/intervent-radiology/profile/krishnasamy  Dr. Osman Ahmed, MD https://bucksbauminstitute.uchicago.edu/bio/osman-ahmed-md/  Dr. Siddarth, “Sid”, Padia, MD https://www.uclahealth.org/providers/siddharth-padia Tue, 05 Aug 2025 07:00:00 -0000 full BackTable Which imaging and treatment techniques are optimal for GAE in the OBL? In this BackTable Brief, Dr. Osman Ahmed and Dr. Sid Padia explore instrument selection and CT techniques in the OBL for genicular artery embolization (GAE).  Dr. Ahmed and Dr. Padia discuss the importance of not compromising on patient safety, and the careful selection of their approach to treatment. They further elaborate on the use of cone beam CT for more precise treatment planning, sharing insights on catheter selection, contrast solutions, and best practices for ensuring high-quality patient care, especially in the OBL (office-based lab) setting. Episode Outline 00:00 - Introduction  00:53 - Discussion on Catheter Selection and Preference  03:37 - Use of Cone Beam CT in the OBL 10:42 - Cone Beam CT Protocols and Technique: Selective or Non-Selective? 12:38 - Contrast Solutions and Techniques Resources Dr. Venkatesh, “Kavi”, Krishnasamy, MD https://www.uab.edu/medicine/radiology/faculty/intervent-radiology/profile/krishnasamy  Dr. Osman Ahmed, MD https://bucksbauminstitute.uchicago.edu/bio/osman-ahmed-md/  Dr. Siddarth, “Sid”, Padia, MD https://www.uclahealth.org/providers/siddharth-padia Which imaging and treatment techniques are optimal for GAE in the OBL? In this BackTable Brief, Dr. Osman Ahmed and Dr. Sid Padia explore instrument selection and CT techniques in the OBL for genicular artery embolization (GAE). 


Dr. Ahmed and Dr. Padia discuss the importance of not compromising on patient safety, and the careful selection of their approach to treatment. They further elaborate on the use of cone beam CT for more precise treatment planning, sharing insights on catheter selection, contrast solutions, and best practices for ensuring high-quality patient care, especially in the OBL (office-based lab) setting.


Episode Outline


00:00 - Introduction 

00:53 - Discussion on Catheter Selection and Preference 

03:37 - Use of Cone Beam CT in the OBL

10:42 - Cone Beam CT Protocols and Technique: Selective or Non-Selective?

12:38 - Contrast Solutions and Techniques


Resources


Dr. Venkatesh, “Kavi”, Krishnasamy, MD

https://www.uab.edu/medicine/radiology/faculty/intervent-radiology/profile/krishnasamy 


Dr. Osman Ahmed, MD

https://bucksbauminstitute.uchicago.edu/bio/osman-ahmed-md/ 


Dr. Siddarth, “Sid”, Padia, MD


https://www.uclahealth.org/providers/siddharth-padia

]]> 925 Ep. 81 Multidisciplinary Spine Oncology Care: Insights & Techniques with Dr. Ran Lador and When it comes to spinal oncology, no single specialty holds all the answers. In this episode of the BackTable Podcast, host Dr. Alexa Levey, an interventional radiologist from Yale School of Medicine, is joined by Dr. Mark Amsbaugh, a radiation oncologist, and Dr. Ran Lador, an orthopedic spine surgeon, both from the University of Texas McGovern Medical School. The discussion explores complexities and innovations in the multidisciplinary treatment of spinal tumors. --- SYNPOSIS Dr. Ambsbaugh and Dr. Lador highlight their cohesive, patient-centered approach at Memorial Hermann, integrating various specialties including surgery, radiation oncology, and interventional radiology. The episode emphasizes the importance of collaborative techniques, advances in minimally invasive surgeries, the role of stereotactic radiosurgery, and the critical nature of personalized patient care in improving outcomes for patients with spinal tumors. --- TIMESTAMPS 00:00 - Introduction01:20 - Multidisciplinary Approach to Spinal Tumors at Memorial Hermann10:22 - Surgical Techniques and Timing for Radiation Treatments 12:25 - Approach to Collaborative Treatment Planning25:45 - Connection Between Surgical and Radiation Oncology in Patient Care31:08 - The Role of Vertebral Augmentation in Spinal Oncology40:08 - Multimodal Pain Management Strategies47:35 - Thoughts on Future Directions in Spinal Oncology and Conclusion --- RESOURCES Dr. Mark Amsbaugh, MDhttps://med.uth.edu/neurosciences/dr-mark-j-amsbaugh-md/ Dr. Ran Lador, MDhttps://med.uth.edu/ortho/2022/11/02/ran-lador-md/ Dr. Alexa Levey, MDhttps://medicine.yale.edu/profile/alexa-levey/ Tue, 29 Jul 2025 07:00:00 -0000 full BackTable When it comes to spinal oncology, no single specialty holds all the answers. In this episode of the BackTable Podcast, host Dr. Alexa Levey, an interventional radiologist from Yale School of Medicine, is joined by Dr. Mark Amsbaugh, a radiation oncologist, and Dr. Ran Lador, an orthopedic spine surgeon, both from the University of Texas McGovern Medical School. The discussion explores complexities and innovations in the multidisciplinary treatment of spinal tumors. --- SYNPOSIS Dr. Ambsbaugh and Dr. Lador highlight their cohesive, patient-centered approach at Memorial Hermann, integrating various specialties including surgery, radiation oncology, and interventional radiology. The episode emphasizes the importance of collaborative techniques, advances in minimally invasive surgeries, the role of stereotactic radiosurgery, and the critical nature of personalized patient care in improving outcomes for patients with spinal tumors. --- TIMESTAMPS 00:00 - Introduction01:20 - Multidisciplinary Approach to Spinal Tumors at Memorial Hermann10:22 - Surgical Techniques and Timing for Radiation Treatments 12:25 - Approach to Collaborative Treatment Planning25:45 - Connection Between Surgical and Radiation Oncology in Patient Care31:08 - The Role of Vertebral Augmentation in Spinal Oncology40:08 - Multimodal Pain Management Strategies47:35 - Thoughts on Future Directions in Spinal Oncology and Conclusion --- RESOURCES Dr. Mark Amsbaugh, MDhttps://med.uth.edu/neurosciences/dr-mark-j-amsbaugh-md/ Dr. Ran Lador, MDhttps://med.uth.edu/ortho/2022/11/02/ran-lador-md/ Dr. Alexa Levey, MDhttps://medicine.yale.edu/profile/alexa-levey/ When it comes to spinal oncology, no single specialty holds all the answers. In this episode of the BackTable Podcast, host Dr. Alexa Levey, an interventional radiologist from Yale School of Medicine, is joined by Dr. Mark Amsbaugh, a radiation oncologist, and Dr. Ran Lador, an orthopedic spine surgeon, both from the University of Texas McGovern Medical School. The discussion explores complexities and innovations in the multidisciplinary treatment of spinal tumors.


---


SYNPOSIS


Dr. Ambsbaugh and Dr. Lador highlight their cohesive, patient-centered approach at Memorial Hermann, integrating various specialties including surgery, radiation oncology, and interventional radiology. The episode emphasizes the importance of collaborative techniques, advances in minimally invasive surgeries, the role of stereotactic radiosurgery, and the critical nature of personalized patient care in improving outcomes for patients with spinal tumors.


---


TIMESTAMPS


00:00 - Introduction
01:20 - Multidisciplinary Approach to Spinal Tumors at Memorial Hermann
10:22 - Surgical Techniques and Timing for Radiation Treatments
12:25 - Approach to Collaborative Treatment Planning
25:45 - Connection Between Surgical and Radiation Oncology in Patient Care
31:08 - The Role of Vertebral Augmentation in Spinal Oncology
40:08 - Multimodal Pain Management Strategies
47:35 - Thoughts on Future Directions in Spinal Oncology and Conclusion


---


RESOURCES


Dr. Mark Amsbaugh, MD
https://med.uth.edu/neurosciences/dr-mark-j-amsbaugh-md/


Dr. Ran Lador, MD
https://med.uth.edu/ortho/2022/11/02/ran-lador-md/


Dr. Alexa Levey, MD
https://medicine.yale.edu/profile/alexa-levey/

]]> 3242 Backtable Brief: Workup and Patient Selection for Genicular Artery Embolization with Dr. Sid Padia and Dr. Osman Ahmed Shownotes Who is the ideal candidate for genicular artery embolization (GAE)? In this BackTable Brief, Dr. Osman Ahmed and Dr. Sid Padia share how they work up and select GAE patients. Dr. Padia and Dr. Ahmed discuss the challenges of patient selection in genicular artery embolization, specifically debating the necessity and utility of MRI with contrast. The discussion also explores the pros and cons of femoral vs. pedal access techniques, considering patient characteristics such as BMI and the practicality of these approaches in various clinical settings. Episode Outline 00:00 - Introduction 00:20 - Use of MRI with Contrast in Patient Selection 04:22 - Challenges and Future Directions of MRI in GAE 07:46 - Pros and Cons of Femoral vs. Pedal Access 10:00 - Practical Considerations Resources Dr. Venkatesh, “Kavi”, Krishnasamy, MD https://www.uab.edu/medicine/radiology/faculty/intervent-radiology/profile/krishnasamy  Dr. Osman Ahmed, MD https://bucksbauminstitute.uchicago.edu/bio/osman-ahmed-md/  Dr. Siddarth, “Sid”, Padia, MD https://www.uclahealth.org/providers/siddharth-padia Tue, 15 Jul 2025 07:00:00 -0000 full BackTable Shownotes Who is the ideal candidate for genicular artery embolization (GAE)? In this BackTable Brief, Dr. Osman Ahmed and Dr. Sid Padia share how they work up and select GAE patients. Dr. Padia and Dr. Ahmed discuss the challenges of patient selection in genicular artery embolization, specifically debating the necessity and utility of MRI with contrast. The discussion also explores the pros and cons of femoral vs. pedal access techniques, considering patient characteristics such as BMI and the practicality of these approaches in various clinical settings. Episode Outline 00:00 - Introduction 00:20 - Use of MRI with Contrast in Patient Selection 04:22 - Challenges and Future Directions of MRI in GAE 07:46 - Pros and Cons of Femoral vs. Pedal Access 10:00 - Practical Considerations Resources Dr. Venkatesh, “Kavi”, Krishnasamy, MD https://www.uab.edu/medicine/radiology/faculty/intervent-radiology/profile/krishnasamy  Dr. Osman Ahmed, MD https://bucksbauminstitute.uchicago.edu/bio/osman-ahmed-md/  Dr. Siddarth, “Sid”, Padia, MD https://www.uclahealth.org/providers/siddharth-padia Shownotes

Who is the ideal candidate for genicular artery embolization (GAE)? In this BackTable Brief, Dr. Osman Ahmed and Dr. Sid Padia share how they work up and select GAE patients.

Dr. Padia and Dr. Ahmed discuss the challenges of patient selection in genicular artery embolization, specifically debating the necessity and utility of MRI with contrast. The discussion also explores the pros and cons of femoral vs. pedal access techniques, considering patient characteristics such as BMI and the practicality of these approaches in various clinical settings.

Episode Outline

00:00 - Introduction

00:20 - Use of MRI with Contrast in Patient Selection

04:22 - Challenges and Future Directions of MRI in GAE

07:46 - Pros and Cons of Femoral vs. Pedal Access

10:00 - Practical Considerations

Resources

Dr. Venkatesh, “Kavi”, Krishnasamy, MD

https://www.uab.edu/medicine/radiology/faculty/intervent-radiology/profile/krishnasamy 


Dr. Osman Ahmed, MD

https://bucksbauminstitute.uchicago.edu/bio/osman-ahmed-md/ 


Dr. Siddarth, “Sid”, Padia, MD


https://www.uclahealth.org/providers/siddharth-padia

]]> 851 Ep. 80 Cryoneurolysis in Pain Management: Anatomy and Technique with Dr. Alexa Levey Where does cryoneurolysis fit in contemporary pain management? In this episode of Backtable MSK, host Jacob Fleming is joined by Dr. Alexa Levey to discuss the role of cryoneurolysis in various pain presentations, covering indications, anatomical targets, and techniques in different clinical scenarios. --- SYNPOSIS This episode offers practical guidance on how to take a detailed patient history, how to use cryoneurolysis for pain management, and the significance of multidisciplinary collaboration. The conversation also highlights the importance of setting proper patient expectations, understanding different types of pain, and the need for standardizing cryoneurolysis procedures through structured research and education.Dr. Levey also shares her recent career move to Yale, her passion for research, and the challenges she faced returning to academia from private practice. --- TIMESTAMPS 00:00 - Introduction03:49 - Discussion of Dr. Levey’s Recent Research Paper09:35 - The Fine Details of Pain and Pain Management 18:42 - Patient Quality of Life Assessment in Regards to Pain Management28:28 - Game Plan for Managing Neuritis37:19 - Collaboration Between Different Specialists40:16 - Offering Patient Education and Support 42:31 - Final Reflections and Gratitude --- RESOURCES Dr. Alexa Leveyhttps://medicine.yale.edu/profile/alexa-levey/ Common Cryoneurolysis Targets in Pain Management: Indications, Critical Anatomy, and Potential Complicationshttps://pubmed.ncbi.nlm.nih.gov/40376212/ Tue, 01 Jul 2025 07:00:00 -0000 full BackTable Where does cryoneurolysis fit in contemporary pain management? In this episode of Backtable MSK, host Jacob Fleming is joined by Dr. Alexa Levey to discuss the role of cryoneurolysis in various pain presentations, covering indications, anatomical targets, and techniques in different clinical scenarios. --- SYNPOSIS This episode offers practical guidance on how to take a detailed patient history, how to use cryoneurolysis for pain management, and the significance of multidisciplinary collaboration. The conversation also highlights the importance of setting proper patient expectations, understanding different types of pain, and the need for standardizing cryoneurolysis procedures through structured research and education.Dr. Levey also shares her recent career move to Yale, her passion for research, and the challenges she faced returning to academia from private practice. --- TIMESTAMPS 00:00 - Introduction03:49 - Discussion of Dr. Levey’s Recent Research Paper09:35 - The Fine Details of Pain and Pain Management 18:42 - Patient Quality of Life Assessment in Regards to Pain Management28:28 - Game Plan for Managing Neuritis37:19 - Collaboration Between Different Specialists40:16 - Offering Patient Education and Support 42:31 - Final Reflections and Gratitude --- RESOURCES Dr. Alexa Leveyhttps://medicine.yale.edu/profile/alexa-levey/ Common Cryoneurolysis Targets in Pain Management: Indications, Critical Anatomy, and Potential Complicationshttps://pubmed.ncbi.nlm.nih.gov/40376212/ Where does cryoneurolysis fit in contemporary pain management? In this episode of Backtable MSK, host Jacob Fleming is joined by Dr. Alexa Levey to discuss the role of cryoneurolysis in various pain presentations, covering indications, anatomical targets, and techniques in different clinical scenarios.


---


SYNPOSIS


This episode offers practical guidance on how to take a detailed patient history, how to use cryoneurolysis for pain management, and the significance of multidisciplinary collaboration. The conversation also highlights the importance of setting proper patient expectations, understanding different types of pain, and the need for standardizing cryoneurolysis procedures through structured research and education.
Dr. Levey also shares her recent career move to Yale, her passion for research, and the challenges she faced returning to academia from private practice.


---


TIMESTAMPS


00:00 - Introduction
03:49 - Discussion of Dr. Levey’s Recent Research Paper
09:35 - The Fine Details of Pain and Pain Management
18:42 - Patient Quality of Life Assessment in Regards to Pain Management
28:28 - Game Plan for Managing Neuritis
37:19 - Collaboration Between Different Specialists
40:16 - Offering Patient Education and Support
42:31 - Final Reflections and Gratitude


---


RESOURCES


Dr. Alexa Levey
https://medicine.yale.edu/profile/alexa-levey/


Common Cryoneurolysis Targets in Pain Management: Indications, Critical Anatomy, and Potential Complications
https://pubmed.ncbi.nlm.nih.gov/40376212/

]]> 2933 Ep. 79 Managing Vertebrogenic Pain: Ablation Procedures & Outcomes with Dr. Luigi Manfre Paging all neuroradiologists and spine specialists interested in enhancing their vertebral nerve ablation practice. In this special ESNR edition of Backtable MSK, host Jacob Fleming welcomes neuroradiologist Dr. Luigi Manfre to discuss the intricacies of vertebral nerve ablation, focusing on patient selection, technical approaches, and emerging practice trends. --- SYNPOSIS The physicians discuss the importance of careful diagnosis using MRI, SPECT scanning, and nerve block tests to improve treatment efficacy. Dr. Manfre emphasizes the need for strict patient selection to mitigate failures and highlights the variability in vertebral innervation between patients that can affect outcomes. The conversation also explores the nuances of conducting procedures under CT guidance and addresses challenges in treating different spinal levels, including L5 and S1. BONUS: Details on the ESNR Hands-On Spine Course held in Catania, Italy from October 16th-18th, 2025. --- TIMESTAMPS 00:00 - Introduction02:43 - Upcoming Hands-On Spine Course 08:40 - The Rundown: Basivertebral Nerve Ablation15:18 - Understanding Modic Changes and Their Implications26:03 - Unique Innervation and Corresponding Challenges in Ablation38:13 - Technical Approaches and Difficulties in BVNA51:16 - Patient Selection and Procedure Efficacy for Ablative Procedures01:00:29 - Conclusion and ESNR Course Information --- RESOURCES Dr. Luigi Manfre https://www.linkedin.com/in/luigi-manfre-20b61284/?originalSubdomain=it European Society of Neuroradiology (ESNR)https://www.esnr.org/ Tue, 17 Jun 2025 07:00:00 -0000 full BackTable Paging all neuroradiologists and spine specialists interested in enhancing their vertebral nerve ablation practice. In this special ESNR edition of Backtable MSK, host Jacob Fleming welcomes neuroradiologist Dr. Luigi Manfre to discuss the intricacies of vertebral nerve ablation, focusing on patient selection, technical approaches, and emerging practice trends. --- SYNPOSIS The physicians discuss the importance of careful diagnosis using MRI, SPECT scanning, and nerve block tests to improve treatment efficacy. Dr. Manfre emphasizes the need for strict patient selection to mitigate failures and highlights the variability in vertebral innervation between patients that can affect outcomes. The conversation also explores the nuances of conducting procedures under CT guidance and addresses challenges in treating different spinal levels, including L5 and S1. BONUS: Details on the ESNR Hands-On Spine Course held in Catania, Italy from October 16th-18th, 2025. --- TIMESTAMPS 00:00 - Introduction02:43 - Upcoming Hands-On Spine Course 08:40 - The Rundown: Basivertebral Nerve Ablation15:18 - Understanding Modic Changes and Their Implications26:03 - Unique Innervation and Corresponding Challenges in Ablation38:13 - Technical Approaches and Difficulties in BVNA51:16 - Patient Selection and Procedure Efficacy for Ablative Procedures01:00:29 - Conclusion and ESNR Course Information --- RESOURCES Dr. Luigi Manfre https://www.linkedin.com/in/luigi-manfre-20b61284/?originalSubdomain=it European Society of Neuroradiology (ESNR)https://www.esnr.org/ Paging all neuroradiologists and spine specialists interested in enhancing their vertebral nerve ablation practice. In this special ESNR edition of Backtable MSK, host Jacob Fleming welcomes neuroradiologist Dr. Luigi Manfre to discuss the intricacies of vertebral nerve ablation, focusing on patient selection, technical approaches, and emerging practice trends.


---


SYNPOSIS


The physicians discuss the importance of careful diagnosis using MRI, SPECT scanning, and nerve block tests to improve treatment efficacy. Dr. Manfre emphasizes the need for strict patient selection to mitigate failures and highlights the variability in vertebral innervation between patients that can affect outcomes. The conversation also explores the nuances of conducting procedures under CT guidance and addresses challenges in treating different spinal levels, including L5 and S1. BONUS: Details on the ESNR Hands-On Spine Course held in Catania, Italy from October 16th-18th, 2025.


---


TIMESTAMPS


00:00 - Introduction
02:43 - Upcoming Hands-On Spine Course
08:40 - The Rundown: Basivertebral Nerve Ablation
15:18 - Understanding Modic Changes and Their Implications
26:03 - Unique Innervation and Corresponding Challenges in Ablation
38:13 - Technical Approaches and Difficulties in BVNA
51:16 - Patient Selection and Procedure Efficacy for Ablative Procedures
01:00:29 - Conclusion and ESNR Course Information


---


RESOURCES


Dr. Luigi Manfre
https://www.linkedin.com/in/luigi-manfre-20b61284/?originalSubdomain=it


European Society of Neuroradiology (ESNR)
https://www.esnr.org/

]]> 3927 Ep. 78 MSK Embolization: Techniques, Outcomes, and Referral Strategies with Dr. Ahmed Farag Musculoskeletal (MSK) embolization is emerging as a transformative, minimally-invasive option for various chronic pain conditions. In this week’s episode of Backtable MSK, host Dr. Jacob Fleming talks with Dr. Ahmed Farag, an interventional radiologist with expertise in MSK embolization. The conversation covers practice building, tools, and techniques. --- SYNPOSIS Dr. Farag shares insights from his journey beginning with a career in engineering to now a career in medicine and private practice. He emphasizes how good patient outcomes, networking, and continuous learning all work synergistically as a marketing tool. He also touches upon the challenges and triumphs in practice management and the future prospects of outpatient musculoskeletal interventional radiology. This episode provides valuable advice for both veteran practitioners and trainees looking to carve their own paths in this evolving field. --- TIMESTAMPS 00:00 - Introduction 10:53 - Developing a Referral Network in Private Practice15:54 - Discussing the Variety of MSK Embolization Procedures19:39 - Sampling Products and Techniques for MSK Embolization 24:52 - Optimizing Relationships with Hospitals28:05 - Advice for New IR Practitioners33:39 - Keeping Up to Date: Training and Conferences37:10 - Future Directions of Outpatient MSK IR40:52 - Conclusion and Final Thoughts --- RESOURCES Dr. Ahmed Faraghttps://www.flvascular.com/about Tue, 03 Jun 2025 07:00:00 -0000 full BackTable Musculoskeletal (MSK) embolization is emerging as a transformative, minimally-invasive option for various chronic pain conditions. In this week’s episode of Backtable MSK, host Dr. Jacob Fleming talks with Dr. Ahmed Farag, an interventional radiologist with expertise in MSK embolization. The conversation covers practice building, tools, and techniques. Musculoskeletal (MSK) embolization is emerging as a transformative, minimally-invasive option for various chronic pain conditions. In this week’s episode of Backtable MSK, host Dr. Jacob Fleming talks with Dr. Ahmed Farag, an interventional radiologist with expertise in MSK embolization. The conversation covers practice building, tools, and techniques. --- SYNPOSIS Dr. Farag shares insights from his journey beginning with a career in engineering to now a career in medicine and private practice. He emphasizes how good patient outcomes, networking, and continuous learning all work synergistically as a marketing tool. He also touches upon the challenges and triumphs in practice management and the future prospects of outpatient musculoskeletal interventional radiology. This episode provides valuable advice for both veteran practitioners and trainees looking to carve their own paths in this evolving field. --- TIMESTAMPS 00:00 - Introduction 10:53 - Developing a Referral Network in Private Practice15:54 - Discussing the Variety of MSK Embolization Procedures19:39 - Sampling Products and Techniques for MSK Embolization 24:52 - Optimizing Relationships with Hospitals28:05 - Advice for New IR Practitioners33:39 - Keeping Up to Date: Training and Conferences37:10 - Future Directions of Outpatient MSK IR40:52 - Conclusion and Final Thoughts --- RESOURCES Dr. Ahmed Faraghttps://www.flvascular.com/about Musculoskeletal (MSK) embolization is emerging as a transformative, minimally-invasive option for various chronic pain conditions. In this week’s episode of Backtable MSK, host Dr. Jacob Fleming talks with Dr. Ahmed Farag, an interventional radiologist with expertise in MSK embolization. The conversation covers practice building, tools, and techniques.


---


SYNPOSIS


Dr. Farag shares insights from his journey beginning with a career in engineering to now a career in medicine and private practice. He emphasizes how good patient outcomes, networking, and continuous learning all work synergistically as a marketing tool. He also touches upon the challenges and triumphs in practice management and the future prospects of outpatient musculoskeletal interventional radiology. This episode provides valuable advice for both veteran practitioners and trainees looking to carve their own paths in this evolving field.


---


TIMESTAMPS


00:00 - Introduction
10:53 - Developing a Referral Network in Private Practice
15:54 - Discussing the Variety of MSK Embolization Procedures
19:39 - Sampling Products and Techniques for MSK Embolization
24:52 - Optimizing Relationships with Hospitals
28:05 - Advice for New IR Practitioners
33:39 - Keeping Up to Date: Training and Conferences
37:10 - Future Directions of Outpatient MSK IR
40:52 - Conclusion and Final Thoughts


---


RESOURCES


Dr. Ahmed Farag
https://www.flvascular.com/about

]]> 2697 Ep. 77 Treatment of Lumbar Radiculopathy with Intradiscal Ozone with Dr. Alexis Kelekis Intradiscal ozone offers a minimally invasive approach to disc pain that can reduce inflammation and restore function. How well does it work and where does it fit in the lumbar radiculopathy treatment algorithm? In this episode of the Backtable MSK Podcast, host Jacob Fleming speaks with Dr. Alexis Kelekis about the contemporary role of intradiscal ozone and emerging innovations in interventional spine treatment.---SYNPOSISDr. Kelekis, a prominent figure in radiology and interventional pain management, shares insights from the 2025 GRIBOI meeting held in Banff, AB, Canada. Topics discussed include the development and possibility of bone augmentation polymers, intradiscal ozone therapy, and various interventional treatments for degenerative disc disease and vertebral fractures. Dr. Kelekis also touches on the need for specialized training in interventional radiology and the future of personalized medicine in pain management.---TIMESTAMPS00:00 - Introduction06:40 - Ozone Treatment: Mechanism and Efficacy13:23 - Challenges and Innovations in Spine Treatments20:09 - Treatment Algorithm in Patients with Lower Extremity Radiculopathy 24:00 - Future Directions in Interventional Spine Treatments 30:28 - Closing Remarks---RESOURCESSpinaFx:https://spinafx.com/GRIBOI:https://www.griboi.org/ Tue, 20 May 2025 07:00:00 -0000 full BackTable Intradiscal ozone offers a minimally invasive approach to disc pain that can reduce inflammation and restore function. How well does it work and where does it fit in the lumbar radiculopathy treatment algorithm? In this episode of the Backtable MSK Podcast, host Jacob Fleming speaks with Dr. Alexis Kelekis about the contemporary role of intradiscal ozone and emerging innovations in interventional spine treatment. Intradiscal ozone offers a minimally invasive approach to disc pain that can reduce inflammation and restore function. How well does it work and where does it fit in the lumbar radiculopathy treatment algorithm? In this episode of the Backtable MSK Podcast, host Jacob Fleming speaks with Dr. Alexis Kelekis about the contemporary role of intradiscal ozone and emerging innovations in interventional spine treatment.---SYNPOSISDr. Kelekis, a prominent figure in radiology and interventional pain management, shares insights from the 2025 GRIBOI meeting held in Banff, AB, Canada. Topics discussed include the development and possibility of bone augmentation polymers, intradiscal ozone therapy, and various interventional treatments for degenerative disc disease and vertebral fractures. Dr. Kelekis also touches on the need for specialized training in interventional radiology and the future of personalized medicine in pain management.---TIMESTAMPS00:00 - Introduction06:40 - Ozone Treatment: Mechanism and Efficacy13:23 - Challenges and Innovations in Spine Treatments20:09 - Treatment Algorithm in Patients with Lower Extremity Radiculopathy 24:00 - Future Directions in Interventional Spine Treatments 30:28 - Closing Remarks---RESOURCESSpinaFx:https://spinafx.com/GRIBOI:https://www.griboi.org/ Intradiscal ozone offers a minimally invasive approach to disc pain that can reduce inflammation and restore function. How well does it work and where does it fit in the lumbar radiculopathy treatment algorithm? In this episode of the Backtable MSK Podcast, host Jacob Fleming speaks with Dr. Alexis Kelekis about the contemporary role of intradiscal ozone and emerging innovations in interventional spine treatment.
---
SYNPOSIS
Dr. Kelekis, a prominent figure in radiology and interventional pain management, shares insights from the 2025 GRIBOI meeting held in Banff, AB, Canada. Topics discussed include the development and possibility of bone augmentation polymers, intradiscal ozone therapy, and various interventional treatments for degenerative disc disease and vertebral fractures. Dr. Kelekis also touches on the need for specialized training in interventional radiology and the future of personalized medicine in pain management.
---
TIMESTAMPS
00:00 - Introduction
06:40 - Ozone Treatment: Mechanism and Efficacy
13:23 - Challenges and Innovations in Spine Treatments
20:09 - Treatment Algorithm in Patients with Lower Extremity Radiculopathy
24:00 - Future Directions in Interventional Spine Treatments
30:28 - Closing Remarks
---
RESOURCES
SpinaFx:
https://spinafx.com/
GRIBOI:
https://www.griboi.org/

]]> 2004 Ep. 76 Culture and Leadership: Enhancing the Training Experience and Beyond with Dr. Wayne Olan and Mr. David Tilton What sets apart those who are good from those who are great? This episode of Backtable MSK features a profound discussion on leadership and legacy with Dana Dunleavy, MD, Wayne Olan, MD, and David Tilton. Dr. Olan, Director of Minimally Invasive Neurosurgery at George Washington University Medical Center, and David Tilton, a former Navy SEAL and current business and racing professional, share their unique experiences and insights surrounding perseverance in success.---SYNPOSISThe doctors discuss the importance of mentorship, collaboration, and cultivating a culture of growth and accountability. The conversation highlights how nurturing leaders can impact both professional and personal development, emphasizing that the best measure of success lies within the success of those you lead.---TIMESTAMPS00:00 - Introduction10:50 - Learning from Those Around You16:56 - The Value of Continuous Learning and Avoiding Complacency31:43 - The Importance of Teamwork and Mentorship 50:07 - The Role of Failure in Success 52:45 - Closing Remarks: Support and Courage Tue, 06 May 2025 07:00:00 -0000 full BackTable What sets apart those who are good from those who are great? This episode of Backtable MSK features a profound discussion on leadership and legacy with Dana Dunleavy, MD, Wayne Olan, MD, and David Tilton. Dr. Olan, Director of Minimally Invasive Neurosurgery at George Washington University Medical Center, and David Tilton, a former Navy SEAL and current business and racing professional, share their unique experiences and insights surrounding perseverance in success. What sets apart those who are good from those who are great? This episode of Backtable MSK features a profound discussion on leadership and legacy with Dana Dunleavy, MD, Wayne Olan, MD, and David Tilton. Dr. Olan, Director of Minimally Invasive Neurosurgery at George Washington University Medical Center, and David Tilton, a former Navy SEAL and current business and racing professional, share their unique experiences and insights surrounding perseverance in success.---SYNPOSISThe doctors discuss the importance of mentorship, collaboration, and cultivating a culture of growth and accountability. The conversation highlights how nurturing leaders can impact both professional and personal development, emphasizing that the best measure of success lies within the success of those you lead.---TIMESTAMPS00:00 - Introduction10:50 - Learning from Those Around You16:56 - The Value of Continuous Learning and Avoiding Complacency31:43 - The Importance of Teamwork and Mentorship 50:07 - The Role of Failure in Success 52:45 - Closing Remarks: Support and Courage What sets apart those who are good from those who are great? This episode of Backtable MSK features a profound discussion on leadership and legacy with Dana Dunleavy, MD, Wayne Olan, MD, and David Tilton. Dr. Olan, Director of Minimally Invasive Neurosurgery at George Washington University Medical Center, and David Tilton, a former Navy SEAL and current business and racing professional, share their unique experiences and insights surrounding perseverance in success.
---
SYNPOSIS
The doctors discuss the importance of mentorship, collaboration, and cultivating a culture of growth and accountability. The conversation highlights how nurturing leaders can impact both professional and personal development, emphasizing that the best measure of success lies within the success of those you lead.
---
TIMESTAMPS
00:00 - Introduction
10:50 - Learning from Those Around You
16:56 - The Value of Continuous Learning and Avoiding Complacency
31:43 - The Importance of Teamwork and Mentorship
50:07 - The Role of Failure in Success
52:45 - Closing Remarks: Support and Courage

]]> 3712 Ep. 75 Genicular Artery Embolization: Current Controversies and Insights with Dr. Sid Padia and Dr. Osman Ahmed Who is the ultimate candidate for GAE, which technical approach is best, and how do you set your patients up for success? Tune into this week’s episode of BackTable to hear from interventional radiologists Dr. Osman Ahmed (University of Chicago Medicine) and Dr. Siddharth Padia (UCLA Health) as they discuss everything from patient selection to follow-up care, covering pre-procedure imaging, access, embolics, technical challenges, clinical data, and the future of genicular artery embolization. --- This podcast is supported by: Guerbet --- SYNPOSIS Dr. Ahmed and Dr. Padia debate their approaches to patient selection criteria, the use of MRI and cone beam CT, permanent vs. resorbable embolic materials, how many arteries to embolize, and the relevance of pain metrics post GAE. They also delve into follow-up considerations and the potential for GAE as a long term treatment. --- TIMESTAMPS 00:00 Introduction 01:08 MRI for Patient Selection in GAE 08:53 Access Techniques: Femoral vs. Pedal 17:07 Cone Beam CT in GAE Procedures 27:20 Embolization Strategies 39:30 Challenges and Complications in Embolization 44:50 Follow-Up and Pain Metrics in Clinical Practice and Research 01:06:30 Repeat GAE Procedures: When and Why? 01:11:13 Post-Total Knee Replacement and GAE 01:21:01 Advice for IRs Looking to do GAE 01:24:32 Conclusion and Final Thoughts --- RESOURCES GENESIS Trial: https://pubmed.ncbi.nlm.nih.gov/33474601/ Landers et al Trial: https://pubmed.ncbi.nlm.nih.gov/37051829/ Tue, 22 Apr 2025 06:00:00 -0000 full BackTable Who is the ultimate candidate for GAE, which technical approach is best, and how do you set your patients up for success? Tune into this week’s episode of BackTable to hear from interventional radiologists Dr. Osman Ahmed (University of Chicago Medicine) and Dr. Siddharth Padia (UCLA Health) as they discuss everything from patient selection to follow-up care, covering pre-procedure imaging, access, embolics, technical challenges, clinical data, and the future of genicular artery embolization. Who is the ultimate candidate for GAE, which technical approach is best, and how do you set your patients up for success? Tune into this week’s episode of BackTable to hear from interventional radiologists Dr. Osman Ahmed (University of Chicago Medicine) and Dr. Siddharth Padia (UCLA Health) as they discuss everything from patient selection to follow-up care, covering pre-procedure imaging, access, embolics, technical challenges, clinical data, and the future of genicular artery embolization. --- This podcast is supported by: Guerbet --- SYNPOSIS Dr. Ahmed and Dr. Padia debate their approaches to patient selection criteria, the use of MRI and cone beam CT, permanent vs. resorbable embolic materials, how many arteries to embolize, and the relevance of pain metrics post GAE. They also delve into follow-up considerations and the potential for GAE as a long term treatment. --- TIMESTAMPS 00:00 Introduction 01:08 MRI for Patient Selection in GAE 08:53 Access Techniques: Femoral vs. Pedal 17:07 Cone Beam CT in GAE Procedures 27:20 Embolization Strategies 39:30 Challenges and Complications in Embolization 44:50 Follow-Up and Pain Metrics in Clinical Practice and Research 01:06:30 Repeat GAE Procedures: When and Why? 01:11:13 Post-Total Knee Replacement and GAE 01:21:01 Advice for IRs Looking to do GAE 01:24:32 Conclusion and Final Thoughts --- RESOURCES GENESIS Trial: https://pubmed.ncbi.nlm.nih.gov/33474601/ Landers et al Trial: https://pubmed.ncbi.nlm.nih.gov/37051829/ Who is the ultimate candidate for GAE, which technical approach is best, and how do you set your patients up for success? Tune into this week’s episode of BackTable to hear from interventional radiologists Dr. Osman Ahmed (University of Chicago Medicine) and Dr. Siddharth Padia (UCLA Health) as they discuss everything from patient selection to follow-up care, covering pre-procedure imaging, access, embolics, technical challenges, clinical data, and the future of genicular artery embolization.


---


This podcast is supported by:


Guerbet



---


SYNPOSIS


Dr. Ahmed and Dr. Padia debate their approaches to patient selection criteria, the use of MRI and cone beam CT, permanent vs. resorbable embolic materials, how many arteries to embolize, and the relevance of pain metrics post GAE. They also delve into follow-up considerations and the potential for GAE as a long term treatment.


---


TIMESTAMPS


00:00 Introduction

01:08 MRI for Patient Selection in GAE

08:53 Access Techniques: Femoral vs. Pedal

17:07 Cone Beam CT in GAE Procedures

27:20 Embolization Strategies

39:30 Challenges and Complications in Embolization

44:50 Follow-Up and Pain Metrics in Clinical Practice and Research

01:06:30 Repeat GAE Procedures: When and Why?

01:11:13 Post-Total Knee Replacement and GAE

01:21:01 Advice for IRs Looking to do GAE

01:24:32 Conclusion and Final Thoughts



---


RESOURCES


GENESIS Trial: https://pubmed.ncbi.nlm.nih.gov/33474601/

Landers et al Trial: https://pubmed.ncbi.nlm.nih.gov/37051829/

]]> 5323 Ep. 74 Diagnosis and Treatment of Tarlov Cysts with Dr. Kieran Murphy Attention radiologists: Were you trained to look for Tarlov cysts when reading spine MRI? In this episode of Backtable MSK, interventional neuroradiologist Dr. Kieran Murphy joins the studio to discuss the serious issue of chronic pain related to Tarlov cysts, a condition often overlooked in both diagnosis and treatment. Tarlov cysts, also known as perineural cysts, are fluid-filled sacs that form due to the dilation of the subarachnoid space around spinal nerve roots, most commonly at the base of the spine. --- SYNPOSIS Dr. Murphy highlights the high risk of depression and suicide among patients, who are often misdiagnosed and overprescribed ineffective pain medications. He explains how to identify and treat Tarlov cysts through aspiration and fibrin sealing, addresses the historical dismissal of their significance, and underscores the need for a better understanding of CSF leaks. Additionally, Dr. Murphy emphasizes the importance of institutional responsibility in occupational radiation safety for interventionalists, advocating for improved lead protection and antioxidant use to mitigate radiation damage. The episode concludes with a humbling reminder of the implicit biases present in medical practice and the ongoing need for more inclusive and attentive patient care. --- TIMESTAMPS 00:00 - Introduction 01:24 - Challenges in Diagnosing and Treating Tarlov Cysts 04:05 - Patient Experiences and Misdiagnoses 06:06 - Cyst Aspiration Techniques 15:12 - Improved Diagnosis of CSF Abnormalities 22:10 - Allergic Reactions to Fibrin 25:30 - Implicit Bias in Medicine 34:50 - Radiation Safety in Radiology 43:47 - Final Thoughts and Reflections Tue, 08 Apr 2025 06:00:00 -0000 full BackTable Attention radiologists: Were you trained to look for Tarlov cysts when reading spine MRI? In this episode of Backtable MSK, interventional neuroradiologist Dr. Kieran Murphy joins the studio to discuss the serious issue of chronic pain related to Tarlov cysts, a condition often overlooked in both diagnosis and treatment. Tarlov cysts, also known as perineural cysts, are fluid-filled sacs that form due to the dilation of the subarachnoid space around spinal nerve roots, most commonly at the base of the spine. Attention radiologists: Were you trained to look for Tarlov cysts when reading spine MRI? In this episode of Backtable MSK, interventional neuroradiologist Dr. Kieran Murphy joins the studio to discuss the serious issue of chronic pain related to Tarlov cysts, a condition often overlooked in both diagnosis and treatment. Tarlov cysts, also known as perineural cysts, are fluid-filled sacs that form due to the dilation of the subarachnoid space around spinal nerve roots, most commonly at the base of the spine. --- SYNPOSIS Dr. Murphy highlights the high risk of depression and suicide among patients, who are often misdiagnosed and overprescribed ineffective pain medications. He explains how to identify and treat Tarlov cysts through aspiration and fibrin sealing, addresses the historical dismissal of their significance, and underscores the need for a better understanding of CSF leaks. Additionally, Dr. Murphy emphasizes the importance of institutional responsibility in occupational radiation safety for interventionalists, advocating for improved lead protection and antioxidant use to mitigate radiation damage. The episode concludes with a humbling reminder of the implicit biases present in medical practice and the ongoing need for more inclusive and attentive patient care. --- TIMESTAMPS 00:00 - Introduction 01:24 - Challenges in Diagnosing and Treating Tarlov Cysts 04:05 - Patient Experiences and Misdiagnoses 06:06 - Cyst Aspiration Techniques 15:12 - Improved Diagnosis of CSF Abnormalities 22:10 - Allergic Reactions to Fibrin 25:30 - Implicit Bias in Medicine 34:50 - Radiation Safety in Radiology 43:47 - Final Thoughts and Reflections Attention radiologists: Were you trained to look for Tarlov cysts when reading spine MRI? In this episode of Backtable MSK, interventional neuroradiologist Dr. Kieran Murphy joins the studio to discuss the serious issue of chronic pain related to Tarlov cysts, a condition often overlooked in both diagnosis and treatment. Tarlov cysts, also known as perineural cysts, are fluid-filled sacs that form due to the dilation of the subarachnoid space around spinal nerve roots, most commonly at the base of the spine.


---


SYNPOSIS


Dr. Murphy highlights the high risk of depression and suicide among patients, who are often misdiagnosed and overprescribed ineffective pain medications. He explains how to identify and treat Tarlov cysts through aspiration and fibrin sealing, addresses the historical dismissal of their significance, and underscores the need for a better understanding of CSF leaks. Additionally, Dr. Murphy emphasizes the importance of institutional responsibility in occupational radiation safety for interventionalists, advocating for improved lead protection and antioxidant use to mitigate radiation damage. The episode concludes with a humbling reminder of the implicit biases present in medical practice and the ongoing need for more inclusive and attentive patient care.


---


TIMESTAMPS


00:00 - Introduction

01:24 - Challenges in Diagnosing and Treating Tarlov Cysts

04:05 - Patient Experiences and Misdiagnoses

06:06 - Cyst Aspiration Techniques

15:12 - Improved Diagnosis of CSF Abnormalities

22:10 - Allergic Reactions to Fibrin

25:30 - Implicit Bias in Medicine

34:50 - Radiation Safety in Radiology

43:47 - Final Thoughts and Reflections

]]> 2865 Ep. 73 Understanding Basivertebral Nerve Ablation (BVNA) with Dr. Asad Baig You asked, and we delivered – here’s a comprehensive episode on Basivertebral Nerve Ablation (BVNA) for vertebrogenic lumbar pain! In this episode of Backtable MSK, our host Dr. Christopher Beck is joined by Dr. Asad Baig, Director of Interventional Spine at Columbia University, to discuss BVNA patient selection and procedural techniques. --- SYNPOSIS Dr. Baig begins by sharing his journey from residency to his current role, including his initial exposure to spine procedures and the mentors who guided him. He offers examples of his workup for back pain, covering detailed patient history and key MRI findings. Dr. Baig emphasizes the importance of understanding risks and alternatives, as well as how to effectively counsel patients on these topics. Additionally, he walks through the BVNA procedure and shares his technical pearls. The episode concludes with Dr. Baig highlighting valuable resources for those interested in starting BVNA procedures and recognizing the supporting role of industry partners. --- TIMESTAMPS 00:00 - Introduction 10:14 - Patient Selection for BVNA 14:45 - Imaging Findings 19:38 - Consent Process and Risks 22:18 - Procedural Technique 28:32 - Sedation and Pain Management 34:03 - Post-Procedure Care and Follow-Up 37:09 - Challenges and Troubleshooting 40:34 - Resources and Mentorship Tue, 25 Mar 2025 06:00:00 -0000 full BackTable You asked, and we delivered – here’s a comprehensive episode on Basivertebral Nerve Ablation (BVNA) for vertebrogenic lumbar pain! In this episode of Backtable MSK, our host Dr. Christopher Beck is joined by Dr. Asad Baig, Director of Interventional Spine at Columbia University, to discuss BVNA patient selection and procedural techniques. You asked, and we delivered – here’s a comprehensive episode on Basivertebral Nerve Ablation (BVNA) for vertebrogenic lumbar pain! In this episode of Backtable MSK, our host Dr. Christopher Beck is joined by Dr. Asad Baig, Director of Interventional Spine at Columbia University, to discuss BVNA patient selection and procedural techniques. --- SYNPOSIS Dr. Baig begins by sharing his journey from residency to his current role, including his initial exposure to spine procedures and the mentors who guided him. He offers examples of his workup for back pain, covering detailed patient history and key MRI findings. Dr. Baig emphasizes the importance of understanding risks and alternatives, as well as how to effectively counsel patients on these topics. Additionally, he walks through the BVNA procedure and shares his technical pearls. The episode concludes with Dr. Baig highlighting valuable resources for those interested in starting BVNA procedures and recognizing the supporting role of industry partners. --- TIMESTAMPS 00:00 - Introduction 10:14 - Patient Selection for BVNA 14:45 - Imaging Findings 19:38 - Consent Process and Risks 22:18 - Procedural Technique 28:32 - Sedation and Pain Management 34:03 - Post-Procedure Care and Follow-Up 37:09 - Challenges and Troubleshooting 40:34 - Resources and Mentorship You asked, and we delivered – here’s a comprehensive episode on Basivertebral Nerve Ablation (BVNA) for vertebrogenic lumbar pain! In this episode of Backtable MSK, our host Dr. Christopher Beck is joined by Dr. Asad Baig, Director of Interventional Spine at Columbia University, to discuss BVNA patient selection and procedural techniques.



---


SYNPOSIS


Dr. Baig begins by sharing his journey from residency to his current role, including his initial exposure to spine procedures and the mentors who guided him. He offers examples of his workup for back pain, covering detailed patient history and key MRI findings. Dr. Baig emphasizes the importance of understanding risks and alternatives, as well as how to effectively counsel patients on these topics. Additionally, he walks through the BVNA procedure and shares his technical pearls.


The episode concludes with Dr. Baig highlighting valuable resources for those interested in starting BVNA procedures and recognizing the supporting role of industry partners.



---


TIMESTAMPS


00:00 - Introduction

10:14 - Patient Selection for BVNA

14:45 - Imaging Findings

19:38 - Consent Process and Risks

22:18 - Procedural Technique

28:32 - Sedation and Pain Management

34:03 - Post-Procedure Care and Follow-Up

37:09 - Challenges and Troubleshooting

40:34 - Resources and Mentorship

]]> 2823 Ep. 72 Vertebral Augmentation: Demystifying the Data with Dr. Josh Hirsch We’ve had many discussions about the technical aspects of vertebroplasty and kyphoplasty on BackTable MSK. However, in this episode, we take a deeper look into the history of these procedures, exploring early research controversies and the challenges that threatened their existence. Our host, Dr. Jacob Fleming, is joined in the BackTable Studio by interventional neuroradiologist Dr. Joshua Hirsch, who was in San Diego for the ASSR 2025 meeting. Dr. Hirsch is the Chief of the Interventional Spine Service at Massachusetts General Hospital. --- This podcast is supported by: Medtronic MVP https://www.medtronic.com/en-us/healthcare-professionals/products/spinal-orthopedic.html#aq=%40pagetype%3D%22product-model%22&cq=%40products_category%3D%22Spinal%20and%20orthopedic%22%20OR%20%40ontology_isa%3D%22Spinal%20and%20orthopedic%22 --- SYNPOSIS Dr. Hirsch begins by outlining the historical origins of radiologists using cement injection and how this practice evolved into vertebroplasty. He then highlights early research on the procedure, focusing on key 2009 NEJM papers that sparked both scientific and public controversy, leading to setbacks in research and disparities in access to life-changing care. Since that time, newer studies have demonstrated the clear benefits of spinal augmentation for patients with vertebral insufficiency fractures, including Dr. Hirsch’s own research showing a mortality benefit compared to nonsurgical treatment. Overall, the doctors discuss how far this field has advanced and the exciting developments currently in progress. --- TIMESTAMPS 00:00 - Introduction 03:09 - Historical Origins of Vertebroplasty 07:08 - Development and Evolution of Vertebroplasty 10:21 - Controversy Over 2009 Randomized Control Trials 16:35 - Disparities in Access to Vertebroplasty 21:01 - Dr. Hirsch’s Research on Mortality Benefit of Vertebroplasty 32:31 - Opportunities for Patient Education 35:29 - Vertebroplasty vs. Kyphoplasty 37:34 - Challenges in Research Interpretations and Insurance Coverage 42:26 - Future Directions in Vertebral Augmentation --- RESOURCES Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects (Jensen et al, 1997): https://pmc.ncbi.nlm.nih.gov/articles/PMC8337380/ Simplicity of randomized, controlled trials of percutaneous vertebroplasty (Hirsch et al, 2003): https://pubmed.ncbi.nlm.nih.gov/16880881/ INvestigational Vertebroplasty Efficacy and Safety Trial (INVEST): a randomized controlled trial of percutaneous vertebroplasty (Gray et al, 2007): https://pubmed.ncbi.nlm.nih.gov/18096050/ A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures (Buchbinder et al, 2009): https://pubmed.ncbi.nlm.nih.gov/19657121/ A Randomized Trial of Balloon Kyphoplasty and Nonsurgical Management for Treating Acute Vertebral Compression Fractures (FREE) (Meirhaeghe et al, 2013): https://pmc.ncbi.nlm.nih.gov/articles/PMC3678891/ A Randomized Trial of Vertebroplasty for Osteoporotic Spinal Fractures (Kallmes et al, 2009): https://www.nejm.org/doi/full/10.1056/NEJMoa0900563 A Randomized Trial of Epidural Glucocorticoid Injections for Spinal Stenosis (Friedly et al, 2014): https://www.nejm.org/doi/full/10.1056/NEJMoa1313265 Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial (Clark et al, 2016): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31341-1/abstract Number Needed to Treat with Vertebral Augmentation to Save a Life (Hirsch et al, 2020): https://pmc.ncbi.nlm.nih.gov/articles/PMC6975314/ Major Medical Outcomes With Spinal Augmentation vs Conservative Therapy (McCullough et al, 2013): https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1710123 Harvey L. Neiman Policy Institute: https://www.neimanhpi.org/ Tue, 18 Mar 2025 06:00:00 -0000 full BackTable We’ve had many discussions about the technical aspects of vertebroplasty and kyphoplasty on BackTable MSK. However, in this episode, we take a deeper look into the history of these procedures, exploring early research controversies and the challenges that threatened their existence. Our host, Dr. Jacob Fleming, is joined in the BackTable Studio by interventional neuroradiologist Dr. Joshua Hirsch, who was in San Diego for the ASSR 2025 meeting. Dr. Hirsch is the Chief of the Interventional Spine Service at Massachusetts General Hospital. We’ve had many discussions about the technical aspects of vertebroplasty and kyphoplasty on BackTable MSK. However, in this episode, we take a deeper look into the history of these procedures, exploring early research controversies and the challenges that threatened their existence. Our host, Dr. Jacob Fleming, is joined in the BackTable Studio by interventional neuroradiologist Dr. Joshua Hirsch, who was in San Diego for the ASSR 2025 meeting. Dr. Hirsch is the Chief of the Interventional Spine Service at Massachusetts General Hospital. --- This podcast is supported by: Medtronic MVP https://www.medtronic.com/en-us/healthcare-professionals/products/spinal-orthopedic.html#aq=%40pagetype%3D%22product-model%22&cq=%40products_category%3D%22Spinal%20and%20orthopedic%22%20OR%20%40ontology_isa%3D%22Spinal%20and%20orthopedic%22 --- SYNPOSIS Dr. Hirsch begins by outlining the historical origins of radiologists using cement injection and how this practice evolved into vertebroplasty. He then highlights early research on the procedure, focusing on key 2009 NEJM papers that sparked both scientific and public controversy, leading to setbacks in research and disparities in access to life-changing care. Since that time, newer studies have demonstrated the clear benefits of spinal augmentation for patients with vertebral insufficiency fractures, including Dr. Hirsch’s own research showing a mortality benefit compared to nonsurgical treatment. Overall, the doctors discuss how far this field has advanced and the exciting developments currently in progress. --- TIMESTAMPS 00:00 - Introduction 03:09 - Historical Origins of Vertebroplasty 07:08 - Development and Evolution of Vertebroplasty 10:21 - Controversy Over 2009 Randomized Control Trials 16:35 - Disparities in Access to Vertebroplasty 21:01 - Dr. Hirsch’s Research on Mortality Benefit of Vertebroplasty 32:31 - Opportunities for Patient Education 35:29 - Vertebroplasty vs. Kyphoplasty 37:34 - Challenges in Research Interpretations and Insurance Coverage 42:26 - Future Directions in Vertebral Augmentation --- RESOURCES Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects (Jensen et al, 1997): https://pmc.ncbi.nlm.nih.gov/articles/PMC8337380/ Simplicity of randomized, controlled trials of percutaneous vertebroplasty (Hirsch et al, 2003): https://pubmed.ncbi.nlm.nih.gov/16880881/ INvestigational Vertebroplasty Efficacy and Safety Trial (INVEST): a randomized controlled trial of percutaneous vertebroplasty (Gray et al, 2007): https://pubmed.ncbi.nlm.nih.gov/18096050/ A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures (Buchbinder et al, 2009): https://pubmed.ncbi.nlm.nih.gov/19657121/ A Randomized Trial of Balloon Kyphoplasty and Nonsurgical Management for Treating Acute Vertebral Compression Fractures (FREE) (Meirhaeghe et al, 2013): https://pmc.ncbi.nlm.nih.gov/articles/PMC3678891/ A Randomized Trial of Vertebroplasty for Osteoporotic Spinal Fractures (Kallmes et al, 2009): https://www.nejm.org/doi/full/10.1056/NEJMoa0900563 A Randomized Trial of Epidural Glucocorticoid Injections for Spinal Stenosis (Friedly et al, 2014): https://www.nejm.org/doi/full/10.1056/NEJMoa1313265 Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial (Clark et al, 2016): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31341-1/abstract Number Needed to Treat with Vertebral Augmentation to Save a Life (Hirsch et al, 2020): https://pmc.ncbi.nlm.nih.gov/articles/PMC6975314/ Major Medical Outcomes With Spinal Augmentation vs Conservative Therapy (McCullough et al, 2013): https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1710123 Harvey L. Neiman Policy Institute: https://www.neimanhpi.org/ We’ve had many discussions about the technical aspects of vertebroplasty and kyphoplasty on BackTable MSK. However, in this episode, we take a deeper look into the history of these procedures, exploring early research controversies and the challenges that threatened their existence. Our host, Dr. Jacob Fleming, is joined in the BackTable Studio by interventional neuroradiologist Dr. Joshua Hirsch, who was in San Diego for the ASSR 2025 meeting. Dr. Hirsch is the Chief of the Interventional Spine Service at Massachusetts General Hospital.


---


This podcast is supported by:


Medtronic MVP

https://www.medtronic.com/en-us/healthcare-professionals/products/spinal-orthopedic.html#aq=%40pagetype%3D%22product-model%22&cq=%40products_category%3D%22Spinal%20and%20orthopedic%22%20OR%20%40ontology_isa%3D%22Spinal%20and%20orthopedic%22


---


SYNPOSIS


Dr. Hirsch begins by outlining the historical origins of radiologists using cement injection and how this practice evolved into vertebroplasty. He then highlights early research on the procedure, focusing on key 2009 NEJM papers that sparked both scientific and public controversy, leading to setbacks in research and disparities in access to life-changing care. Since that time, newer studies have demonstrated the clear benefits of spinal augmentation for patients with vertebral insufficiency fractures, including Dr. Hirsch’s own research showing a mortality benefit compared to nonsurgical treatment. Overall, the doctors discuss how far this field has advanced and the exciting developments currently in progress.


---


TIMESTAMPS


00:00 - Introduction

03:09 - Historical Origins of Vertebroplasty

07:08 - Development and Evolution of Vertebroplasty

10:21 - Controversy Over 2009 Randomized Control Trials

16:35 - Disparities in Access to Vertebroplasty

21:01 - Dr. Hirsch’s Research on Mortality Benefit of Vertebroplasty

32:31 - Opportunities for Patient Education

35:29 - Vertebroplasty vs. Kyphoplasty

37:34 - Challenges in Research Interpretations and Insurance Coverage

42:26 - Future Directions in Vertebral Augmentation



---


RESOURCES


Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects (Jensen et al, 1997):

https://pmc.ncbi.nlm.nih.gov/articles/PMC8337380/


Simplicity of randomized, controlled trials of percutaneous vertebroplasty (Hirsch et al, 2003):

https://pubmed.ncbi.nlm.nih.gov/16880881/


INvestigational Vertebroplasty Efficacy and Safety Trial (INVEST): a randomized controlled trial of percutaneous vertebroplasty (Gray et al, 2007):

https://pubmed.ncbi.nlm.nih.gov/18096050/


A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures (Buchbinder et al, 2009):

https://pubmed.ncbi.nlm.nih.gov/19657121/


A Randomized Trial of Balloon Kyphoplasty and Nonsurgical Management for Treating Acute Vertebral Compression Fractures (FREE) (Meirhaeghe et al, 2013):

https://pmc.ncbi.nlm.nih.gov/articles/PMC3678891/


A Randomized Trial of Vertebroplasty for Osteoporotic Spinal Fractures (Kallmes et al, 2009):

https://www.nejm.org/doi/full/10.1056/NEJMoa0900563


A Randomized Trial of Epidural Glucocorticoid Injections for Spinal Stenosis (Friedly et al, 2014):

https://www.nejm.org/doi/full/10.1056/NEJMoa1313265


Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial (Clark et al, 2016):

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31341-1/abstract


Number Needed to Treat with Vertebral Augmentation to Save a Life (Hirsch et al, 2020):

https://pmc.ncbi.nlm.nih.gov/articles/PMC6975314/


Major Medical Outcomes With Spinal Augmentation vs Conservative Therapy (McCullough et al, 2013):

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1710123


Harvey L. Neiman Policy Institute:

https://www.neimanhpi.org/

]]> 3258 Ep. 71 Genicular Nerve Ablation Insights: Techniques and Data with Dr. John Smirniotopoulos Dr. John Smirniotopoulos, an interventional radiologist at Georgetown/MedStar Washington Hospital Center, discusses the intricacies of genicular nerve ablation (GNA) for pain management in patients with osteoarthritis and post-surgical knee pain. He delves into the history and evolution of GNA, outlines the neurovascular anatomy, and explains his specific rationale for targeting various nerves for ablation. --- SYNPOSIS Dr. Smirniotopoulos also compares GNA with other procedures such as corticosteroid injections, hyaluronic acid injections, and genicular artery embolization (GAE). He emphasizes the importance of managing patient expectations, the role of physical therapy, and explores different modalities of GNA, including the use of cryoablation versus radiofrequency technology. The episode offers a comprehensive overview of expert insights for evaluating knee pain and performing effective GNA. --- TIMESTAMPS 00:00 - Introduction 03:13 - Understanding Genicular Nerve Anatomy 12:06 - Tailoring GNA Treatment to Each Patient 22:39 - Comparing Ablation Devices and Methods 28:06 - GNA in Surgical and Post-Traumatic Patients 33:19 - Patient-Centered Decision Making 38:50 - Evaluating Functional Outcomes 43:39 - Comparing Treatment Modalities 49:34 - Post-Procedure Counseling and Expectations 58:40 - Future Directions in GNA Research --- RESOURCES Safety and efficacy comparison of three- vs four-needle technique in the management of moderate to severe osteoarthritis of the knee using cooled radiofrequency ablation (Wong, et al 2021): https://pubmed.ncbi.nlm.nih.gov/32968824/ Tue, 11 Mar 2025 06:00:00 -0000 full BackTable In this episode of Backtable MSK, Dr. John Smirniotopoulos, an interventional radiologist at Georgetown/MedStar Washington Hospital Center, discusses the intricacies of genicular nerve ablation (GNA) for pain management in patients with osteoarthritis and post-surgical knee pain. He delves into the history and evolution of GNA, outlines the neurovascular anatomy, and explains his specific rationale for targeting various nerves for ablation. Dr. John Smirniotopoulos, an interventional radiologist at Georgetown/MedStar Washington Hospital Center, discusses the intricacies of genicular nerve ablation (GNA) for pain management in patients with osteoarthritis and post-surgical knee pain. He delves into the history and evolution of GNA, outlines the neurovascular anatomy, and explains his specific rationale for targeting various nerves for ablation. --- SYNPOSIS Dr. Smirniotopoulos also compares GNA with other procedures such as corticosteroid injections, hyaluronic acid injections, and genicular artery embolization (GAE). He emphasizes the importance of managing patient expectations, the role of physical therapy, and explores different modalities of GNA, including the use of cryoablation versus radiofrequency technology. The episode offers a comprehensive overview of expert insights for evaluating knee pain and performing effective GNA. --- TIMESTAMPS 00:00 - Introduction 03:13 - Understanding Genicular Nerve Anatomy 12:06 - Tailoring GNA Treatment to Each Patient 22:39 - Comparing Ablation Devices and Methods 28:06 - GNA in Surgical and Post-Traumatic Patients 33:19 - Patient-Centered Decision Making 38:50 - Evaluating Functional Outcomes 43:39 - Comparing Treatment Modalities 49:34 - Post-Procedure Counseling and Expectations 58:40 - Future Directions in GNA Research --- RESOURCES Safety and efficacy comparison of three- vs four-needle technique in the management of moderate to severe osteoarthritis of the knee using cooled radiofrequency ablation (Wong, et al 2021): https://pubmed.ncbi.nlm.nih.gov/32968824/ Dr. John Smirniotopoulos, an interventional radiologist at Georgetown/MedStar Washington Hospital Center, discusses the intricacies of genicular nerve ablation (GNA) for pain management in patients with osteoarthritis and post-surgical knee pain. He delves into the history and evolution of GNA, outlines the neurovascular anatomy, and explains his specific rationale for targeting various nerves for ablation.


---


SYNPOSIS


Dr. Smirniotopoulos also compares GNA with other procedures such as corticosteroid injections, hyaluronic acid injections, and genicular artery embolization (GAE). He emphasizes the importance of managing patient expectations, the role of physical therapy, and explores different modalities of GNA, including the use of cryoablation versus radiofrequency technology. The episode offers a comprehensive overview of expert insights for evaluating knee pain and performing effective GNA.


---


TIMESTAMPS


00:00 - Introduction

03:13 - Understanding Genicular Nerve Anatomy

12:06 - Tailoring GNA Treatment to Each Patient

22:39 - Comparing Ablation Devices and Methods

28:06 - GNA in Surgical and Post-Traumatic Patients

33:19 - Patient-Centered Decision Making

38:50 - Evaluating Functional Outcomes

43:39 - Comparing Treatment Modalities

49:34 - Post-Procedure Counseling and Expectations

58:40 - Future Directions in GNA Research


---


RESOURCES


Safety and efficacy comparison of three- vs four-needle technique in the management of moderate to severe osteoarthritis of the knee using cooled radiofrequency ablation (Wong, et al 2021):

https://pubmed.ncbi.nlm.nih.gov/32968824/

]]> 3812 Ep. 70 Frontiers in Musculoskeletal Embolization with Dr. Yuji Okuno Musculoskeletal embolization is generating significant excitement in the field of chronic pain management. In this episode, Dr. Jacob Fleming hosts a discussion with Dr. Yuji Okuno from Japan, a pioneer in both basic science and clinical practice within the field of musculoskeletal embolization. --- This podcast is supported by: Medtronic MVP https://www.medtronic.com/mvp --- SYNPOSIS The conversation delves into Dr. Okuno's groundbreaking work using embolization to treat chronic pain from conditions such as frozen shoulder, knee osteoarthritis, plantar fasciitis, and various sports injuries. Dr. Okuno discusses the development of new temporary embolic agents and compares different approaches to embolization treatments, including the innovative use of antibiotics as embolic material. The doctors also cover the intriguing concept of differential recanalization, where abnormal inflammatory vessels are less likely to recanalize than normal vessels after embolic treatment. Identifying hypervascularity through MRI, ultrasound, or angiogram is a crucial step before attempting embolization. Overall, Dr. Okuno offers valuable insights into his clinical practice and the potential for groundbreaking advancements in musculoskeletal care worldwide. --- TIMESTAMPS 00:00 - Introduction 01:54 - Origins of Embolization for Pain 04:15 - Basic Science Research Discoveries and Clinical Trials 09:02 - Temporary Embolic Materials 15:28 - Techniques for Embolization 17:33 - Plantar Fasciitis Treatment 24:04 - Future of Embolization in Sports Injuries 28:11 - Diagnostic Imaging in Embolization 36:10 - Global Expansion and Collaborations Tue, 25 Feb 2025 07:00:00 -0000 full BackTable Musculoskeletal embolization is generating significant excitement in the field of chronic pain management. In this episode, Dr. Jacob Fleming hosts a discussion with Dr. Yuji Okuno from Japan, a pioneer in both basic science and clinical practice within the field of musculoskeletal embolization. Musculoskeletal embolization is generating significant excitement in the field of chronic pain management. In this episode, Dr. Jacob Fleming hosts a discussion with Dr. Yuji Okuno from Japan, a pioneer in both basic science and clinical practice within the field of musculoskeletal embolization. --- This podcast is supported by: Medtronic MVP https://www.medtronic.com/mvp --- SYNPOSIS The conversation delves into Dr. Okuno's groundbreaking work using embolization to treat chronic pain from conditions such as frozen shoulder, knee osteoarthritis, plantar fasciitis, and various sports injuries. Dr. Okuno discusses the development of new temporary embolic agents and compares different approaches to embolization treatments, including the innovative use of antibiotics as embolic material. The doctors also cover the intriguing concept of differential recanalization, where abnormal inflammatory vessels are less likely to recanalize than normal vessels after embolic treatment. Identifying hypervascularity through MRI, ultrasound, or angiogram is a crucial step before attempting embolization. Overall, Dr. Okuno offers valuable insights into his clinical practice and the potential for groundbreaking advancements in musculoskeletal care worldwide. --- TIMESTAMPS 00:00 - Introduction 01:54 - Origins of Embolization for Pain 04:15 - Basic Science Research Discoveries and Clinical Trials 09:02 - Temporary Embolic Materials 15:28 - Techniques for Embolization 17:33 - Plantar Fasciitis Treatment 24:04 - Future of Embolization in Sports Injuries 28:11 - Diagnostic Imaging in Embolization 36:10 - Global Expansion and Collaborations Musculoskeletal embolization is generating significant excitement in the field of chronic pain management. In this episode, Dr. Jacob Fleming hosts a discussion with Dr. Yuji Okuno from Japan, a pioneer in both basic science and clinical practice within the field of musculoskeletal embolization.


---


This podcast is supported by:


Medtronic MVP

https://www.medtronic.com/mvp


---


SYNPOSIS


The conversation delves into Dr. Okuno's groundbreaking work using embolization to treat chronic pain from conditions such as frozen shoulder, knee osteoarthritis, plantar fasciitis, and various sports injuries. Dr. Okuno discusses the development of new temporary embolic agents and compares different approaches to embolization treatments, including the innovative use of antibiotics as embolic material. The doctors also cover the intriguing concept of differential recanalization, where abnormal inflammatory vessels are less likely to recanalize than normal vessels after embolic treatment. Identifying hypervascularity through MRI, ultrasound, or angiogram is a crucial step before attempting embolization.


Overall, Dr. Okuno offers valuable insights into his clinical practice and the potential for groundbreaking advancements in musculoskeletal care worldwide.



---


TIMESTAMPS


00:00 - Introduction

01:54 - Origins of Embolization for Pain

04:15 - Basic Science Research Discoveries and Clinical Trials

09:02 - Temporary Embolic Materials

15:28 - Techniques for Embolization

17:33 - Plantar Fasciitis Treatment

24:04 - Future of Embolization in Sports Injuries

28:11 - Diagnostic Imaging in Embolization

36:10 - Global Expansion and Collaborations

]]> 2382 Ep. 69 Intradiscal Augmentation and Frontiers in Back Pain Treatment with Dr. Olivier Clerk Vertebral augmentation for degenerative disc disease has traditionally been performed using cement injections. However, new biomaterials are emerging that may offer more precise targeting of the vertebral discs, potentially leading to higher patient satisfaction. In this episode of Backtable MSK, Dr. Olivier Clerk-Lamalice discusses significant advances in the treatment of degenerative disc disease, with a particular focus on disc augmentation using intradiscal hydrogel. This episode marks the third and final installment in our series on degenerative disc disease with Dr. Clerk-Lamalice. --- This podcast is supported by: Medtronic Interventional https://www.medtronic.com/interventional --- SYNPOSIS Dr. Clerk-Lamalice begins by exploring the history of hydrogel use for degenerative disc disease, highlighting the different iterations of this biomaterial. As an experienced practitioner in this field, he shares valuable tips on injection volume and technique. His work is especially meaningful to him because the procedure provides significant pain relief for patients. The doctors also delve into patient selection criteria and ongoing clinical trials aimed at obtaining FDA approval in North America. Additionally, the episode offers a preview of the upcoming GRIBOI conference, which will focus on the use of injectable osteoarticular biomaterials in bone augmentation. --- TIMESTAMPS 00:00 - Introduction 02:28 - History and Current Use of Intradiscal Hydrogel 07:19 - Technical Insights for Injection 12:51 - Clinical Outcomes and Patient Satisfaction 15:33 - Ongoing FDA Clinical Trials 16:38 - Future Research and GRIBOI Conference Details --- RESOURCES BackTable MSK Ep. 67- Introduction to the Treatment of Discogenic Back Pain: https://www.backtable.com/shows/msk/podcasts/67/introduction-to-treatment-of-discogenic-back-pain BackTable MSK Ep. 68- BackTable Basics: Lumbar Access and Discography https://www.backtable.com/shows/msk/podcasts/68/backtable-basics-lumbar-disc-access-discography GRIBOI Conference: https://www.griboi.org/annualconference Hydrogel Augmentation of the Lumbar Intervertebral Disc: An Early Feasibility Study of a Treatment for Discogenic Low Back Pain (Beal et al, 2024): https://www.jvir.org/article/S1051-0443(23)00694-2/fulltext Tue, 18 Feb 2025 07:00:00 -0000 full BackTable Vertebral augmentation for degenerative disc disease has traditionally been performed using cement injections. However, new biomaterials are emerging that may offer more precise targeting of the vertebral discs, potentially leading to higher patient satisfaction. In this episode of Backtable MSK, Dr. Olivier Clerk-Lamalice discusses significant advances in the treatment of degenerative disc disease, with a particular focus on disc augmentation using intradiscal hydrogel. This episode marks the third and final installment in our series on degenerative disc disease with Dr. Clerk-Lamalice. Vertebral augmentation for degenerative disc disease has traditionally been performed using cement injections. However, new biomaterials are emerging that may offer more precise targeting of the vertebral discs, potentially leading to higher patient satisfaction. In this episode of Backtable MSK, Dr. Olivier Clerk-Lamalice discusses significant advances in the treatment of degenerative disc disease, with a particular focus on disc augmentation using intradiscal hydrogel. This episode marks the third and final installment in our series on degenerative disc disease with Dr. Clerk-Lamalice. --- This podcast is supported by: Medtronic Interventional https://www.medtronic.com/interventional --- SYNPOSIS Dr. Clerk-Lamalice begins by exploring the history of hydrogel use for degenerative disc disease, highlighting the different iterations of this biomaterial. As an experienced practitioner in this field, he shares valuable tips on injection volume and technique. His work is especially meaningful to him because the procedure provides significant pain relief for patients. The doctors also delve into patient selection criteria and ongoing clinical trials aimed at obtaining FDA approval in North America. Additionally, the episode offers a preview of the upcoming GRIBOI conference, which will focus on the use of injectable osteoarticular biomaterials in bone augmentation. --- TIMESTAMPS 00:00 - Introduction 02:28 - History and Current Use of Intradiscal Hydrogel 07:19 - Technical Insights for Injection 12:51 - Clinical Outcomes and Patient Satisfaction 15:33 - Ongoing FDA Clinical Trials 16:38 - Future Research and GRIBOI Conference Details --- RESOURCES BackTable MSK Ep. 67- Introduction to the Treatment of Discogenic Back Pain: https://www.backtable.com/shows/msk/podcasts/67/introduction-to-treatment-of-discogenic-back-pain BackTable MSK Ep. 68- BackTable Basics: Lumbar Access and Discography https://www.backtable.com/shows/msk/podcasts/68/backtable-basics-lumbar-disc-access-discography GRIBOI Conference: https://www.griboi.org/annualconference Hydrogel Augmentation of the Lumbar Intervertebral Disc: An Early Feasibility Study of a Treatment for Discogenic Low Back Pain (Beal et al, 2024): https://www.jvir.org/article/S1051-0443(23)00694-2/fulltext Vertebral augmentation for degenerative disc disease has traditionally been performed using cement injections. However, new biomaterials are emerging that may offer more precise targeting of the vertebral discs, potentially leading to higher patient satisfaction. In this episode of Backtable MSK, Dr. Olivier Clerk-Lamalice discusses significant advances in the treatment of degenerative disc disease, with a particular focus on disc augmentation using intradiscal hydrogel. This episode marks the third and final installment in our series on degenerative disc disease with Dr. Clerk-Lamalice.


---


This podcast is supported by:


Medtronic Interventional

https://www.medtronic.com/interventional


---


SYNPOSIS


Dr. Clerk-Lamalice begins by exploring the history of hydrogel use for degenerative disc disease, highlighting the different iterations of this biomaterial. As an experienced practitioner in this field, he shares valuable tips on injection volume and technique. His work is especially meaningful to him because the procedure provides significant pain relief for patients. The doctors also delve into patient selection criteria and ongoing clinical trials aimed at obtaining FDA approval in North America. Additionally, the episode offers a preview of the upcoming GRIBOI conference, which will focus on the use of injectable osteoarticular biomaterials in bone augmentation.


---


TIMESTAMPS


00:00 - Introduction

02:28 - History and Current Use of Intradiscal Hydrogel

07:19 - Technical Insights for Injection

12:51 - Clinical Outcomes and Patient Satisfaction

15:33 - Ongoing FDA Clinical Trials

16:38 - Future Research and GRIBOI Conference Details



---


RESOURCES


BackTable MSK Ep. 67- Introduction to the Treatment of Discogenic Back Pain:

https://www.backtable.com/shows/msk/podcasts/67/introduction-to-treatment-of-discogenic-back-pain


BackTable MSK Ep. 68- BackTable Basics: Lumbar Access and Discography

https://www.backtable.com/shows/msk/podcasts/68/backtable-basics-lumbar-disc-access-discography


GRIBOI Conference:

https://www.griboi.org/annualconference


Hydrogel Augmentation of the Lumbar Intervertebral Disc: An Early Feasibility Study of a Treatment for Discogenic Low Back Pain (Beal et al, 2024):

https://www.jvir.org/article/S1051-0443(23)00694-2/fulltext

]]> 1549 Ep. 68 BackTable Basics: Lumbar Disc Access and Discography with Dr. Olivier Clerk The lumbar discogram is a cornerstone of musculoskeletal (MSK) radiology, as it enables interventionalists to pinpoint the exact level of discogenic back pain. In this episode of Backtable MSK, the Dr. Olivier Clerk-Lamalice and host Dr. Jacob Fleming explore the techniques and applications of the discogram, a procedure highly valued for its effectiveness in both diagnosis and pain management. --- This podcast is supported by: Medtronic Interventional https://www.medtronic.com/interventional --- SYNPOSIS They discuss the fluoroscopically guided approach, focusing on techniques like Kambin’s triangle and the far-lateral approach. The doctors also cover their preferred contrast agents and injection methods, along with concurrent therapeutic injections. The conversation delves into the varied disc anatomies that require different approaches, including adjustments in needle angulation. They also emphasize the importance of prophylactic antibiotics, potential challenges, and the evolving landscape of therapeutic options, including intradiscal platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC). --- TIMESTAMPS 00:00 - Introduction 01:17 - Overview of Lumbar Discogram Technique 04:56 - Contrast Injection and Pain Response 07:40 - Therapeutic Injections 10:00 - Discography Under CT Guidance 12:43 - Strategies for Challenging Cases 17:52 - Protocol for Infection Prevention 20:15 - Post-Discogram Treatment Options 21:30 - Emerging Therapies --- RESOURCES BackTable MSK Ep. 68- Introduction to the Treatment of Discogenic Back Pain: https://www.backtable.com/shows/msk/podcasts/67/introduction-to-treatment-of-discogenic-back-pain BackTable MSK Ep. 62- Exploring Intradiscal PRP for Back Pain Relief with Dr. Guilherme Ferreira Dos Santos: https://www.backtable.com/shows/msk/podcasts/62/exploring-intradiscal-prp-for-back-pain-relief Tue, 11 Feb 2025 07:00:00 -0000 full BackTable The lumbar discogram is a cornerstone of musculoskeletal (MSK) radiology, as it enables interventionalists to pinpoint the exact level of discogenic back pain. In this episode of Backtable MSK, the Dr. Olivier Clerk-Lamalice and host Dr. Jacob Fleming explore the techniques and applications of the discogram, a procedure highly valued for its effectiveness in both diagnosis and pain management. The lumbar discogram is a cornerstone of musculoskeletal (MSK) radiology, as it enables interventionalists to pinpoint the exact level of discogenic back pain. In this episode of Backtable MSK, the Dr. Olivier Clerk-Lamalice and host Dr. Jacob Fleming explore the techniques and applications of the discogram, a procedure highly valued for its effectiveness in both diagnosis and pain management. --- This podcast is supported by: Medtronic Interventional https://www.medtronic.com/interventional --- SYNPOSIS They discuss the fluoroscopically guided approach, focusing on techniques like Kambin’s triangle and the far-lateral approach. The doctors also cover their preferred contrast agents and injection methods, along with concurrent therapeutic injections. The conversation delves into the varied disc anatomies that require different approaches, including adjustments in needle angulation. They also emphasize the importance of prophylactic antibiotics, potential challenges, and the evolving landscape of therapeutic options, including intradiscal platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC). --- TIMESTAMPS 00:00 - Introduction 01:17 - Overview of Lumbar Discogram Technique 04:56 - Contrast Injection and Pain Response 07:40 - Therapeutic Injections 10:00 - Discography Under CT Guidance 12:43 - Strategies for Challenging Cases 17:52 - Protocol for Infection Prevention 20:15 - Post-Discogram Treatment Options 21:30 - Emerging Therapies --- RESOURCES BackTable MSK Ep. 68- Introduction to the Treatment of Discogenic Back Pain: https://www.backtable.com/shows/msk/podcasts/67/introduction-to-treatment-of-discogenic-back-pain BackTable MSK Ep. 62- Exploring Intradiscal PRP for Back Pain Relief with Dr. Guilherme Ferreira Dos Santos: https://www.backtable.com/shows/msk/podcasts/62/exploring-intradiscal-prp-for-back-pain-relief The lumbar discogram is a cornerstone of musculoskeletal (MSK) radiology, as it enables interventionalists to pinpoint the exact level of discogenic back pain. In this episode of Backtable MSK, the Dr. Olivier Clerk-Lamalice and host Dr. Jacob Fleming explore the techniques and applications of the discogram, a procedure highly valued for its effectiveness in both diagnosis and pain management.


---


This podcast is supported by:


Medtronic Interventional

https://www.medtronic.com/interventional


---


SYNPOSIS


They discuss the fluoroscopically guided approach, focusing on techniques like Kambin’s triangle and the far-lateral approach. The doctors also cover their preferred contrast agents and injection methods, along with concurrent therapeutic injections.


The conversation delves into the varied disc anatomies that require different approaches, including adjustments in needle angulation. They also emphasize the importance of prophylactic antibiotics, potential challenges, and the evolving landscape of therapeutic options, including intradiscal platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC).



---


TIMESTAMPS


00:00 - Introduction

01:17 - Overview of Lumbar Discogram Technique

04:56 - Contrast Injection and Pain Response

07:40 - Therapeutic Injections

10:00 - Discography Under CT Guidance

12:43 - Strategies for Challenging Cases

17:52 - Protocol for Infection Prevention

20:15 - Post-Discogram Treatment Options

21:30 - Emerging Therapies


---


RESOURCES


BackTable MSK Ep. 68- Introduction to the Treatment of Discogenic Back Pain:

https://www.backtable.com/shows/msk/podcasts/67/introduction-to-treatment-of-discogenic-back-pain


BackTable MSK Ep. 62- Exploring Intradiscal PRP for Back Pain Relief with Dr. Guilherme Ferreira Dos Santos:

https://www.backtable.com/shows/msk/podcasts/62/exploring-intradiscal-prp-for-back-pain-relief

]]> 1656 Ep. 67 Introduction to Treatment of Discogenic Back Pain with Dr. Olivier Clerk-Lamalice Degenerative disc disease, a major cause of low back pain, is the most common musculoskeletal issue worldwide, affecting an estimated 15-30% of the population. In this episode of BackTable MSK, interventional radiologists Dr. Olivier Clerk-Lamalice and Dr. Jacob Fleming cover symptomatic degenerative disc disease, focusing on its diagnosis and treatment with anesthetic injections. This is the first episode in a two-part series on discogenic back pain. --- Get $100 off of your GRIBOI Conference registration using this link: www.eventbrite.com/e/1027273521757/?discount=BackDoorGRIBOIPromoCode Visit the GRIBOI website for special hotel rates, available until March 11, 2025: https://www.griboi.org/annualconference --- This podcast is supported by: Medtronic Interventional https://www.medtronic.com/interventional --- SYNPOSIS Dr. Clerk-Lamalice begins by explaining the pathophysiology of disc degeneration, which can lead to painful annular tears and loss of disc height. The doctors also reflect on the history of discography, from provocative discograms to the more recent anesthetic and CT discograms. They review the modified Dallas Discogram Classification for annular tears, the vacuum disc phenomenon, and the importance of dynamic imaging to assess treatment candidacy. Dr. Clerk-Lamalice emphasizes the need to correlate imaging with physical examination to better identify the symptomatic disc level. The episode also discusses the challenges of managing multi-level disc degeneration and underscores the importance of early-stage intervention. --- TIMESTAMPS 00:00 - Introduction 02:44 - Pathophysiology of Disc Degeneration 06:49 - Evolution of Discography 12:55 - Classification of Annular Tears 09:01 - Diagnostic Tools and Techniques 14:00 - CT Discogram and Annular Tear Classification 17:12 - Dynamic Aspects and Instability 22:20 - Identifying Symptomatic Disc Level 28:25 - Treatment Approaches and Patient Selection --- RESOURCES BackTable MSK Ep. 13- Basivertebral Nerve Ablation with Dr. Olivier Clerk-Lamalice: https://www.backtable.com/shows/msk/podcasts/13/basivertebral-nerve-ablation Modified Dallas Discogram Classification System: https://pubmed.ncbi.nlm.nih.gov/2954226/ Tue, 04 Feb 2025 07:00:00 -0000 full BackTable Degenerative disc disease, a major cause of low back pain, is the most common musculoskeletal issue worldwide, affecting an estimated 15-30% of the population. In this episode of BackTable MSK, interventional radiologists Dr. Olivier Clerk-Lamalice and Dr. Jacob Fleming cover symptomatic degenerative disc disease, focusing on its diagnosis and treatment with anesthetic injections. This is the first episode in a two-part series on discogenic back pain. Degenerative disc disease, a major cause of low back pain, is the most common musculoskeletal issue worldwide, affecting an estimated 15-30% of the population. In this episode of BackTable MSK, interventional radiologists Dr. Olivier Clerk-Lamalice and Dr. Jacob Fleming cover symptomatic degenerative disc disease, focusing on its diagnosis and treatment with anesthetic injections. This is the first episode in a two-part series on discogenic back pain. --- Get $100 off of your GRIBOI Conference registration using this link: www.eventbrite.com/e/1027273521757/?discount=BackDoorGRIBOIPromoCode Visit the GRIBOI website for special hotel rates, available until March 11, 2025: https://www.griboi.org/annualconference --- This podcast is supported by: Medtronic Interventional https://www.medtronic.com/interventional --- SYNPOSIS Dr. Clerk-Lamalice begins by explaining the pathophysiology of disc degeneration, which can lead to painful annular tears and loss of disc height. The doctors also reflect on the history of discography, from provocative discograms to the more recent anesthetic and CT discograms. They review the modified Dallas Discogram Classification for annular tears, the vacuum disc phenomenon, and the importance of dynamic imaging to assess treatment candidacy. Dr. Clerk-Lamalice emphasizes the need to correlate imaging with physical examination to better identify the symptomatic disc level. The episode also discusses the challenges of managing multi-level disc degeneration and underscores the importance of early-stage intervention. --- TIMESTAMPS 00:00 - Introduction 02:44 - Pathophysiology of Disc Degeneration 06:49 - Evolution of Discography 12:55 - Classification of Annular Tears 09:01 - Diagnostic Tools and Techniques 14:00 - CT Discogram and Annular Tear Classification 17:12 - Dynamic Aspects and Instability 22:20 - Identifying Symptomatic Disc Level 28:25 - Treatment Approaches and Patient Selection --- RESOURCES BackTable MSK Ep. 13- Basivertebral Nerve Ablation with Dr. Olivier Clerk-Lamalice: https://www.backtable.com/shows/msk/podcasts/13/basivertebral-nerve-ablation Modified Dallas Discogram Classification System: https://pubmed.ncbi.nlm.nih.gov/2954226/ Degenerative disc disease, a major cause of low back pain, is the most common musculoskeletal issue worldwide, affecting an estimated 15-30% of the population. In this episode of BackTable MSK, interventional radiologists Dr. Olivier Clerk-Lamalice and Dr. Jacob Fleming cover symptomatic degenerative disc disease, focusing on its diagnosis and treatment with anesthetic injections. This is the first episode in a two-part series on discogenic back pain.


---


Get $100 off of your GRIBOI Conference registration using this link:

www.eventbrite.com/e/1027273521757/?discount=BackDoorGRIBOIPromoCode


Visit the GRIBOI website for special hotel rates, available until March 11, 2025:

https://www.griboi.org/annualconference


---


This podcast is supported by:


Medtronic Interventional

https://www.medtronic.com/interventional


---


SYNPOSIS


Dr. Clerk-Lamalice begins by explaining the pathophysiology of disc degeneration, which can lead to painful annular tears and loss of disc height. The doctors also reflect on the history of discography, from provocative discograms to the more recent anesthetic and CT discograms. They review the modified Dallas Discogram Classification for annular tears, the vacuum disc phenomenon, and the importance of dynamic imaging to assess treatment candidacy. Dr. Clerk-Lamalice emphasizes the need to correlate imaging with physical examination to better identify the symptomatic disc level.


The episode also discusses the challenges of managing multi-level disc degeneration and underscores the importance of early-stage intervention.



---


TIMESTAMPS


00:00 - Introduction

02:44 - Pathophysiology of Disc Degeneration

06:49 - Evolution of Discography

12:55 - Classification of Annular Tears

09:01 - Diagnostic Tools and Techniques

14:00 - CT Discogram and Annular Tear Classification

17:12 - Dynamic Aspects and Instability

22:20 - Identifying Symptomatic Disc Level

28:25 - Treatment Approaches and Patient Selection



---


RESOURCES


BackTable MSK Ep. 13- Basivertebral Nerve Ablation with Dr. Olivier Clerk-Lamalice:

https://www.backtable.com/shows/msk/podcasts/13/basivertebral-nerve-ablation


Modified Dallas Discogram Classification System:

https://pubmed.ncbi.nlm.nih.gov/2954226/

]]> 2394 Ep. 66 Dr. Kieran Murphy on Creativity in Medicine Many physicians are perfectly positioned to recognize areas of clinical need, so why are so few of them involved in medical innovation? In this episode of BackTable MSK, Dr. Kieran Murphy discusses the ideal circumstances and critical characteristics of physician innovators. Dr. Murphy is an interventional neuroradiologist, a professor at the University of Toronto, and a medical device innovator who has made significant contributions to the field, including the development of the Murphy needle for vertebral augmentation. --- This podcast is supported by an educational grant from: Medtronic https://www.medtronic.com/ --- SYNPOSIS Dr. Murphy talks about his recent book, “The Essence of Invention: Medicine and the Joy of Creativity,” which chronicles key innovations in interventional radiology. The book focuses specifically on the characteristics and circumstances of the innovators themselves. Dr. Murphy became interested in this topic after noticing patterns of innovation that clustered around certain institutions and leaders. He shares his insights on innovation, including the idea that innovation peaks during fellowship, the importance of uninterrupted reflective time for creativity, and how building long-term relationships can be essential for generating ideas and gaining support. He also discusses his work on ozone therapy, the development of the Murphy needle, and the significance of securing small-scale funding through patient donations for research. Additionally, Dr. Murphy touches on his upcoming books and explores the essential fusion of medicine and the liberal arts. --- TIMESTAMPS 00:00 - Introduction to the Podcast 02:05 - The Role of Creativity in Interventional Radiology 09:52 - Inspiration Behind The Book 14:51 - Environments for Inventors to Flourish 25:18 - Use of Honey in Biopsies 31:32 - Advice for Physician Innovators 45:02 - Balancing Career and Family 51:23 - Upcoming Book 56:31 - Innovations in Radiation Protection 59:45 - The Future of Medical Education --- RESOURCES The Essence of Invention: Medicine and the Joy of Creativity: https://www.amazon.com/Essence-Invention-Medicine-Joy-Creativity/dp/1459754034 Tue, 28 Jan 2025 07:00:00 -0000 full BackTable Many physicians are perfectly positioned to recognize areas of clinical need, so why are so few of them involved in medical innovation? In this episode of BackTable MSK, Dr. Kieran Murphy discusses the ideal circumstances and critical characteristics of physician innovators. Many physicians are perfectly positioned to recognize areas of clinical need, so why are so few of them involved in medical innovation? In this episode of BackTable MSK, Dr. Kieran Murphy discusses the ideal circumstances and critical characteristics of physician innovators. Dr. Murphy is an interventional neuroradiologist, a professor at the University of Toronto, and a medical device innovator who has made significant contributions to the field, including the development of the Murphy needle for vertebral augmentation. --- This podcast is supported by an educational grant from: Medtronic https://www.medtronic.com/ --- SYNPOSIS Dr. Murphy talks about his recent book, “The Essence of Invention: Medicine and the Joy of Creativity,” which chronicles key innovations in interventional radiology. The book focuses specifically on the characteristics and circumstances of the innovators themselves. Dr. Murphy became interested in this topic after noticing patterns of innovation that clustered around certain institutions and leaders. He shares his insights on innovation, including the idea that innovation peaks during fellowship, the importance of uninterrupted reflective time for creativity, and how building long-term relationships can be essential for generating ideas and gaining support. He also discusses his work on ozone therapy, the development of the Murphy needle, and the significance of securing small-scale funding through patient donations for research. Additionally, Dr. Murphy touches on his upcoming books and explores the essential fusion of medicine and the liberal arts. --- TIMESTAMPS 00:00 - Introduction to the Podcast 02:05 - The Role of Creativity in Interventional Radiology 09:52 - Inspiration Behind The Book 14:51 - Environments for Inventors to Flourish 25:18 - Use of Honey in Biopsies 31:32 - Advice for Physician Innovators 45:02 - Balancing Career and Family 51:23 - Upcoming Book 56:31 - Innovations in Radiation Protection 59:45 - The Future of Medical Education --- RESOURCES The Essence of Invention: Medicine and the Joy of Creativity: https://www.amazon.com/Essence-Invention-Medicine-Joy-Creativity/dp/1459754034 Many physicians are perfectly positioned to recognize areas of clinical need, so why are so few of them involved in medical innovation? In this episode of BackTable MSK, Dr. Kieran Murphy discusses the ideal circumstances and critical characteristics of physician innovators. Dr. Murphy is an interventional neuroradiologist, a professor at the University of Toronto, and a medical device innovator who has made significant contributions to the field, including the development of the Murphy needle for vertebral augmentation.


---


This podcast is supported by an educational grant from:


Medtronic

https://www.medtronic.com/


---


SYNPOSIS


Dr. Murphy talks about his recent book, “The Essence of Invention: Medicine and the Joy of Creativity,” which chronicles key innovations in interventional radiology. The book focuses specifically on the characteristics and circumstances of the innovators themselves. Dr. Murphy became interested in this topic after noticing patterns of innovation that clustered around certain institutions and leaders.


He shares his insights on innovation, including the idea that innovation peaks during fellowship, the importance of uninterrupted reflective time for creativity, and how building long-term relationships can be essential for generating ideas and gaining support. He also discusses his work on ozone therapy, the development of the Murphy needle, and the significance of securing small-scale funding through patient donations for research.


Additionally, Dr. Murphy touches on his upcoming books and explores the essential fusion of medicine and the liberal arts.



---


TIMESTAMPS


00:00 - Introduction to the Podcast

02:05 - The Role of Creativity in Interventional Radiology

09:52 - Inspiration Behind The Book

14:51 - Environments for Inventors to Flourish

25:18 - Use of Honey in Biopsies

31:32 - Advice for Physician Innovators

45:02 - Balancing Career and Family

51:23 - Upcoming Book

56:31 - Innovations in Radiation Protection

59:45 - The Future of Medical Education



---


RESOURCES


The Essence of Invention: Medicine and the Joy of Creativity:

https://www.amazon.com/Essence-Invention-Medicine-Joy-Creativity/dp/1459754034

]]> 3996 Ep. 65 Robotics Revolution in Interventional Radiology with Dr. Sean Tutton and Dr. Raj Narayanan Robot-assisted technology has revolutionized surgical fields such as general surgery and urology—could interventional radiology be the next frontier? In this episode of the BackTable podcast, host Dr. Jacob Fleming explores the transformative potential of robotic-assisted percutaneous biopsies and ablations with experts Dr. Govindarajan “Raj” Narayanan from the Miami Cancer Institute and Dr. Sean Tutton from UC San Diego. --- This podcast is supported by: Quantum Surgical https://www.quantumsurgical.com/ --- SYNPOSIS Dr. Narayanan begins by sharing his initial interest in robotic applications for tumor ablations, aiming to maximize efficiency in his practice. Dr. Tutton then highlights the advantages of robotics for probe placement, especially in challenging cases. The two doctors discuss the logistics of the robotic system, including setup, imaging, and access choices. They also reflect on the learning curve associated with robotics and how it gradually enhances procedural efficiency while reducing mental fatigue. This improvement allows them to take on more complex cases with confidence. Overall, both experts agree that robotics has the potential to democratize minimally invasive procedures, offering new opportunities for skill development and advancement within the field of interventional radiology. --- TIMESTAMPS 00:00 - Introduction to the Podcast 03:30 - Developing an Interest in Robotics 10:44 - Integration of Robotics in the Procedural Suite 13:27 - Logistics of Robot System 18:38 - Planning for Percutaneous Access 22:39 - Future Implications of Robotics on Training Programs 35:51 - Efficiency and Volume Management with Robotics 40:39 - Learning Curves for Robotic Procedures 48:09 - Conclusion and Final Thoughts --- RESOURCES Quantum Surgical Epione Robot: https://www.quantumsurgical.com/epione/ ACCLAIM Trial: https://www.sio-central.org/ACCLAIM-Trial Tue, 21 Jan 2025 07:00:00 -0000 full BackTable Robot-assisted technology has revolutionized surgical fields such as general surgery and urology—could interventional radiology be the next frontier? In this episode of the BackTable podcast, host Dr. Jacob Fleming explores the transformative potential of robotic-assisted percutaneous biopsies and ablations with experts Dr. Govindarajan “Raj” Narayanan from the Miami Cancer Institute and Dr. Sean Tutton from UC San Diego. Robot-assisted technology has revolutionized surgical fields such as general surgery and urology—could interventional radiology be the next frontier? In this episode of the BackTable podcast, host Dr. Jacob Fleming explores the transformative potential of robotic-assisted percutaneous biopsies and ablations with experts Dr. Govindarajan “Raj” Narayanan from the Miami Cancer Institute and Dr. Sean Tutton from UC San Diego. --- This podcast is supported by: Quantum Surgical https://www.quantumsurgical.com/ --- SYNPOSIS Dr. Narayanan begins by sharing his initial interest in robotic applications for tumor ablations, aiming to maximize efficiency in his practice. Dr. Tutton then highlights the advantages of robotics for probe placement, especially in challenging cases. The two doctors discuss the logistics of the robotic system, including setup, imaging, and access choices. They also reflect on the learning curve associated with robotics and how it gradually enhances procedural efficiency while reducing mental fatigue. This improvement allows them to take on more complex cases with confidence. Overall, both experts agree that robotics has the potential to democratize minimally invasive procedures, offering new opportunities for skill development and advancement within the field of interventional radiology. --- TIMESTAMPS 00:00 - Introduction to the Podcast 03:30 - Developing an Interest in Robotics 10:44 - Integration of Robotics in the Procedural Suite 13:27 - Logistics of Robot System 18:38 - Planning for Percutaneous Access 22:39 - Future Implications of Robotics on Training Programs 35:51 - Efficiency and Volume Management with Robotics 40:39 - Learning Curves for Robotic Procedures 48:09 - Conclusion and Final Thoughts --- RESOURCES Quantum Surgical Epione Robot: https://www.quantumsurgical.com/epione/ ACCLAIM Trial: https://www.sio-central.org/ACCLAIM-Trial Robot-assisted technology has revolutionized surgical fields such as general surgery and urology—could interventional radiology be the next frontier? In this episode of the BackTable podcast, host Dr. Jacob Fleming explores the transformative potential of robotic-assisted percutaneous biopsies and ablations with experts Dr. Govindarajan “Raj” Narayanan from the Miami Cancer Institute and Dr. Sean Tutton from UC San Diego.



---


This podcast is supported by:


Quantum Surgical

https://www.quantumsurgical.com/


---


SYNPOSIS


Dr. Narayanan begins by sharing his initial interest in robotic applications for tumor ablations, aiming to maximize efficiency in his practice. Dr. Tutton then highlights the advantages of robotics for probe placement, especially in challenging cases. The two doctors discuss the logistics of the robotic system, including setup, imaging, and access choices. They also reflect on the learning curve associated with robotics and how it gradually enhances procedural efficiency while reducing mental fatigue. This improvement allows them to take on more complex cases with confidence. Overall, both experts agree that robotics has the potential to democratize minimally invasive procedures, offering new opportunities for skill development and advancement within the field of interventional radiology.


---


TIMESTAMPS


00:00 - Introduction to the Podcast

03:30 - Developing an Interest in Robotics

10:44 - Integration of Robotics in the Procedural Suite

13:27 - Logistics of Robot System

18:38 - Planning for Percutaneous Access

22:39 - Future Implications of Robotics on Training Programs

35:51 - Efficiency and Volume Management with Robotics

40:39 - Learning Curves for Robotic Procedures

48:09 - Conclusion and Final Thoughts



---


RESOURCES


Quantum Surgical Epione Robot:

https://www.quantumsurgical.com/epione/


ACCLAIM Trial:

https://www.sio-central.org/ACCLAIM-Trial

]]> 3391 BackTable Brief: Genesis 2 Trial Design and Challenges for GAE with Dr. Mark Little What evidence is currently available regarding the use of genicular artery embolization (GAE) for treating knee osteoarthritis? Principal investigator Dr. Mark Little discusses the GENESIS 2 trial, a large randomized controlled study aimed at assessing the outcomes of embolizing abnormal genicular arteries to reduce pain in patients with mild to moderate knee osteoarthritis. Dr. Little explains the trial’s design, methodology, and the significance of key data points such as the Knee Injury and Osteoarthritis Outcome Score (KOOS), cost-effectiveness, and quality of life measures. He also covers the materials and techniques used in both the GENESIS 1 and 2 trials, the neuropsychological tests integrated into the study, and potential geographic and anatomical challenges encountered during GAE. Dr. Little highlights the importance of high-quality research and data to support the procedure's efficacy and safety. TIMESTAMPS 00:00 - Overview of GENESIS 2 Trial 04:42 - Embolic Materials and Techniques 09:10 - Challenges in Patient Anatomy & Comorbidities 12:40 - Final Thoughts CHECK OUT THE FULL EPISODE Exploring GAE: Clinical Insights & Outcomes with Dr. Mark Little https://www.backtable.com/shows/msk/podcasts/50/exploring-gae-clinical-insights-outcomes Tue, 07 Jan 2025 08:00:00 -0000 full BackTable What evidence is currently available regarding the use of genicular artery embolization (GAE) for treating knee osteoarthritis? Principal investigator Dr. Mark Little discusses the GENESIS 2 trial, a large randomized controlled study aimed at assessing the outcomes of embolizing abnormal genicular arteries to reduce pain in patients with mild to moderate knee osteoarthritis. What evidence is currently available regarding the use of genicular artery embolization (GAE) for treating knee osteoarthritis? Principal investigator Dr. Mark Little discusses the GENESIS 2 trial, a large randomized controlled study aimed at assessing the outcomes of embolizing abnormal genicular arteries to reduce pain in patients with mild to moderate knee osteoarthritis. Dr. Little explains the trial’s design, methodology, and the significance of key data points such as the Knee Injury and Osteoarthritis Outcome Score (KOOS), cost-effectiveness, and quality of life measures. He also covers the materials and techniques used in both the GENESIS 1 and 2 trials, the neuropsychological tests integrated into the study, and potential geographic and anatomical challenges encountered during GAE. Dr. Little highlights the importance of high-quality research and data to support the procedure's efficacy and safety. TIMESTAMPS 00:00 - Overview of GENESIS 2 Trial 04:42 - Embolic Materials and Techniques 09:10 - Challenges in Patient Anatomy & Comorbidities 12:40 - Final Thoughts CHECK OUT THE FULL EPISODE Exploring GAE: Clinical Insights & Outcomes with Dr. Mark Little https://www.backtable.com/shows/msk/podcasts/50/exploring-gae-clinical-insights-outcomes What evidence is currently available regarding the use of genicular artery embolization (GAE) for treating knee osteoarthritis? Principal investigator Dr. Mark Little discusses the GENESIS 2 trial, a large randomized controlled study aimed at assessing the outcomes of embolizing abnormal genicular arteries to reduce pain in patients with mild to moderate knee osteoarthritis.


Dr. Little explains the trial’s design, methodology, and the significance of key data points such as the Knee Injury and Osteoarthritis Outcome Score (KOOS), cost-effectiveness, and quality of life measures. He also covers the materials and techniques used in both the GENESIS 1 and 2 trials, the neuropsychological tests integrated into the study, and potential geographic and anatomical challenges encountered during GAE. Dr. Little highlights the importance of high-quality research and data to support the procedure's efficacy and safety.


TIMESTAMPS


00:00 - Overview of GENESIS 2 Trial

04:42 - Embolic Materials and Techniques

09:10 - Challenges in Patient Anatomy & Comorbidities

12:40 - Final Thoughts


CHECK OUT THE FULL EPISODE


Exploring GAE: Clinical Insights & Outcomes with Dr. Mark Little

https://www.backtable.com/shows/msk/podcasts/50/exploring-gae-clinical-insights-outcomes

]]> 927 BackTable Brief: Getting Started with MSK Embolizations with Dr. Mark Little For patients suffering from intractable pain due to knee osteoarthritis, genicular artery embolization (GAE) offers a minimally invasive treatment with potential long-term benefits. Dr. Mark Little, an interventional radiologist at Royal Berkshire NHS Foundation Trust, joins us to provide an introduction to GAE. He shares his experience with the procedure and compares it to other treatments, such as steroid injections and surgery. Dr. Little also discusses the disease process of osteoarthritis and explains how GAE targets abnormal blood vessels to reduce inflammation and alleviate pain. TIMESTAMPS 00:00 - Introduction  03:38 - Understanding Knee Osteoarthritis 06:57 - Patient Selection for GAE 08:57 - Challenges and Opportunities in GAE 12:18 - Safety and Procedure Details CHECK OUT THE FULL EPISODE Exploring GAE: Clinical Insights & Outcomes with Dr. Mark Little https://www.backtable.com/shows/msk/podcasts/50/exploring-gae-clinical-insights-outcomes Tue, 31 Dec 2024 08:00:00 -0000 full BackTable For patients suffering from intractable pain due to knee osteoarthritis, genicular artery embolization (GAE) offers a minimally invasive treatment with potential long-term benefits. Dr. Mark Little, an interventional radiologist at Royal Berkshire NHS Foundation Trust, joins us to provide an introduction to GAE. He shares his experience with the procedure and compares it to other treatments, such as steroid injections and surgery. Dr. Little also discusses the disease process of osteoarthritis and explains how GAE targets abnormal blood vessels to reduce inflammation and alleviate pain. For patients suffering from intractable pain due to knee osteoarthritis, genicular artery embolization (GAE) offers a minimally invasive treatment with potential long-term benefits. Dr. Mark Little, an interventional radiologist at Royal Berkshire NHS Foundation Trust, joins us to provide an introduction to GAE. He shares his experience with the procedure and compares it to other treatments, such as steroid injections and surgery. Dr. Little also discusses the disease process of osteoarthritis and explains how GAE targets abnormal blood vessels to reduce inflammation and alleviate pain. TIMESTAMPS 00:00 - Introduction  03:38 - Understanding Knee Osteoarthritis 06:57 - Patient Selection for GAE 08:57 - Challenges and Opportunities in GAE 12:18 - Safety and Procedure Details CHECK OUT THE FULL EPISODE Exploring GAE: Clinical Insights & Outcomes with Dr. Mark Little https://www.backtable.com/shows/msk/podcasts/50/exploring-gae-clinical-insights-outcomes For patients suffering from intractable pain due to knee osteoarthritis, genicular artery embolization (GAE) offers a minimally invasive treatment with potential long-term benefits. Dr. Mark Little, an interventional radiologist at Royal Berkshire NHS Foundation Trust, joins us to provide an introduction to GAE. He shares his experience with the procedure and compares it to other treatments, such as steroid injections and surgery. Dr. Little also discusses the disease process of osteoarthritis and explains how GAE targets abnormal blood vessels to reduce inflammation and alleviate pain.


TIMESTAMPS


00:00 - Introduction 

03:38 - Understanding Knee Osteoarthritis

06:57 - Patient Selection for GAE

08:57 - Challenges and Opportunities in GAE

12:18 - Safety and Procedure Details


CHECK OUT THE FULL EPISODE


Exploring GAE: Clinical Insights & Outcomes with Dr. Mark Little

https://www.backtable.com/shows/msk/podcasts/50/exploring-gae-clinical-insights-outcomes

]]> 911 Ep. 64 Advanced Kyphoplasty Techniques with Dr. Glade Roper How can we ensure long-term spine health after tumor ablation? In this follow-up to our previous discussion, Dr. Glade Roper returns to the show to focus on early kyphoplasty treatment for ablation patients, aiming to prevent kyphosis and postural fatigue syndrome. --- This podcast is supported by an educational grant from Medtronic. --- SYNPOSIS Dr. Roper provides detailed advice on performing kyphoplasty effectively, including methods to ensure optimal cement fill and the use of various tools. He also discusses the challenges of treating irradiated bones, the importance of restoring sagittal alignment for patients, and the need to accurately assess fracture morphologies on imaging. --- TIMESTAMPS 00:00 Kyphoplasty Tips and Tools 10:05 Impact of Radiation Therapy on the Spine 15:43 Cement Injection Techniques 25:00 Prevention of Postural Fatigue Syndrome 30:12 Fracture Morphology on Imaging 34:33 Balancing Work and Personal Life --- RESOURCES BackTable MSK Ep. 63- Building a Bone Tumor Ablation Practice, Part 1: https://www.backtable.com/shows/msk/podcasts/63/building-a-bone-tumor-ablation-practice-part-1 BackTable VI Ep. 211- Extra-Spinal Augmentation & The Future of Vertebral Augmentation: https://www.backtable.com/shows/vi/podcasts/211/extraspinal-augmentation-the-future-of-vertebral-augmentation Kyphon V System: https://www.medtronic.com/en-us/healthcare-professionals/products/spinal-orthopedic/vertebral-augmentation/vertebroplasty/kyphon-v-premium-vertebroplasty-platform.html Fri, 20 Dec 2024 08:00:00 -0000 full BackTable How can we ensure long-term spine health after tumor ablation? In this follow-up to our previous discussion, Dr. Glade Roper returns to the show to focus on early kyphoplasty treatment for ablation patients, aiming to prevent kyphosis and postural fatigue syndrome. How can we ensure long-term spine health after tumor ablation? In this follow-up to our previous discussion, Dr. Glade Roper returns to the show to focus on early kyphoplasty treatment for ablation patients, aiming to prevent kyphosis and postural fatigue syndrome. --- This podcast is supported by an educational grant from Medtronic. --- SYNPOSIS Dr. Roper provides detailed advice on performing kyphoplasty effectively, including methods to ensure optimal cement fill and the use of various tools. He also discusses the challenges of treating irradiated bones, the importance of restoring sagittal alignment for patients, and the need to accurately assess fracture morphologies on imaging. --- TIMESTAMPS 00:00 Kyphoplasty Tips and Tools 10:05 Impact of Radiation Therapy on the Spine 15:43 Cement Injection Techniques 25:00 Prevention of Postural Fatigue Syndrome 30:12 Fracture Morphology on Imaging 34:33 Balancing Work and Personal Life --- RESOURCES BackTable MSK Ep. 63- Building a Bone Tumor Ablation Practice, Part 1: https://www.backtable.com/shows/msk/podcasts/63/building-a-bone-tumor-ablation-practice-part-1 BackTable VI Ep. 211- Extra-Spinal Augmentation & The Future of Vertebral Augmentation: https://www.backtable.com/shows/vi/podcasts/211/extraspinal-augmentation-the-future-of-vertebral-augmentation Kyphon V System: https://www.medtronic.com/en-us/healthcare-professionals/products/spinal-orthopedic/vertebral-augmentation/vertebroplasty/kyphon-v-premium-vertebroplasty-platform.html How can we ensure long-term spine health after tumor ablation? In this follow-up to our previous discussion, Dr. Glade Roper returns to the show to focus on early kyphoplasty treatment for ablation patients, aiming to prevent kyphosis and postural fatigue syndrome.


---


This podcast is supported by an educational grant from Medtronic.


---


SYNPOSIS


Dr. Roper provides detailed advice on performing kyphoplasty effectively, including methods to ensure optimal cement fill and the use of various tools. He also discusses the challenges of treating irradiated bones, the importance of restoring sagittal alignment for patients, and the need to accurately assess fracture morphologies on imaging.



---


TIMESTAMPS


00:00 Kyphoplasty Tips and Tools

10:05 Impact of Radiation Therapy on the Spine

15:43 Cement Injection Techniques

25:00 Prevention of Postural Fatigue Syndrome

30:12 Fracture Morphology on Imaging

34:33 Balancing Work and Personal Life


---


RESOURCES


BackTable MSK Ep. 63- Building a Bone Tumor Ablation Practice, Part 1:

https://www.backtable.com/shows/msk/podcasts/63/building-a-bone-tumor-ablation-practice-part-1


BackTable VI Ep. 211- Extra-Spinal Augmentation & The Future of Vertebral Augmentation:

https://www.backtable.com/shows/vi/podcasts/211/extraspinal-augmentation-the-future-of-vertebral-augmentation


Kyphon V System:

https://www.medtronic.com/en-us/healthcare-professionals/products/spinal-orthopedic/vertebral-augmentation/vertebroplasty/kyphon-v-premium-vertebroplasty-platform.html

]]> 2530 Ep. 63 Bone Tumor Ablation: Techniques and Insights with Dr. Glade Roper Spine metastases are often painful and can impair a patient's ability to lie flat for radiation therapy. However, radiofrequency ablation (RFA) can address the bulk of the tumor and provide significant pain relief, enabling the patient to undergo radiation therapy. In this episode of BackTable MSK, musculoskeletal radiologist Dr. Glade Roper discusses his experience with spinal tumor RFA, his role on a multidisciplinary oncology team, and key considerations when planning for ablation. --- This podcast is supported by an educational grant from Medtronic. --- SYNPOSIS Dr. Roper emphasizes that RFA should be viewed as an adjunct to radiation therapy rather than a replacement. He reviews the procedural steps for RFA and explains the basic mechanisms of the device. Additionally, Dr. Roper shares his experience with placing intrathecal pain pumps post-ablation to manage residual pain. Finally, he offers advice on patient and caregiver education, focusing on how to deliver comprehensive, easily understandable information. --- TIMESTAMPS 00:00 - Introduction 01:57 - Building Relationships with Radiation Oncologists 01:42 - Overview of Bone Tumor Ablation 06:23 - Pre-Procedural Considerations 09:13 - The Role of Pain Pumps 14:04 - Stepwise Patient Education 19:57 - Procedural Technique --- RESOURCES OPuS One Study: https://pubmed.ncbi.nlm.nih.gov/33129427/ BackTable VI Ep. 211- Extra-Spinal Augmentation & The Future of Vertebral Augmentation: https://www.backtable.com/shows/vi/podcasts/211/extraspinal-augmentation-the-future-of-vertebral-augmentation Tue, 17 Dec 2024 08:00:00 -0000 full BackTable Spine metastases are often painful and can impair a patient's ability to lie flat for radiation therapy. However, radiofrequency ablation (RFA) can address the bulk of the tumor and provide significant pain relief, enabling the patient to undergo radiation therapy. In this episode of BackTable MSK, musculoskeletal radiologist Dr. Glade Roper discusses his experience with spinal tumor RFA, his role on a multidisciplinary oncology team, and key considerations when planning for ablation. Spine metastases are often painful and can impair a patient's ability to lie flat for radiation therapy. However, radiofrequency ablation (RFA) can address the bulk of the tumor and provide significant pain relief, enabling the patient to undergo radiation therapy. In this episode of BackTable MSK, musculoskeletal radiologist Dr. Glade Roper discusses his experience with spinal tumor RFA, his role on a multidisciplinary oncology team, and key considerations when planning for ablation. --- This podcast is supported by an educational grant from Medtronic. --- SYNPOSIS Dr. Roper emphasizes that RFA should be viewed as an adjunct to radiation therapy rather than a replacement. He reviews the procedural steps for RFA and explains the basic mechanisms of the device. Additionally, Dr. Roper shares his experience with placing intrathecal pain pumps post-ablation to manage residual pain. Finally, he offers advice on patient and caregiver education, focusing on how to deliver comprehensive, easily understandable information. --- TIMESTAMPS 00:00 - Introduction 01:57 - Building Relationships with Radiation Oncologists 01:42 - Overview of Bone Tumor Ablation 06:23 - Pre-Procedural Considerations 09:13 - The Role of Pain Pumps 14:04 - Stepwise Patient Education 19:57 - Procedural Technique --- RESOURCES OPuS One Study: https://pubmed.ncbi.nlm.nih.gov/33129427/ BackTable VI Ep. 211- Extra-Spinal Augmentation & The Future of Vertebral Augmentation: https://www.backtable.com/shows/vi/podcasts/211/extraspinal-augmentation-the-future-of-vertebral-augmentation Spine metastases are often painful and can impair a patient's ability to lie flat for radiation therapy. However, radiofrequency ablation (RFA) can address the bulk of the tumor and provide significant pain relief, enabling the patient to undergo radiation therapy. In this episode of BackTable MSK, musculoskeletal radiologist Dr. Glade Roper discusses his experience with spinal tumor RFA, his role on a multidisciplinary oncology team, and key considerations when planning for ablation.


---


This podcast is supported by an educational grant from Medtronic.


---


SYNPOSIS


Dr. Roper emphasizes that RFA should be viewed as an adjunct to radiation therapy rather than a replacement. He reviews the procedural steps for RFA and explains the basic mechanisms of the device. Additionally, Dr. Roper shares his experience with placing intrathecal pain pumps post-ablation to manage residual pain. Finally, he offers advice on patient and caregiver education, focusing on how to deliver comprehensive, easily understandable information.


---


TIMESTAMPS


00:00 - Introduction

01:57 - Building Relationships with Radiation Oncologists

01:42 - Overview of Bone Tumor Ablation

06:23 - Pre-Procedural Considerations

09:13 - The Role of Pain Pumps

14:04 - Stepwise Patient Education

19:57 - Procedural Technique


---


RESOURCES


OPuS One Study:

https://pubmed.ncbi.nlm.nih.gov/33129427/


BackTable VI Ep. 211- Extra-Spinal Augmentation & The Future of Vertebral Augmentation:

https://www.backtable.com/shows/vi/podcasts/211/extraspinal-augmentation-the-future-of-vertebral-augmentation

]]> 2079 BackTable Brief: Why Cryoneurolysis to Treat Pain? with Dr. Aron Chary With the breadth of minimally invasive pain management techniques that are now available, it can be challenging to sort through the options and determine the most appropriate treatment for your patient. In this BackTable Brief, Dr. Aron Chary provides an overview of cryoneurolysis and its role in interventional pain management. He describes the advantages of cryoneurolysis compared to other methods, including its potential for longer-term pain relief and unique ability to promote nerve regeneration. He also delves into procedural protocols, including the use of diagnostic nerve blocks before cryoneurolysis, and the importance of managing patient expectations and follow-up care. TIMESTAMPS 00:00 - Understanding Cryoablation for Pain 01:38 - Comparing Cryoablation with Other Modalities 04:41 - Patient Expectations and Outcomes 06:22 - Case Studies and Clinical Experiences 08:35 - Challenges in Pain Management CHECK OUT THE FULL EPISODE BackTable MSK Podcast Episode #49 Chilling Solutions: Cryoneurolysis in Clinical Practice with Dr. Aron Chary: https://www.backtable.com/shows/msk/podcasts/49/chilling-solutions-cryoneurolysis-in-clinical-practice Tue, 10 Dec 2024 08:00:00 -0000 full BackTable With the breadth of minimally invasive pain management techniques that are now available, it can be challenging to sort through the options and determine the most appropriate treatment for your patient. In this BackTable Brief, Dr. Aron Chary provides an overview of cryoneurolysis and its role in interventional pain management. He describes the advantages of cryoneurolysis compared to other methods, including its potential for longer-term pain relief and unique ability to promote nerve regeneration. He also delves into procedural protocols, including the use of diagnostic nerve blocks before cryoneurolysis, and the importance of managing patient expectations and follow-up care. With the breadth of minimally invasive pain management techniques that are now available, it can be challenging to sort through the options and determine the most appropriate treatment for your patient. In this BackTable Brief, Dr. Aron Chary provides an overview of cryoneurolysis and its role in interventional pain management. He describes the advantages of cryoneurolysis compared to other methods, including its potential for longer-term pain relief and unique ability to promote nerve regeneration. He also delves into procedural protocols, including the use of diagnostic nerve blocks before cryoneurolysis, and the importance of managing patient expectations and follow-up care. TIMESTAMPS 00:00 - Understanding Cryoablation for Pain 01:38 - Comparing Cryoablation with Other Modalities 04:41 - Patient Expectations and Outcomes 06:22 - Case Studies and Clinical Experiences 08:35 - Challenges in Pain Management CHECK OUT THE FULL EPISODE BackTable MSK Podcast Episode #49 Chilling Solutions: Cryoneurolysis in Clinical Practice with Dr. Aron Chary: https://www.backtable.com/shows/msk/podcasts/49/chilling-solutions-cryoneurolysis-in-clinical-practice With the breadth of minimally invasive pain management techniques that are now available, it can be challenging to sort through the options and determine the most appropriate treatment for your patient. In this BackTable Brief, Dr. Aron Chary provides an overview of cryoneurolysis and its role in interventional pain management. He describes the advantages of cryoneurolysis compared to other methods, including its potential for longer-term pain relief and unique ability to promote nerve regeneration. He also delves into procedural protocols, including the use of diagnostic nerve blocks before cryoneurolysis, and the importance of managing patient expectations and follow-up care.


TIMESTAMPS


00:00 - Understanding Cryoablation for Pain

01:38 - Comparing Cryoablation with Other Modalities

04:41 - Patient Expectations and Outcomes

06:22 - Case Studies and Clinical Experiences

08:35 - Challenges in Pain Management


CHECK OUT THE FULL EPISODE


BackTable MSK Podcast Episode #49

Chilling Solutions: Cryoneurolysis in Clinical Practice with Dr. Aron Chary:

https://www.backtable.com/shows/msk/podcasts/49/chilling-solutions-cryoneurolysis-in-clinical-practice


]]> 882 BackTable Brief: Building a Cryoneurolysis Service Line with Dr. Aron Chary Learn how your patients might benefit from new pain management therapies. Dr. Aron Chary and host Dr. Michael Barraza discuss the role of cryoneurolysis as an emerging therapy for knee and cancer-related pain. The doctors also discuss other practical applications and evolutions of cryo treatments in both non-cancer and cancer-related pain management. TIMESTAMPS 00:00 - Introduction 05:08 - Expanding Pain Interventions 07:02 - Techniques and Procedures 09:28 - Understanding and Diagnosing Pain 11:34 - Art of Patient Workup CHECK OUT THE FULL EPISODE BackTable MSK Podcast Episode #49 Chilling Solutions: Cryoneurolysis in Clinical Practice with Dr. Aron Chary: https://www.backtable.com/shows/msk/podcasts/49/chilling-solutions-cryoneurolysis-in-clinical-practice Tue, 19 Nov 2024 08:00:00 -0000 full BackTable Learn how your patients might benefit from new pain management therapies. Dr. Aron Chary and host Dr. Michael Barraza discuss the role of cryoneurolysis as an emerging therapy for knee and cancer-related pain. The doctors also discuss other practical applications and evolutions of cryo treatments in both non-cancer and cancer-related pain management. Learn how your patients might benefit from new pain management therapies. Dr. Aron Chary and host Dr. Michael Barraza discuss the role of cryoneurolysis as an emerging therapy for knee and cancer-related pain. The doctors also discuss other practical applications and evolutions of cryo treatments in both non-cancer and cancer-related pain management. TIMESTAMPS 00:00 - Introduction 05:08 - Expanding Pain Interventions 07:02 - Techniques and Procedures 09:28 - Understanding and Diagnosing Pain 11:34 - Art of Patient Workup CHECK OUT THE FULL EPISODE BackTable MSK Podcast Episode #49 Chilling Solutions: Cryoneurolysis in Clinical Practice with Dr. Aron Chary: https://www.backtable.com/shows/msk/podcasts/49/chilling-solutions-cryoneurolysis-in-clinical-practice Learn how your patients might benefit from new pain management therapies. Dr. Aron Chary and host Dr. Michael Barraza discuss the role of cryoneurolysis as an emerging therapy for knee and cancer-related pain. The doctors also discuss other practical applications and evolutions of cryo treatments in both non-cancer and cancer-related pain management.


TIMESTAMPS


00:00 - Introduction

05:08 - Expanding Pain Interventions

07:02 - Techniques and Procedures

09:28 - Understanding and Diagnosing Pain

11:34 - Art of Patient Workup


CHECK OUT THE FULL EPISODE


BackTable MSK Podcast Episode #49

Chilling Solutions: Cryoneurolysis in Clinical Practice with Dr. Aron Chary:

https://www.backtable.com/shows/msk/podcasts/49/chilling-solutions-cryoneurolysis-in-clinical-practice


]]> 862 Backtable Brief: Effective Strategies for Managing Diabetic Neuropathy in Vascular Clinics with Dr. Blake Parsons If your patients are living with painful diabetic neuropathy that is refractory to medications, spinal cord stimulation (SCS) may be an option. Dr. Dana Dunleavy interviews interventional radiologist Dr. Blake Parsons about managing diabetic neuropathy in a multidisciplinary setting and the role of SCS. They also discuss new research findings that support the use of spinal cord stimulators and their broader impact on quality of life, including reduced fall risks and improved foot sensation for patients with diabetes. TIMESTAMPS 00:00 - Understanding Diabetic Neuropathy 02:06 - Establishing a Neuropathy Clinic 06:29 - Challenges and Solutions in Patient Referrals 08:04 - Success and Future Directions CHECK OUT THE FULL EPISODE BackTable MSK Ep. 48- SCS for Neuropathy: Clinical Insights & Patient Impact with Dr. Blake Parsons: https://www.backtable.com/shows/msk/podcasts/48/scs-for-neuropathy-clinical-insights-patient-impact Tue, 05 Nov 2024 08:00:00 -0000 full BackTable If your patients are living with painful diabetic neuropathy that is refractory to medications, spinal cord stimulation (SCS) may be an option. Dr. Dana Dunleavy interviews interventional radiologist Dr. Blake Parsons about managing diabetic neuropathy in a multidisciplinary setting and the role of SCS. They also discuss new research findings that support the use of spinal cord stimulators and their broader impact on quality of life, including reduced fall risks and improved foot sensation for patients with diabetes. If your patients are living with painful diabetic neuropathy that is refractory to medications, spinal cord stimulation (SCS) may be an option. Dr. Dana Dunleavy interviews interventional radiologist Dr. Blake Parsons about managing diabetic neuropathy in a multidisciplinary setting and the role of SCS. They also discuss new research findings that support the use of spinal cord stimulators and their broader impact on quality of life, including reduced fall risks and improved foot sensation for patients with diabetes. TIMESTAMPS 00:00 - Understanding Diabetic Neuropathy 02:06 - Establishing a Neuropathy Clinic 06:29 - Challenges and Solutions in Patient Referrals 08:04 - Success and Future Directions CHECK OUT THE FULL EPISODE BackTable MSK Ep. 48- SCS for Neuropathy: Clinical Insights & Patient Impact with Dr. Blake Parsons: https://www.backtable.com/shows/msk/podcasts/48/scs-for-neuropathy-clinical-insights-patient-impact If your patients are living with painful diabetic neuropathy that is refractory to medications, spinal cord stimulation (SCS) may be an option. Dr. Dana Dunleavy interviews interventional radiologist Dr. Blake Parsons about managing diabetic neuropathy in a multidisciplinary setting and the role of SCS. They also discuss new research findings that support the use of spinal cord stimulators and their broader impact on quality of life, including reduced fall risks and improved foot sensation for patients with diabetes.


TIMESTAMPS


00:00 - Understanding Diabetic Neuropathy

02:06 - Establishing a Neuropathy Clinic

06:29 - Challenges and Solutions in Patient Referrals

08:04 - Success and Future Directions


CHECK OUT THE FULL EPISODE


BackTable MSK Ep. 48- SCS for Neuropathy: Clinical Insights & Patient Impact with Dr. Blake Parsons:

https://www.backtable.com/shows/msk/podcasts/48/scs-for-neuropathy-clinical-insights-patient-impact

]]> 813 Ep. 62 Exploring Intradiscal PRP for Back Pain Relief with Dr. Guilherme Ferreira Dos Santos How are orthobiologics transforming the back pain treatment algorithm? In this episode of BackTable MSK, host Jacob Fleming is joined by Dr. Guilherme Ferreira Dos Santos to discuss the management of lumbar pain and the role of platelet-rich plasma (PRP) injections. Dr. Santos is trained in Physical Medicine & Rehabilitation as well as Interventional Pain Medicine, and currently practices at the Hospital Clinic of Barcelona. --- SYNPOSIS Dr. Santos gives an overview of discogenic pain. Each patient case is unique, as pain can be caused by single level or multilevel disease, pure disc disease, or additional facet joint disease. Additionally, discogenic pain can affect young, active patients and typically worsens with spinal flexion. They discuss the Pfirrmann system for intervertebral disc degeneration, medial branch blocks to identify posterior column pain, the risk of disc degeneration after discography, and the rise of orthobiologic treatments such as intradiscal and facet joint PRP injections. Dr. Santos highlights important steps for PRP preparation and techniques for injection. He also gives advice for counseling patients about the timeline to pain relief, longevity of treatment effects, and options for refractory pain. Finally, Dr. Santos encourages the audience to stay tuned for the upcoming RESPINE multicenter trial results. --- TIMESTAMPS 00:00 - Introduction 02:18 - Dr. Santos’ Multicultural Experiences 08:58 - Challenges in Diagnosing and Treating Discogenic Pain 20:26 - Role of Intradiscal and Facet Joint PRP Injections 30:16 - PRP Preparation and Dosing 34:52 - Technical Aspects of Disc Treatments 42:54 - Patient Counseling 56:58 - Future Directions in Regenerative Medicine --- RESOURCES RESPINE Trial: https://ecrin.org/clinical-trials/respine Lumbar Intradiskal Platelet-Rich Plasma (PRP) Injections: A Prospective, Double-Blind, Randomized Controlled Study (Tuakli-Wosornu, 2016): https://pubmed.ncbi.nlm.nih.gov/26314234/ Clinical outcomes following intradiscal injections of higher-concentration platelet-rich plasma in patients with chronic lumbar discogenic pain (Lutz, 2022): https://pubmed.ncbi.nlm.nih.gov/35344055/ Tue, 29 Oct 2024 07:00:00 -0000 full BackTable How are orthobiologics transforming the back pain treatment algorithm? In this episode of BackTable MSK, host Jacob Fleming is joined by Dr. Guilherme Ferreira Dos Santos to discuss the management of lumbar pain and the role of platelet-rich plasma (PRP) injections. Dr. Santos is trained in Physical Medicine & Rehabilitation as well as Interventional Pain Medicine, and currently practices at the Hospital Clinic of Barcelona. How are orthobiologics transforming the back pain treatment algorithm? In this episode of BackTable MSK, host Jacob Fleming is joined by Dr. Guilherme Ferreira Dos Santos to discuss the management of lumbar pain and the role of platelet-rich plasma (PRP) injections. Dr. Santos is trained in Physical Medicine & Rehabilitation as well as Interventional Pain Medicine, and currently practices at the Hospital Clinic of Barcelona. --- SYNPOSIS Dr. Santos gives an overview of discogenic pain. Each patient case is unique, as pain can be caused by single level or multilevel disease, pure disc disease, or additional facet joint disease. Additionally, discogenic pain can affect young, active patients and typically worsens with spinal flexion. They discuss the Pfirrmann system for intervertebral disc degeneration, medial branch blocks to identify posterior column pain, the risk of disc degeneration after discography, and the rise of orthobiologic treatments such as intradiscal and facet joint PRP injections. Dr. Santos highlights important steps for PRP preparation and techniques for injection. He also gives advice for counseling patients about the timeline to pain relief, longevity of treatment effects, and options for refractory pain. Finally, Dr. Santos encourages the audience to stay tuned for the upcoming RESPINE multicenter trial results. --- TIMESTAMPS 00:00 - Introduction 02:18 - Dr. Santos’ Multicultural Experiences 08:58 - Challenges in Diagnosing and Treating Discogenic Pain 20:26 - Role of Intradiscal and Facet Joint PRP Injections 30:16 - PRP Preparation and Dosing 34:52 - Technical Aspects of Disc Treatments 42:54 - Patient Counseling 56:58 - Future Directions in Regenerative Medicine --- RESOURCES RESPINE Trial: https://ecrin.org/clinical-trials/respine Lumbar Intradiskal Platelet-Rich Plasma (PRP) Injections: A Prospective, Double-Blind, Randomized Controlled Study (Tuakli-Wosornu, 2016): https://pubmed.ncbi.nlm.nih.gov/26314234/ Clinical outcomes following intradiscal injections of higher-concentration platelet-rich plasma in patients with chronic lumbar discogenic pain (Lutz, 2022): https://pubmed.ncbi.nlm.nih.gov/35344055/ How are orthobiologics transforming the back pain treatment algorithm? In this episode of BackTable MSK, host Jacob Fleming is joined by Dr. Guilherme Ferreira Dos Santos to discuss the management of lumbar pain and the role of platelet-rich plasma (PRP) injections. Dr. Santos is trained in Physical Medicine & Rehabilitation as well as Interventional Pain Medicine, and currently practices at the Hospital Clinic of Barcelona.


---


SYNPOSIS


Dr. Santos gives an overview of discogenic pain. Each patient case is unique, as pain can be caused by single level or multilevel disease, pure disc disease, or additional facet joint disease. Additionally, discogenic pain can affect young, active patients and typically worsens with spinal flexion. They discuss the Pfirrmann system for intervertebral disc degeneration, medial branch blocks to identify posterior column pain, the risk of disc degeneration after discography, and the rise of orthobiologic treatments such as intradiscal and facet joint PRP injections. Dr. Santos highlights important steps for PRP preparation and techniques for injection. He also gives advice for counseling patients about the timeline to pain relief, longevity of treatment effects, and options for refractory pain. Finally, Dr. Santos encourages the audience to stay tuned for the upcoming RESPINE multicenter trial results.


---


TIMESTAMPS


00:00 - Introduction

02:18 - Dr. Santos’ Multicultural Experiences

08:58 - Challenges in Diagnosing and Treating Discogenic Pain

20:26 - Role of Intradiscal and Facet Joint PRP Injections

30:16 - PRP Preparation and Dosing

34:52 - Technical Aspects of Disc Treatments

42:54 - Patient Counseling

56:58 - Future Directions in Regenerative Medicine



---


RESOURCES


RESPINE Trial:

https://ecrin.org/clinical-trials/respine


Lumbar Intradiskal Platelet-Rich Plasma (PRP) Injections: A Prospective, Double-Blind, Randomized Controlled Study (Tuakli-Wosornu, 2016):

https://pubmed.ncbi.nlm.nih.gov/26314234/


Clinical outcomes following intradiscal injections of higher-concentration platelet-rich plasma in patients with chronic lumbar discogenic pain (Lutz, 2022):

https://pubmed.ncbi.nlm.nih.gov/35344055/

]]> 3928 Backtable Brief: Techniques for Spinal Cord Stimulator Placement with Dr. Blake Parsons Spinal cord stimulation can be a useful tool for treating chronic low back and leg pain. In this BackTable Brief, Drs. Dana Dunleavy and Blake Parsons discuss the specifics of implanting lumbar spinal cord stimulation. They explore patient positioning, anesthesia, needle angulation, and the importance of targeting spinal levels correlated to pain. TIMESTAMPS 00:00 - Pre-Operative Setup 02:10 - Obtaining Access and Placing Leads 05:05 - Postoperative Considerations 08:43 - Evaluation of Patient Candidacy CHECK OUT THE FULL EPISODE BackTable MSK Ep. 48– SCS for Neuropathy: Clinical Insights & Patient Impact: https://www.backtable.com/shows/msk/podcasts/48/scs-for-neuropathy-clinical-insights-patient-impact Tue, 22 Oct 2024 07:00:00 -0000 full BackTable Spinal cord stimulation can be a useful tool for treating chronic low back and leg pain. In this BackTable Brief, Drs. Dana Dunleavy and Blake Parsons discuss the specifics of implanting lumbar spinal cord stimulation. They explore patient positioning, anesthesia, needle angulation, and the importance of targeting spinal levels correlated to pain. Spinal cord stimulation can be a useful tool for treating chronic low back and leg pain. In this BackTable Brief, Drs. Dana Dunleavy and Blake Parsons discuss the specifics of implanting lumbar spinal cord stimulation. They explore patient positioning, anesthesia, needle angulation, and the importance of targeting spinal levels correlated to pain. TIMESTAMPS 00:00 - Pre-Operative Setup 02:10 - Obtaining Access and Placing Leads 05:05 - Postoperative Considerations 08:43 - Evaluation of Patient Candidacy CHECK OUT THE FULL EPISODE BackTable MSK Ep. 48– SCS for Neuropathy: Clinical Insights & Patient Impact: https://www.backtable.com/shows/msk/podcasts/48/scs-for-neuropathy-clinical-insights-patient-impact Spinal cord stimulation can be a useful tool for treating chronic low back and leg pain. In this BackTable Brief, Drs. Dana Dunleavy and Blake Parsons discuss the specifics of implanting lumbar spinal cord stimulation. They explore patient positioning, anesthesia, needle angulation, and the importance of targeting spinal levels correlated to pain.


TIMESTAMPS


00:00 - Pre-Operative Setup

02:10 - Obtaining Access and Placing Leads

05:05 - Postoperative Considerations

08:43 - Evaluation of Patient Candidacy


CHECK OUT THE FULL EPISODE


BackTable MSK Ep. 48– SCS for Neuropathy: Clinical Insights & Patient Impact:

https://www.backtable.com/shows/msk/podcasts/48/scs-for-neuropathy-clinical-insights-patient-impact

]]> 711 Ep. 61 Ablation Techniques for Acetabular Lesions with Dr. Jason Levy Acetabular lesions present unique challenges for interventionalists due to their location within the pelvis. In this episode of the BackTable Podcast, host Dr. Jacob Fleming interviews Dr. Jason Levy, an experienced practitioner in musculoskeletal interventional oncology based in Atlanta, Georgia, about techniques for ablating acetabular lesions. --- This podcast is supported by an educational grant from Medtronic. --- SYNPOSIS The doctors discuss the unique considerations involved in treating the acetabulum, including its susceptibility to various axial loading, shear, and torsion forces. Dr. Levy prefers to use radiofrequency ablation combined with cement augmentation to enhance joint stability. He outlines the procedural steps and shares his preferred imaging methods. Additionally, he addresses potential complications, such as instability from inadequate cement delivery, cement leakage into the hip joint space, and avascular necrosis. Throughout the episode, the doctors emphasize the importance of collaboration with orthopedic oncologists and staying updated on current research in musculoskeletal interventional oncology. --- TIMESTAMPS 00:00 - Introduction 05:11 - Unique Considerations for Acetabular Lesions 09:06 - Collaboration with Orthopedic Oncologists 13:10 - Anatomy and Procedural Steps 24:40 - Preventing Complications 35:25 - Concluding Thoughts --- RESOURCES BackTable MSK Ep. 17- Multidisciplinary Approach to Treating Spinal Metastases with Dr. Jason Levy and Dr. Amir Lavaf: https://www.backtable.com/shows/msk/podcasts/17/multidisciplinary-approach-to-treating-spinal-metastases BackTable VI Ep. 68- RF Ablation Therapy for Bone Metastases with Dr. Jason Levy and Dr. Sandeep Bagla: https://www.backtable.com/shows/vi/podcasts/68/rf-ablation-therapy-for-bone-metastases BackTable MSK Ep. 12- Ortho/IR Collaboration in Private Practice: https://www.backtable.com/shows/msk/podcasts/12/ortho-ir-collaboration-in-private-practice Radiofrequency Ablation for the Palliative Treatment of Bone Metastases: Outcomes from the Multicenter OsteoCool Tumor Ablation Post-Market Study (OPuS One Study): https://pubmed.ncbi.nlm.nih.gov/33129427/ Hip Joint Distraction Technique during Cryoablation of Acetabular Bone Tumor to Prevent Femoral Head Osteonecrosis: https://www.jvir.org/article/S1051-0443(22)01119-8/fulltext Tue, 15 Oct 2024 07:00:00 -0000 full BackTable Acetabular lesions present unique challenges for interventionalists due to their location within the pelvis. In this episode of the BackTable Podcast, host Dr. Jacob Fleming interviews Dr. Jason Levy, an experienced practitioner in musculoskeletal interventional oncology based in Atlanta, Georgia, about techniques for ablating acetabular lesions. Acetabular lesions present unique challenges for interventionalists due to their location within the pelvis. In this episode of the BackTable Podcast, host Dr. Jacob Fleming interviews Dr. Jason Levy, an experienced practitioner in musculoskeletal interventional oncology based in Atlanta, Georgia, about techniques for ablating acetabular lesions. --- This podcast is supported by an educational grant from Medtronic. --- SYNPOSIS The doctors discuss the unique considerations involved in treating the acetabulum, including its susceptibility to various axial loading, shear, and torsion forces. Dr. Levy prefers to use radiofrequency ablation combined with cement augmentation to enhance joint stability. He outlines the procedural steps and shares his preferred imaging methods. Additionally, he addresses potential complications, such as instability from inadequate cement delivery, cement leakage into the hip joint space, and avascular necrosis. Throughout the episode, the doctors emphasize the importance of collaboration with orthopedic oncologists and staying updated on current research in musculoskeletal interventional oncology. --- TIMESTAMPS 00:00 - Introduction 05:11 - Unique Considerations for Acetabular Lesions 09:06 - Collaboration with Orthopedic Oncologists 13:10 - Anatomy and Procedural Steps 24:40 - Preventing Complications 35:25 - Concluding Thoughts --- RESOURCES BackTable MSK Ep. 17- Multidisciplinary Approach to Treating Spinal Metastases with Dr. Jason Levy and Dr. Amir Lavaf: https://www.backtable.com/shows/msk/podcasts/17/multidisciplinary-approach-to-treating-spinal-metastases BackTable VI Ep. 68- RF Ablation Therapy for Bone Metastases with Dr. Jason Levy and Dr. Sandeep Bagla: https://www.backtable.com/shows/vi/podcasts/68/rf-ablation-therapy-for-bone-metastases BackTable MSK Ep. 12- Ortho/IR Collaboration in Private Practice: https://www.backtable.com/shows/msk/podcasts/12/ortho-ir-collaboration-in-private-practice Radiofrequency Ablation for the Palliative Treatment of Bone Metastases: Outcomes from the Multicenter OsteoCool Tumor Ablation Post-Market Study (OPuS One Study): https://pubmed.ncbi.nlm.nih.gov/33129427/ Hip Joint Distraction Technique during Cryoablation of Acetabular Bone Tumor to Prevent Femoral Head Osteonecrosis: https://www.jvir.org/article/S1051-0443(22)01119-8/fulltext Acetabular lesions present unique challenges for interventionalists due to their location within the pelvis. In this episode of the BackTable Podcast, host Dr. Jacob Fleming interviews Dr. Jason Levy, an experienced practitioner in musculoskeletal interventional oncology based in Atlanta, Georgia, about techniques for ablating acetabular lesions.


---


This podcast is supported by an educational grant from Medtronic.


---


SYNPOSIS


The doctors discuss the unique considerations involved in treating the acetabulum, including its susceptibility to various axial loading, shear, and torsion forces. Dr. Levy prefers to use radiofrequency ablation combined with cement augmentation to enhance joint stability. He outlines the procedural steps and shares his preferred imaging methods. Additionally, he addresses potential complications, such as instability from inadequate cement delivery, cement leakage into the hip joint space, and avascular necrosis. Throughout the episode, the doctors emphasize the importance of collaboration with orthopedic oncologists and staying updated on current research in musculoskeletal interventional oncology.


---


TIMESTAMPS


00:00 - Introduction

05:11 - Unique Considerations for Acetabular Lesions

09:06 - Collaboration with Orthopedic Oncologists

13:10 - Anatomy and Procedural Steps

24:40 - Preventing Complications

35:25 - Concluding Thoughts


---


RESOURCES


BackTable MSK Ep. 17- Multidisciplinary Approach to Treating Spinal Metastases with Dr. Jason Levy and Dr. Amir Lavaf:

https://www.backtable.com/shows/msk/podcasts/17/multidisciplinary-approach-to-treating-spinal-metastases


BackTable VI Ep. 68- RF Ablation Therapy for Bone Metastases with Dr. Jason Levy and Dr. Sandeep Bagla:

https://www.backtable.com/shows/vi/podcasts/68/rf-ablation-therapy-for-bone-metastases



BackTable MSK Ep. 12- Ortho/IR Collaboration in Private Practice:

https://www.backtable.com/shows/msk/podcasts/12/ortho-ir-collaboration-in-private-practice



Radiofrequency Ablation for the Palliative Treatment of Bone Metastases: Outcomes from the Multicenter OsteoCool Tumor Ablation Post-Market Study (OPuS One Study):

https://pubmed.ncbi.nlm.nih.gov/33129427/



Hip Joint Distraction Technique during Cryoablation of Acetabular Bone Tumor to Prevent Femoral Head Osteonecrosis:

https://www.jvir.org/article/S1051-0443(22)01119-8/fulltext

]]> 2686 Ep. 60 Musculoskeletal Tumor Embolizations with Dr. Gina Landinez Tumor embolization is a versatile procedure that can provide symptomatic and long-term benefits for patients. In this episode of BackTable MSK, host Dr. Michael Barraza discusses musculoskeletal tumor embolizations with Dr. Gina Landinez from the Miami Cardiac and Vascular Institute, where she is helping to grow the MSK interventions program. --- SYNPOSIS Dr. Landinez explains that the main indications for embolization are preoperative tumor shrinkage and pain palliation. Embolization decreases hemorrhagic risk and procedure time during surgical resection and leads to better surgical margins. Pain palliation can also be achieved due to tumor size reduction and decreased pressure on surrounding nerves and tissue. Dr. Landinez explains that lesions well-suited embolization are hypervascular, large, not sensitive to radiation, and painful. She also describes the risks of off-target skin and muscle embolization and the importance of exercising caution with vertebral tumors. Finally, Dr. Landinez shares valuable practice-building tips about developing relationships with orthopedic surgeons and providing adequate follow up care. --- TIMESTAMPS 00:00 - Introduction 03:51 - Indications for Embolization 08:08 - Building Referral Networks 13:45 - Preoperative Planning 18:34 - Technical Aspects of Embolization 27:25 - Challenges and Considerations 31:23 - Importance of Outpatient Follow Up Fri, 11 Oct 2024 07:00:00 -0000 full BackTable Tumor embolization is a versatile procedure that can provide symptomatic and long-term benefits for patients. In this episode of BackTable MSK, host Dr. Michael Barraza discusses musculoskeletal tumor embolizations with Dr. Gina Landinez from the Miami Cardiac and Vascular Institute, where she is helping to grow the MSK interventions program. Tumor embolization is a versatile procedure that can provide symptomatic and long-term benefits for patients. In this episode of BackTable MSK, host Dr. Michael Barraza discusses musculoskeletal tumor embolizations with Dr. Gina Landinez from the Miami Cardiac and Vascular Institute, where she is helping to grow the MSK interventions program. --- SYNPOSIS Dr. Landinez explains that the main indications for embolization are preoperative tumor shrinkage and pain palliation. Embolization decreases hemorrhagic risk and procedure time during surgical resection and leads to better surgical margins. Pain palliation can also be achieved due to tumor size reduction and decreased pressure on surrounding nerves and tissue. Dr. Landinez explains that lesions well-suited embolization are hypervascular, large, not sensitive to radiation, and painful. She also describes the risks of off-target skin and muscle embolization and the importance of exercising caution with vertebral tumors. Finally, Dr. Landinez shares valuable practice-building tips about developing relationships with orthopedic surgeons and providing adequate follow up care. --- TIMESTAMPS 00:00 - Introduction 03:51 - Indications for Embolization 08:08 - Building Referral Networks 13:45 - Preoperative Planning 18:34 - Technical Aspects of Embolization 27:25 - Challenges and Considerations 31:23 - Importance of Outpatient Follow Up Tumor embolization is a versatile procedure that can provide symptomatic and long-term benefits for patients. In this episode of BackTable MSK, host Dr. Michael Barraza discusses musculoskeletal tumor embolizations with Dr. Gina Landinez from the Miami Cardiac and Vascular Institute, where she is helping to grow the MSK interventions program.


---


SYNPOSIS


Dr. Landinez explains that the main indications for embolization are preoperative tumor shrinkage and pain palliation. Embolization decreases hemorrhagic risk and procedure time during surgical resection and leads to better surgical margins. Pain palliation can also be achieved due to tumor size reduction and decreased pressure on surrounding nerves and tissue. Dr. Landinez explains that lesions well-suited embolization are hypervascular, large, not sensitive to radiation, and painful. She also describes the risks of off-target skin and muscle embolization and the importance of exercising caution with vertebral tumors.

Finally, Dr. Landinez shares valuable practice-building tips about developing relationships with orthopedic surgeons and providing adequate follow up care.


---


TIMESTAMPS


00:00 - Introduction

03:51 - Indications for Embolization

08:08 - Building Referral Networks

13:45 - Preoperative Planning

18:34 - Technical Aspects of Embolization

27:25 - Challenges and Considerations

31:23 - Importance of Outpatient Follow Up

]]> 2209 Backtable Brief: Spinal Cord Stimulators, Trials to Permanents with Dr. Blake Parsons Interventional radiologists can play a vital role in pain management and palliative care through spinal cord stimulation (SCS). In this BackTable Brief, Dr. Dana Dunleavy speaks with Dr. Blake Parsons about this technology and the learning opportunities it presents. Dr. Parsons reflects on his introduction to outpatient spinal cord stimulation during his training at the Medical College of Wisconsin, where he gained exposure to both palliative care and interventional oncology. He discusses the technical aspects and challenges associated with permanent SCS procedures, including accessing the epidural space and the risks of nerve injury. Additionally, Dr. Parsons explores the economic considerations of SCS, comparing reimbursement rates for trials and permanent implants across various settings. TIMESTAMPS 00:00 - Introduction 02:38 - Understanding Permanent Implants 04:38 - Procedure Details and Challenges 06:52 - Reimbursement and Financial Considerations 09:28 - Time Utilization and Efficiency 11:44 - Final Thoughts CHECK OUT THE FULL EPISODE BackTable MSK Ep. 48– SCS for Neuropathy: Clinical Insights & Patient Impact: https://www.backtable.com/shows/msk/podcasts/48/scs-for-neuropathy-clinical-insights-patient-impact Tue, 08 Oct 2024 07:00:00 -0000 full BackTable Interventional radiologists can play a vital role in pain management and palliative care through spinal cord stimulation (SCS). In this BackTable Brief, Dr. Dana Dunleavy speaks with Dr. Blake Parsons about this technology and the learning opportunities it presents. Interventional radiologists can play a vital role in pain management and palliative care through spinal cord stimulation (SCS). In this BackTable Brief, Dr. Dana Dunleavy speaks with Dr. Blake Parsons about this technology and the learning opportunities it presents. Dr. Parsons reflects on his introduction to outpatient spinal cord stimulation during his training at the Medical College of Wisconsin, where he gained exposure to both palliative care and interventional oncology. He discusses the technical aspects and challenges associated with permanent SCS procedures, including accessing the epidural space and the risks of nerve injury. Additionally, Dr. Parsons explores the economic considerations of SCS, comparing reimbursement rates for trials and permanent implants across various settings. TIMESTAMPS 00:00 - Introduction 02:38 - Understanding Permanent Implants 04:38 - Procedure Details and Challenges 06:52 - Reimbursement and Financial Considerations 09:28 - Time Utilization and Efficiency 11:44 - Final Thoughts CHECK OUT THE FULL EPISODE BackTable MSK Ep. 48– SCS for Neuropathy: Clinical Insights & Patient Impact: https://www.backtable.com/shows/msk/podcasts/48/scs-for-neuropathy-clinical-insights-patient-impact Interventional radiologists can play a vital role in pain management and palliative care through spinal cord stimulation (SCS). In this BackTable Brief, Dr. Dana Dunleavy speaks with Dr. Blake Parsons about this technology and the learning opportunities it presents.


Dr. Parsons reflects on his introduction to outpatient spinal cord stimulation during his training at the Medical College of Wisconsin, where he gained exposure to both palliative care and interventional oncology. He discusses the technical aspects and challenges associated with permanent SCS procedures, including accessing the epidural space and the risks of nerve injury. Additionally, Dr. Parsons explores the economic considerations of SCS, comparing reimbursement rates for trials and permanent implants across various settings.


TIMESTAMPS


00:00 - Introduction

02:38 - Understanding Permanent Implants

04:38 - Procedure Details and Challenges

06:52 - Reimbursement and Financial Considerations

09:28 - Time Utilization and Efficiency

11:44 - Final Thoughts


CHECK OUT THE FULL EPISODE


BackTable MSK Ep. 48– SCS for Neuropathy: Clinical Insights & Patient Impact:

https://www.backtable.com/shows/msk/podcasts/48/scs-for-neuropathy-clinical-insights-patient-impact

]]> 837 Ep. 59 Minimally Invasive Bone Grafting and Orthopedic Innovation with Dr. Jim Marino More often than not, a surgical innovation is not the result of an overnight success, but rather the result of iterative improvements on a tool or technique that leads to better outcomes. In this episode of the BackTable MSK Podcast, we interview Dr. Jim Marino, a retired orthopedic surgeon and prolific medtech innovator. Dr. Marino gives us an inside look at his extensive career, detailing his role in orthopedic device innovation and the trials and tribulations that he faced along the way. --- SYNPOSIS Having trained in an era where joint arthroscopy was emerging, Dr. Marino had a vision to build devices for minimally invasive spine surgery that paralleled developments in peripheral joint surgery. Alongside venture capitalists, he founded the company NuVasive, and eventually Trinity Orthopedics. He discusses the COREX device, a percutaneous autologous bone harvester that rivals the use of biologics. COREX maintains the gold standard of using cancellous bone grafts and significantly decreases donor site pain. Applications for this device started with bone grafting for spinal fusion surgery, but are now expanding to foot and ankle procedures. Throughout this episode, Dr. Marino also shares valuable advice for aspiring physician innovators on maintaining a clinical practice during the entrepreneurship journey and balancing patient safety with innovative practices. --- TIMESTAMPS 00:00 - Introduction 14:34 - Reflections on Spine Innovation 25:03 - Clinical and Radiographic Evaluation 31:50 - Founding NuVasive: From Ideas to Reality 43:28 - Minimally Invasive Bone Grafting with COREX 1:00:06 - Future Applications of COREX 01:10:21 - Advice for Aspiring Physician Innovators --- RESOURCES NuVasive: https://www.nuvasive.com/ COREX Minimally Invasive Bone Harvester: https://trinityorthodevice.com/ YODA Project for rhBMP-2 safety and efficacy : https://yoda.yale.edu/about/data-holders/medtronicrhbmp-2/ Seattle Science Foundation YouTube: https://www.youtube.com/channel/UChIIig54yF9aQYvpWGe1DPg Tue, 01 Oct 2024 07:00:00 -0000 full BackTable More often than not, a surgical innovation is not the result of an overnight success, but rather the result of iterative improvements on a tool or technique that leads to better outcomes. In this episode of the BackTable MSK Podcast, we interview Dr. Jim Marino, a retired orthopedic surgeon and prolific medtech innovator. Dr. Marino gives us an inside look at his extensive career, detailing his role in orthopedic device innovation and the trials and tribulations that he faced along the way. More often than not, a surgical innovation is not the result of an overnight success, but rather the result of iterative improvements on a tool or technique that leads to better outcomes. In this episode of the BackTable MSK Podcast, we interview Dr. Jim Marino, a retired orthopedic surgeon and prolific medtech innovator. Dr. Marino gives us an inside look at his extensive career, detailing his role in orthopedic device innovation and the trials and tribulations that he faced along the way. --- SYNPOSIS Having trained in an era where joint arthroscopy was emerging, Dr. Marino had a vision to build devices for minimally invasive spine surgery that paralleled developments in peripheral joint surgery. Alongside venture capitalists, he founded the company NuVasive, and eventually Trinity Orthopedics. He discusses the COREX device, a percutaneous autologous bone harvester that rivals the use of biologics. COREX maintains the gold standard of using cancellous bone grafts and significantly decreases donor site pain. Applications for this device started with bone grafting for spinal fusion surgery, but are now expanding to foot and ankle procedures. Throughout this episode, Dr. Marino also shares valuable advice for aspiring physician innovators on maintaining a clinical practice during the entrepreneurship journey and balancing patient safety with innovative practices. --- TIMESTAMPS 00:00 - Introduction 14:34 - Reflections on Spine Innovation 25:03 - Clinical and Radiographic Evaluation 31:50 - Founding NuVasive: From Ideas to Reality 43:28 - Minimally Invasive Bone Grafting with COREX 1:00:06 - Future Applications of COREX 01:10:21 - Advice for Aspiring Physician Innovators --- RESOURCES NuVasive: https://www.nuvasive.com/ COREX Minimally Invasive Bone Harvester: https://trinityorthodevice.com/ YODA Project for rhBMP-2 safety and efficacy : https://yoda.yale.edu/about/data-holders/medtronicrhbmp-2/ Seattle Science Foundation YouTube: https://www.youtube.com/channel/UChIIig54yF9aQYvpWGe1DPg More often than not, a surgical innovation is not the result of an overnight success, but rather the result of iterative improvements on a tool or technique that leads to better outcomes. In this episode of the BackTable MSK Podcast, we interview Dr. Jim Marino, a retired orthopedic surgeon and prolific medtech innovator. Dr. Marino gives us an inside look at his extensive career, detailing his role in orthopedic device innovation and the trials and tribulations that he faced along the way.


---


SYNPOSIS


Having trained in an era where joint arthroscopy was emerging, Dr. Marino had a vision to build devices for minimally invasive spine surgery that paralleled developments in peripheral joint surgery. Alongside venture capitalists, he founded the company NuVasive, and eventually Trinity Orthopedics. He discusses the COREX device, a percutaneous autologous bone harvester that rivals the use of biologics. COREX maintains the gold standard of using cancellous bone grafts and significantly decreases donor site pain. Applications for this device started with bone grafting for spinal fusion surgery, but are now expanding to foot and ankle procedures.

Throughout this episode, Dr. Marino also shares valuable advice for aspiring physician innovators on maintaining a clinical practice during the entrepreneurship journey and balancing patient safety with innovative practices.


---


TIMESTAMPS


00:00 - Introduction

14:34 - Reflections on Spine Innovation

25:03 - Clinical and Radiographic Evaluation

31:50 - Founding NuVasive: From Ideas to Reality

43:28 - Minimally Invasive Bone Grafting with COREX

1:00:06 - Future Applications of COREX

01:10:21 - Advice for Aspiring Physician Innovators


---


RESOURCES


NuVasive:

https://www.nuvasive.com/


COREX Minimally Invasive Bone Harvester:

https://trinityorthodevice.com/


YODA Project for rhBMP-2 safety and efficacy :

https://yoda.yale.edu/about/data-holders/medtronicrhbmp-2/


Seattle Science Foundation YouTube:

https://www.youtube.com/channel/UChIIig54yF9aQYvpWGe1DPg

]]> 4761 Ep. 58 Genicular Artery Embolization: How I Do It with Dr. Osman Ahmed Genicular artery embolization (GAE) is quickly emerging as a treatment option for knee osteoarthritis when other therapies have failed. In this episode of the BackTable Podcast, Dr. Osman Ahmed discusses the origins of GAE and how he employs it in his practice. --- This podcast is supported by an educational grant from Guerbet. --- SYNPOSIS Dr. Ahmed, an interventional radiologist at the University of Chicago, shares details about the procedure, his journey in adopting it, and his thoughts on the current landscape of GAE. Topics include procedural techniques, patient selection, anatomical considerations, potential complications, and the importance of ongoing research in this field. --- TIMESTAMPS 00:00 - Introduction 04:43 - Knee Osteoarthritis and Current Treatments 07:54 - Building a GAE Practice 13:23 - Tools and Procedure: Step-by-Step 25:05 - Post-Procedure Care and Complications 30:26 - Future of GAE and Other Applications 34:03 - Conclusion and Contact Information --- RESOURCES BackTable INN Ep. 46- New Innovations in Treatment of PE: The Flow Medical Story with Founders Dr. Osman Ahmed and Dr. Jonathan Paul: https://www.backtable.com/shows/innovation/podcasts/46/new-innovations-in-treatment-of-pe-the-flow-medical-story BackTable VI Ep. 429- Tackling Upper GI Bleeds: Techniques and Tools with Dr. Osman Ahmed: https://www.backtable.com/shows/vi/podcasts/429/tackling-upper-gi-bleeds-techniques-tools BackTable VI Ep. 447- Exploring GAE: Clinical Insights & Outcomes with Dr. Mark Little: https://www.backtable.com/shows/vi/podcasts/447/exploring-gae-clinical-insights-outcomes GEST MSK Conference 2025 (Paris): https://www.gestmsk.com/ Okuno Y et al. Transcatheter arterial embolization as a treatment for medial knee pain in patients with mild to moderate osteoarthritis (2014): https://pubmed.ncbi.nlm.nih.gov/24993956/ Little MW et al. Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS 1) Using Permanent Microspheres: Interim Analysis (2021): https://pubmed.ncbi.nlm.nih.gov/33474601/ Little MW et al. Genicular Artery Embolisation in Patients with Osteoarthritis of the Knee (GENESIS 2): Protocol for a Double-Blind Randomised Sham-Controlled Trial (2023): https://pubmed.ncbi.nlm.nih.gov/37337060/ Correa MP et al.GAUCHO - Trial Genicular Artery Embolization Using Imipenem/Cilastatin vs. Microsphere for Knee Osteoarthritis: A Randomized Controlled Trial (2022): https://pubmed.ncbi.nlm.nih.gov/35304614/ Sapoval M et al. Genicular artery embolization for knee osteoarthritis: Results of the LipioJoint-1 trial (2024): https://pubmed.ncbi.nlm.nih.gov/38102013/ Fri, 20 Sep 2024 07:00:00 -0000 full BackTable Genicular artery embolization (GAE) is quickly emerging as a treatment option for knee osteoarthritis when other therapies have failed. In this episode of the BackTable Podcast, Dr. Osman Ahmed discusses the origins of GAE and how he employs it in his practice. Genicular artery embolization (GAE) is quickly emerging as a treatment option for knee osteoarthritis when other therapies have failed. In this episode of the BackTable Podcast, Dr. Osman Ahmed discusses the origins of GAE and how he employs it in his practice. --- This podcast is supported by an educational grant from Guerbet. --- SYNPOSIS Dr. Ahmed, an interventional radiologist at the University of Chicago, shares details about the procedure, his journey in adopting it, and his thoughts on the current landscape of GAE. Topics include procedural techniques, patient selection, anatomical considerations, potential complications, and the importance of ongoing research in this field. --- TIMESTAMPS 00:00 - Introduction 04:43 - Knee Osteoarthritis and Current Treatments 07:54 - Building a GAE Practice 13:23 - Tools and Procedure: Step-by-Step 25:05 - Post-Procedure Care and Complications 30:26 - Future of GAE and Other Applications 34:03 - Conclusion and Contact Information --- RESOURCES BackTable INN Ep. 46- New Innovations in Treatment of PE: The Flow Medical Story with Founders Dr. Osman Ahmed and Dr. Jonathan Paul: https://www.backtable.com/shows/innovation/podcasts/46/new-innovations-in-treatment-of-pe-the-flow-medical-story BackTable VI Ep. 429- Tackling Upper GI Bleeds: Techniques and Tools with Dr. Osman Ahmed: https://www.backtable.com/shows/vi/podcasts/429/tackling-upper-gi-bleeds-techniques-tools BackTable VI Ep. 447- Exploring GAE: Clinical Insights & Outcomes with Dr. Mark Little: https://www.backtable.com/shows/vi/podcasts/447/exploring-gae-clinical-insights-outcomes GEST MSK Conference 2025 (Paris): https://www.gestmsk.com/ Okuno Y et al. Transcatheter arterial embolization as a treatment for medial knee pain in patients with mild to moderate osteoarthritis (2014): https://pubmed.ncbi.nlm.nih.gov/24993956/ Little MW et al. Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS 1) Using Permanent Microspheres: Interim Analysis (2021): https://pubmed.ncbi.nlm.nih.gov/33474601/ Little MW et al. Genicular Artery Embolisation in Patients with Osteoarthritis of the Knee (GENESIS 2): Protocol for a Double-Blind Randomised Sham-Controlled Trial (2023): https://pubmed.ncbi.nlm.nih.gov/37337060/ Correa MP et al.GAUCHO - Trial Genicular Artery Embolization Using Imipenem/Cilastatin vs. Microsphere for Knee Osteoarthritis: A Randomized Controlled Trial (2022): https://pubmed.ncbi.nlm.nih.gov/35304614/ Sapoval M et al. Genicular artery embolization for knee osteoarthritis: Results of the LipioJoint-1 trial (2024): https://pubmed.ncbi.nlm.nih.gov/38102013/ Genicular artery embolization (GAE) is quickly emerging as a treatment option for knee osteoarthritis when other therapies have failed. In this episode of the BackTable Podcast, Dr. Osman Ahmed discusses the origins of GAE and how he employs it in his practice.


---


This podcast is supported by an educational grant from Guerbet.


---


SYNPOSIS


Dr. Ahmed, an interventional radiologist at the University of Chicago, shares details about the procedure, his journey in adopting it, and his thoughts on the current landscape of GAE. Topics include procedural techniques, patient selection, anatomical considerations, potential complications, and the importance of ongoing research in this field.


---


TIMESTAMPS


00:00 - Introduction

04:43 - Knee Osteoarthritis and Current Treatments

07:54 - Building a GAE Practice

13:23 - Tools and Procedure: Step-by-Step

25:05 - Post-Procedure Care and Complications

30:26 - Future of GAE and Other Applications

34:03 - Conclusion and Contact Information



---


RESOURCES


BackTable INN Ep. 46- New Innovations in Treatment of PE: The Flow Medical Story

with Founders Dr. Osman Ahmed and Dr. Jonathan Paul:

https://www.backtable.com/shows/innovation/podcasts/46/new-innovations-in-treatment-of-pe-the-flow-medical-story


BackTable VI Ep. 429- Tackling Upper GI Bleeds: Techniques and Tools with Dr. Osman Ahmed:

https://www.backtable.com/shows/vi/podcasts/429/tackling-upper-gi-bleeds-techniques-tools


BackTable VI Ep. 447- Exploring GAE: Clinical Insights & Outcomes with Dr. Mark Little:

https://www.backtable.com/shows/vi/podcasts/447/exploring-gae-clinical-insights-outcomes


GEST MSK Conference 2025 (Paris):

https://www.gestmsk.com/


Okuno Y et al. Transcatheter arterial embolization as a treatment for medial knee pain in patients with mild to moderate osteoarthritis (2014):

https://pubmed.ncbi.nlm.nih.gov/24993956/


Little MW et al. Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS 1) Using Permanent Microspheres: Interim Analysis (2021):

https://pubmed.ncbi.nlm.nih.gov/33474601/


Little MW et al. Genicular Artery Embolisation in Patients with Osteoarthritis of the Knee (GENESIS 2): Protocol for a Double-Blind Randomised Sham-Controlled Trial (2023):

https://pubmed.ncbi.nlm.nih.gov/37337060/


Correa MP et al.GAUCHO - Trial Genicular Artery Embolization Using Imipenem/Cilastatin vs. Microsphere for Knee Osteoarthritis: A Randomized Controlled Trial (2022):

https://pubmed.ncbi.nlm.nih.gov/35304614/


Sapoval M et al. Genicular artery embolization for knee osteoarthritis: Results of the LipioJoint-1 trial (2024):

https://pubmed.ncbi.nlm.nih.gov/38102013/

]]> 2266 BackTable Brief: Decisions that Prioritize Patient Welfare with Dr. Sean Tutton Decisions that prioritize patient welfare can often be challenging with our physician bias toward action. Interventional radiologists Dr. Eric Keller and Dr. Sean Tutton highlight the importance of education in discussions about end-of-life care and futility. Dr. Tutton shares a poignant story illustrating the necessity of team-based approaches to futile procedures. They also discuss ethical considerations of IR procedures, the significance of proper consent, and the true costs of ‘expensive hope.’  TIMESTAMPS 00:00 - Importance of Training in End-of-Life Conversations 02:15 - Case Study: Ruptured AAA in a High Risk Patient 05:26 - Ethical Dilemmas in Interventional Radiology CHECK OUT THE FULL EPISODE BackTable MSK Ep. 27: Palliative Care in IR with Dr. Sean Tutton: https://www.backtable.com/shows/msk/podcasts/27/palliative-care-in-ir Tue, 10 Sep 2024 07:00:00 -0000 full BackTable Decisions that prioritize patient welfare can often be challenging with our physician bias toward action. Interventional radiologists Dr. Eric Keller and Dr. Sean Tutton highlight the importance of education in discussions about end-of-life care and futility. Dr. Tutton shares a poignant story illustrating the necessity of team-based approaches to futile procedures. They also discuss ethical considerations of IR procedures, the significance of proper consent, and the true costs of ‘expensive hope.’ Decisions that prioritize patient welfare can often be challenging with our physician bias toward action. Interventional radiologists Dr. Eric Keller and Dr. Sean Tutton highlight the importance of education in discussions about end-of-life care and futility. Dr. Tutton shares a poignant story illustrating the necessity of team-based approaches to futile procedures. They also discuss ethical considerations of IR procedures, the significance of proper consent, and the true costs of ‘expensive hope.’  TIMESTAMPS 00:00 - Importance of Training in End-of-Life Conversations 02:15 - Case Study: Ruptured AAA in a High Risk Patient 05:26 - Ethical Dilemmas in Interventional Radiology CHECK OUT THE FULL EPISODE BackTable MSK Ep. 27: Palliative Care in IR with Dr. Sean Tutton: https://www.backtable.com/shows/msk/podcasts/27/palliative-care-in-ir Decisions that prioritize patient welfare can often be challenging with our physician bias toward action. Interventional radiologists Dr. Eric Keller and Dr. Sean Tutton highlight the importance of education in discussions about end-of-life care and futility. Dr. Tutton shares a poignant story illustrating the necessity of team-based approaches to futile procedures. They also discuss ethical considerations of IR procedures, the significance of proper consent, and the true costs of ‘expensive hope.’ 


TIMESTAMPS


00:00 - Importance of Training in End-of-Life Conversations

02:15 - Case Study: Ruptured AAA in a High Risk Patient

05:26 - Ethical Dilemmas in Interventional Radiology


CHECK OUT THE FULL EPISODE


BackTable MSK Ep. 27: Palliative Care in IR with Dr. Sean Tutton:

https://www.backtable.com/shows/msk/podcasts/27/palliative-care-in-ir

]]> 638 Ep. 57 Building a Successful MSK Service Line with Dr. Igor Latich Building a top-tier musculoskeletal (MSK) interventional service line involves taking risks, continuously learning, and always being available for your patients, according to Dr. Igor Latich, an interventional radiologist at the Yale School of Medicine. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SYNPOSIS He discusses his passion for MSK interventions and his collaborative efforts with orthopedic surgeons, radiation oncologists, and industry partners to develop his comprehensive service line. Dr. Latich provides examples of exploring new procedures, such as cervical ablations. His key advice for navigating new territories includes closely studying the patient’s anatomy, reviewing the literature on prior procedures, and communicating with industry partners about the necessary tools. Finally, Dr. Latich underscores the importance of establishing a strong clinical practice and being consistently available to patients to build trust and goodwill. --- TIMESTAMPS 00:00 Introduction 05:33 Carving a Niche in MSK Interventions 16:30 Learning from Global Perspectives 19:48 Collaborations and Overcoming Challenges 24:20 Importance of Building a Clinical Presence 34:30 Learning New Procedures 39:17 Industry Collaboration and Device Innovation 44:22 Maximizing Availability and Support 53:16 Prioritizing Clinical Acumen and Learning Tue, 03 Sep 2024 07:00:00 -0000 full BackTable Building a top-tier musculoskeletal (MSK) interventional service line involves taking risks, continuously learning, and always being available for your patients, according to Dr. Igor Latich, an interventional radiologist at the Yale School of Medicine. Building a top-tier musculoskeletal (MSK) interventional service line involves taking risks, continuously learning, and always being available for your patients, according to Dr. Igor Latich, an interventional radiologist at the Yale School of Medicine. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SYNPOSIS He discusses his passion for MSK interventions and his collaborative efforts with orthopedic surgeons, radiation oncologists, and industry partners to develop his comprehensive service line. Dr. Latich provides examples of exploring new procedures, such as cervical ablations. His key advice for navigating new territories includes closely studying the patient’s anatomy, reviewing the literature on prior procedures, and communicating with industry partners about the necessary tools. Finally, Dr. Latich underscores the importance of establishing a strong clinical practice and being consistently available to patients to build trust and goodwill. --- TIMESTAMPS 00:00 Introduction 05:33 Carving a Niche in MSK Interventions 16:30 Learning from Global Perspectives 19:48 Collaborations and Overcoming Challenges 24:20 Importance of Building a Clinical Presence 34:30 Learning New Procedures 39:17 Industry Collaboration and Device Innovation 44:22 Maximizing Availability and Support 53:16 Prioritizing Clinical Acumen and Learning Building a top-tier musculoskeletal (MSK) interventional service line involves taking risks, continuously learning, and always being available for your patients, according to Dr. Igor Latich, an interventional radiologist at the Yale School of Medicine.


---


CHECK OUT OUR SPONSOR


Stryker Interventional Spine

https://www.strykerivs.com


---


SYNPOSIS


He discusses his passion for MSK interventions and his collaborative efforts with orthopedic surgeons, radiation oncologists, and industry partners to develop his comprehensive service line. Dr. Latich provides examples of exploring new procedures, such as cervical ablations. His key advice for navigating new territories includes closely studying the patient’s anatomy, reviewing the literature on prior procedures, and communicating with industry partners about the necessary tools. Finally, Dr. Latich underscores the importance of establishing a strong clinical practice and being consistently available to patients to build trust and goodwill.


---


TIMESTAMPS


00:00 Introduction

05:33 Carving a Niche in MSK Interventions

16:30 Learning from Global Perspectives

19:48 Collaborations and Overcoming Challenges

24:20 Importance of Building a Clinical Presence

34:30 Learning New Procedures

39:17 Industry Collaboration and Device Innovation

44:22 Maximizing Availability and Support

53:16 Prioritizing Clinical Acumen and Learning


]]> 3886 BackTable Brief: What is Palliative Care vs Hospice? with Dr. Sean Tutton What is the difference between palliative care and hospice? Dr. Sean Tutton clarifies the distinctions and interactions between the two. He explains that palliative care focuses on symptom management and improving quality of life, while addressing common misconceptions about it. Dr. Tutton also provides insights on the role of palliative care physicians and emphasizes the importance of integrating palliative care into treatment plans for patients with terminal or chronic diseases. Additionally, the conversation offers practical advice for interventional radiologists on how to communicate effectively with patients about their conditions and treatment goals. TIMESTAMPS 00:00 - Defining Palliative Care  03:20 - Challenges in Palliative Care Referrals 06:44 - Practical Approaches for Interventional Radiologists 07:51 - Effective Communication with Patients 09:24 - Conclusion and Final Thoughts CHECK OUT THE FULL EPISODE BackTable MSK Ep. 27: Palliative Care in IR with Dr. Sean Tutton: https://www.backtable.com/shows/msk/podcasts/27/palliative-care-in-ir Tue, 27 Aug 2024 07:00:00 -0000 full BackTable What is the difference between palliative care and hospice? Dr. Sean Tutton clarifies the distinctions and interactions between the two. What is the difference between palliative care and hospice? Dr. Sean Tutton clarifies the distinctions and interactions between the two. He explains that palliative care focuses on symptom management and improving quality of life, while addressing common misconceptions about it. Dr. Tutton also provides insights on the role of palliative care physicians and emphasizes the importance of integrating palliative care into treatment plans for patients with terminal or chronic diseases. Additionally, the conversation offers practical advice for interventional radiologists on how to communicate effectively with patients about their conditions and treatment goals. TIMESTAMPS 00:00 - Defining Palliative Care  03:20 - Challenges in Palliative Care Referrals 06:44 - Practical Approaches for Interventional Radiologists 07:51 - Effective Communication with Patients 09:24 - Conclusion and Final Thoughts CHECK OUT THE FULL EPISODE BackTable MSK Ep. 27: Palliative Care in IR with Dr. Sean Tutton: https://www.backtable.com/shows/msk/podcasts/27/palliative-care-in-ir What is the difference between palliative care and hospice? Dr. Sean Tutton clarifies the distinctions and interactions between the two. He explains that palliative care focuses on symptom management and improving quality of life, while addressing common misconceptions about it. Dr. Tutton also provides insights on the role of palliative care physicians and emphasizes the importance of integrating palliative care into treatment plans for patients with terminal or chronic diseases. Additionally, the conversation offers practical advice for interventional radiologists on how to communicate effectively with patients about their conditions and treatment goals.


TIMESTAMPS


00:00 - Defining Palliative Care 

03:20 - Challenges in Palliative Care Referrals

06:44 - Practical Approaches for Interventional Radiologists

07:51 - Effective Communication with Patients

09:24 - Conclusion and Final Thoughts


CHECK OUT THE FULL EPISODE


BackTable MSK Ep. 27: Palliative Care in IR with Dr. Sean Tutton:

https://www.backtable.com/shows/msk/podcasts/27/palliative-care-in-ir

]]> 725 BackTable Brief: Probe Options and Technique for Genicular Nerve Ablation with Dr. John Smirniotopoulos Intentional probe selection is an important part of any ablative procedure. This MSK Brief focuses on tools for genicular nerve ablation. Dr. John Smirniotopoulos shares his perspectives on radiofrequency ablation (RFA) and cryoablation probes, including the Cool Leaf probe and its benefits. He goes on to explain the procedure, including ablation techniques, motor stimulation tests, and handling potential complications such as synovitis and hemarthrosis. TIMESTAMPS 00:12 - Choosing the Right Probe 01:29 - Cryoablation vs. RFA: Pros and Cons 02:32 - Ablation Techniques and Strategies 04:42 - Motor Stimulation and Safety Measures 05:51 - Potential Complications and Mitigation 07:50 - Patient Counseling and Follow-Up CHECK OUT THE FULL EPISODE BackTable MSK Ep. 22- Genicular Nerve Ablation https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation Tue, 20 Aug 2024 07:00:00 -0000 full BackTable Intentional probe selection is an important part of any ablative procedure. This MSK Brief focuses on tools for genicular nerve ablation. Dr. John Smirniotopoulos shares his perspectives on radiofrequency ablation (RFA) and cryoablation probes, including the Cool Leaf probe and its benefits. He goes on to explain the procedure, including ablation techniques, motor stimulation tests, and handling potential complications such as synovitis and hemarthrosis. Intentional probe selection is an important part of any ablative procedure. This MSK Brief focuses on tools for genicular nerve ablation. Dr. John Smirniotopoulos shares his perspectives on radiofrequency ablation (RFA) and cryoablation probes, including the Cool Leaf probe and its benefits. He goes on to explain the procedure, including ablation techniques, motor stimulation tests, and handling potential complications such as synovitis and hemarthrosis. TIMESTAMPS 00:12 - Choosing the Right Probe 01:29 - Cryoablation vs. RFA: Pros and Cons 02:32 - Ablation Techniques and Strategies 04:42 - Motor Stimulation and Safety Measures 05:51 - Potential Complications and Mitigation 07:50 - Patient Counseling and Follow-Up CHECK OUT THE FULL EPISODE BackTable MSK Ep. 22- Genicular Nerve Ablation https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation Intentional probe selection is an important part of any ablative procedure. This MSK Brief focuses on tools for genicular nerve ablation. Dr. John Smirniotopoulos shares his perspectives on radiofrequency ablation (RFA) and cryoablation probes, including the Cool Leaf probe and its benefits. He goes on to explain the procedure, including ablation techniques, motor stimulation tests, and handling potential complications such as synovitis and hemarthrosis.


TIMESTAMPS


00:12 - Choosing the Right Probe

01:29 - Cryoablation vs. RFA: Pros and Cons

02:32 - Ablation Techniques and Strategies

04:42 - Motor Stimulation and Safety Measures

05:51 - Potential Complications and Mitigation

07:50 - Patient Counseling and Follow-Up


CHECK OUT THE FULL EPISODE


BackTable MSK Ep. 22- Genicular Nerve Ablation

https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation

]]> 772 Ep. 56 BackTable Basics: Transforaminal, Cervical, and Thoracic Epidural Injections with Dr. Chris Beck Cervical and thoracic epidural steroid injections (ESIs) can offer relief for patients with chronic pain; however, these procedures can carry serious risks. Providers should be well-trained to anticipate and mitigate these risks before treating patients with ESIs. In this episode of the Backtable MSK Podcast, co-hosts Dr. Chris Beck and Dr. Jacob Fleming dive deep into various techniques and considerations for performing ESIs. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SYNPOSIS Dr. Beck and Dr. Fleming discuss the importance of trajectory and level aiming, the differences between interlaminar and transforaminal approaches, and the nuances of cervical and thoracic ESI procedures. The episode also covers patient positioning and potential complications. --- TIMESTAMPS 00:00 - Introduction 02:10 - Techniques for Transforaminal Approach 08:51 - Cervical ESI 15:15 - Risks of Cervical ESI 24:07 - Thoracic ESI 29:03 - Post-Procedure Considerations 32:34 - Caudal ESI --- RESOURCES BackTable MSK Ep. 55 - BackTable Basics: Lumbar Epidural Injections with. Dr. Chris Beck: https://www.backtable.com/shows/msk/podcasts/55/backtable-basics-lumbar-epidural-injections Tue, 13 Aug 2024 07:00:00 -0000 full BackTable Cervical and thoracic epidural steroid injections (ESIs) can offer relief for patients with chronic pain; however, these procedures can carry serious risks. Providers should be well-trained to anticipate and mitigate these risks before treating patients with ESIs. In this episode of the Backtable MSK Podcast, co-hosts Dr. Chris Beck and Dr. Jacob Fleming dive deep into various techniques and considerations for performing ESIs. Cervical and thoracic epidural steroid injections (ESIs) can offer relief for patients with chronic pain; however, these procedures can carry serious risks. Providers should be well-trained to anticipate and mitigate these risks before treating patients with ESIs. In this episode of the Backtable MSK Podcast, co-hosts Dr. Chris Beck and Dr. Jacob Fleming dive deep into various techniques and considerations for performing ESIs. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SYNPOSIS Dr. Beck and Dr. Fleming discuss the importance of trajectory and level aiming, the differences between interlaminar and transforaminal approaches, and the nuances of cervical and thoracic ESI procedures. The episode also covers patient positioning and potential complications. --- TIMESTAMPS 00:00 - Introduction 02:10 - Techniques for Transforaminal Approach 08:51 - Cervical ESI 15:15 - Risks of Cervical ESI 24:07 - Thoracic ESI 29:03 - Post-Procedure Considerations 32:34 - Caudal ESI --- RESOURCES BackTable MSK Ep. 55 - BackTable Basics: Lumbar Epidural Injections with. Dr. Chris Beck: https://www.backtable.com/shows/msk/podcasts/55/backtable-basics-lumbar-epidural-injections Cervical and thoracic epidural steroid injections (ESIs) can offer relief for patients with chronic pain; however, these procedures can carry serious risks. Providers should be well-trained to anticipate and mitigate these risks before treating patients with ESIs. In this episode of the Backtable MSK Podcast, co-hosts Dr. Chris Beck and Dr. Jacob Fleming dive deep into various techniques and considerations for performing ESIs.


---


CHECK OUT OUR SPONSOR


Stryker Interventional Spine

https://www.strykerivs.com


---


SYNPOSIS


Dr. Beck and Dr. Fleming discuss the importance of trajectory and level aiming, the differences between interlaminar and transforaminal approaches, and the nuances of cervical and thoracic ESI procedures. The episode also covers patient positioning and potential complications.


---


TIMESTAMPS


00:00 - Introduction

02:10 - Techniques for Transforaminal Approach

08:51 - Cervical ESI

15:15 - Risks of Cervical ESI

24:07 - Thoracic ESI

29:03 - Post-Procedure Considerations

32:34 - Caudal ESI


---


RESOURCES


BackTable MSK Ep. 55 - BackTable Basics: Lumbar Epidural Injections

with. Dr. Chris Beck:

https://www.backtable.com/shows/msk/podcasts/55/backtable-basics-lumbar-epidural-injections

]]> 2321 Ep. 55 Backtable Basics Lumbar Epidural Injections with Dr. Chris Beck An epidural steroid injection (ESI) is a minimally invasive technique used to treat back pain. Providers from various specialties and settings can learn and offer this procedure. In this episode of the Back Table MSK Podcast, hosts Jacob Fleming and Chris Beck share their experiences and techniques for performing ESIs. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SYNPOSIS The doctors detail the technical aspects of their ESI procedures, including guidance on patient and C-arm positioning, considerations for an interlaminar approach, and potential complications to watch for. --- TIMESTAMPS 00:00 - Introduction 03:41 - Learning How to Perform ESIs 06:58 - Common Indications for ESIs 10:49 - Dr. Beck’s Technical Approach 32:22 - Dr. Fleming’s Technical Approach 40:49 - Treating Intrathecal Complications --- RESOURCES Atlas of Image-Guided Spinal Procedures (Furman et al, 2018): https://shop.elsevier.com/books/atlas-of-image-guided-spinal-procedures/furman/978-0-323-40153-1 Tue, 06 Aug 2024 07:00:00 -0000 full BackTable An epidural steroid injection (ESI) is a minimally invasive technique used to treat back pain. Providers from various specialties and settings can learn and offer this procedure. In this episode of the Back Table MSK Podcast, hosts Jacob Fleming and Chris Beck share their experiences and techniques for performing ESIs. An epidural steroid injection (ESI) is a minimally invasive technique used to treat back pain. Providers from various specialties and settings can learn and offer this procedure. In this episode of the Back Table MSK Podcast, hosts Jacob Fleming and Chris Beck share their experiences and techniques for performing ESIs. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SYNPOSIS The doctors detail the technical aspects of their ESI procedures, including guidance on patient and C-arm positioning, considerations for an interlaminar approach, and potential complications to watch for. --- TIMESTAMPS 00:00 - Introduction 03:41 - Learning How to Perform ESIs 06:58 - Common Indications for ESIs 10:49 - Dr. Beck’s Technical Approach 32:22 - Dr. Fleming’s Technical Approach 40:49 - Treating Intrathecal Complications --- RESOURCES Atlas of Image-Guided Spinal Procedures (Furman et al, 2018): https://shop.elsevier.com/books/atlas-of-image-guided-spinal-procedures/furman/978-0-323-40153-1 An epidural steroid injection (ESI) is a minimally invasive technique used to treat back pain. Providers from various specialties and settings can learn and offer this procedure. In this episode of the Back Table MSK Podcast, hosts Jacob Fleming and Chris Beck share their experiences and techniques for performing ESIs.


---


CHECK OUT OUR SPONSOR


Stryker Interventional Spine

https://www.strykerivs.com


---


SYNPOSIS


The doctors detail the technical aspects of their ESI procedures, including guidance on patient and C-arm positioning, considerations for an interlaminar approach, and potential complications to watch for.


---


TIMESTAMPS


00:00 - Introduction

03:41 - Learning How to Perform ESIs

06:58 - Common Indications for ESIs

10:49 - Dr. Beck’s Technical Approach

32:22 - Dr. Fleming’s Technical Approach

40:49 - Treating Intrathecal Complications


---


RESOURCES


Atlas of Image-Guided Spinal Procedures (Furman et al, 2018):

https://shop.elsevier.com/books/atlas-of-image-guided-spinal-procedures/furman/978-0-323-40153-1

]]> 2764 BackTable Brief: Anatomy and Setup for Genicular Nerve Ablation with Dr. John Smirniotopoulos Genicular nerve ablation is becoming more common for patients with osteoarthritis, underscoring the preference for nonsurgical,minimally invasive treatment. Our host Dr. Michael Barraza welcomes Dr. John Smirniotopoulos to discuss his experience performing genicular nerve ablation, including a detailed ‘how-to’ on his procedure technique. The conversation delves into the anatomy and key nerves targeted during the procedure, based on recent cadaveric dissections. Dr. Smirniotopoulos also highlights the use of fluoroscopy and ultrasound for precise needle placement. TIMESTAMPS 00:12 - Genicular Nerve Anatomy 01:06 - Procedure Techniques and Tools 03:20 - Patient Interaction and Expectations 04:58 - Sedation and Pain Management CHECK OUT THE FULL EPISODE BackTable MSK Ep. 22- Genicular Nerve Ablation https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation Tue, 30 Jul 2024 07:00:00 -0000 full BackTable Genicular nerve ablation is becoming more common for patients with osteoarthritis, underscoring the preference for nonsurgical,minimally invasive treatment. Our host Dr. Michael Barraza welcomes Dr. John Smirniotopoulos to discuss his experience performing genicular nerve ablation, including a detailed ‘how-to’ on his procedure technique. The conversation delves into the anatomy and key nerves targeted during the procedure, based on recent cadaveric dissections. Dr. Smirniotopoulos also highlights the use of fluoroscopy and ultrasound for precise needle placement. Genicular nerve ablation is becoming more common for patients with osteoarthritis, underscoring the preference for nonsurgical,minimally invasive treatment. Our host Dr. Michael Barraza welcomes Dr. John Smirniotopoulos to discuss his experience performing genicular nerve ablation, including a detailed ‘how-to’ on his procedure technique. The conversation delves into the anatomy and key nerves targeted during the procedure, based on recent cadaveric dissections. Dr. Smirniotopoulos also highlights the use of fluoroscopy and ultrasound for precise needle placement. TIMESTAMPS 00:12 - Genicular Nerve Anatomy 01:06 - Procedure Techniques and Tools 03:20 - Patient Interaction and Expectations 04:58 - Sedation and Pain Management CHECK OUT THE FULL EPISODE BackTable MSK Ep. 22- Genicular Nerve Ablation https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation Genicular nerve ablation is becoming more common for patients with osteoarthritis, underscoring the preference for nonsurgical,minimally invasive treatment. Our host Dr. Michael Barraza welcomes Dr. John Smirniotopoulos to discuss his experience performing genicular nerve ablation, including a detailed ‘how-to’ on his procedure technique. The conversation delves into the anatomy and key nerves targeted during the procedure, based on recent cadaveric dissections. Dr. Smirniotopoulos also highlights the use of fluoroscopy and ultrasound for precise needle placement.


TIMESTAMPS


00:12 - Genicular Nerve Anatomy

01:06 - Procedure Techniques and Tools

03:20 - Patient Interaction and Expectations

04:58 - Sedation and Pain Management


CHECK OUT THE FULL EPISODE


BackTable MSK Ep. 22- Genicular Nerve Ablation

https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation

]]> 504 BackTable Brief: What is the Role of Genicular Nerve Ablation for Knee Osteoarthritis? with Dr. John Smirniotopoulos Intentional probe selection is an important part of any ablative procedure. This MSK Brief focuses on tools for genicular nerve ablation. Dr. John Smirniotopoulos shares his perspectives on radiofrequency ablation (RFA) and cryoablation probes, including the Cool Leaf probe and its benefits. He goes on to explain the procedure, including ablation techniques, motor stimulation tests, and handling potential complications such as synovitis and hemarthrosis. TIMESTAMPS 00:12 - Choosing the Right Probe 01:29 - Cryoablation vs. RFA: Pros and Cons 02:32 - Ablation Techniques and Strategies 04:42 - Motor Stimulation and Safety Measures 05:51 - Potential Complications and Mitigation 07:50 - Patient Counseling and Follow-Up CHECK OUT THE FULL EPISODE BackTable MSK Ep. 22- Genicular Nerve Ablation https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation Tue, 23 Jul 2024 07:00:00 -0000 full BackTable Intentional probe selection is an important part of any ablative procedure. This MSK Brief focuses on tools for genicular nerve ablation. Dr. John Smirniotopoulos shares his perspectives on radiofrequency ablation (RFA) and cryoablation probes, including the Cool Leaf probe and its benefits. He goes on to explain the procedure, including ablation techniques, motor stimulation tests, and handling potential complications such as synovitis and hemarthrosis. Intentional probe selection is an important part of any ablative procedure. This MSK Brief focuses on tools for genicular nerve ablation. Dr. John Smirniotopoulos shares his perspectives on radiofrequency ablation (RFA) and cryoablation probes, including the Cool Leaf probe and its benefits. He goes on to explain the procedure, including ablation techniques, motor stimulation tests, and handling potential complications such as synovitis and hemarthrosis. TIMESTAMPS 00:12 - Choosing the Right Probe 01:29 - Cryoablation vs. RFA: Pros and Cons 02:32 - Ablation Techniques and Strategies 04:42 - Motor Stimulation and Safety Measures 05:51 - Potential Complications and Mitigation 07:50 - Patient Counseling and Follow-Up CHECK OUT THE FULL EPISODE BackTable MSK Ep. 22- Genicular Nerve Ablation https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation Intentional probe selection is an important part of any ablative procedure. This MSK Brief focuses on tools for genicular nerve ablation. Dr. John Smirniotopoulos shares his perspectives on radiofrequency ablation (RFA) and cryoablation probes, including the Cool Leaf probe and its benefits. He goes on to explain the procedure, including ablation techniques, motor stimulation tests, and handling potential complications such as synovitis and hemarthrosis.


TIMESTAMPS


00:12 - Choosing the Right Probe

01:29 - Cryoablation vs. RFA: Pros and Cons

02:32 - Ablation Techniques and Strategies

04:42 - Motor Stimulation and Safety Measures

05:51 - Potential Complications and Mitigation

07:50 - Patient Counseling and Follow-Up


CHECK OUT THE FULL EPISODE


BackTable MSK Ep. 22- Genicular Nerve Ablation

https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation

]]> 632 Ep. 54 Managing Sarcomas: A Multidisciplinary Approach with Dr. Yvette Ho and Dr. Jessica Jones In this episode of The Back Table MSK Podcast, Dr. Alexa Levey discusses the importance of multidisciplinary treatment planning for sarcomas with Dr. Yvette Ho and Dr. Jessica Jones. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SYNPOSIS The conversation explores the necessity of a multidisciplinary approach and the challenges associated with managing both osseous and soft tissue sarcomas. Dr. Jones highlights recent advancements in precision medicine, including a novel drug, nirogacesta, for desmoid tumors. Dr. Ho addresses common misconceptions surrounding desmoid tumors, emphasizing their potential for significant tissue destruction, and shares insights from her experience in limb salvage surgery. Dr. Levey discusses the considerations involved in needle biopsy and presents case studies where cryoablation effectively reduced desmoid tumor sizes. The doctors also discuss strategies for managing nociceptive and mechanical pain, such as intrathecal pain pumps, radiation therapy, and kyphoplasty. --- TIMESTAMPS 00:00 - Introduction 03:51 - Challenges in Sarcoma Management 13:06 - Precision Medicine in Treatment Planning 16:44 - The Role of Biopsy 20:51 - The Importance of Specialized Oncology Care 25:13 - Collaboration Throughout Treatment Course 31:03 - Cryoablation and Case Studies 35:13 - New Drug Development for Desmoid Tumors 39:06 - Limb Salvage Considerations 41:13 - Metastasis, Recurrence, and Pain Management 49:57 - Final Thoughts --- RESOURCES OGSIVEO (Nirogacestat): https://www.ogsiveo.com/ Tue, 16 Jul 2024 07:00:00 -0000 full BackTable In this episode of The Back Table MSK Podcast, Dr. Alexa Levey discusses the importance of multidisciplinary treatment planning for sarcomas with Dr. Yvette Ho and Dr. Jessica Jones. In this episode of The Back Table MSK Podcast, Dr. Alexa Levey discusses the importance of multidisciplinary treatment planning for sarcomas with Dr. Yvette Ho and Dr. Jessica Jones. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SYNPOSIS The conversation explores the necessity of a multidisciplinary approach and the challenges associated with managing both osseous and soft tissue sarcomas. Dr. Jones highlights recent advancements in precision medicine, including a novel drug, nirogacesta, for desmoid tumors. Dr. Ho addresses common misconceptions surrounding desmoid tumors, emphasizing their potential for significant tissue destruction, and shares insights from her experience in limb salvage surgery. Dr. Levey discusses the considerations involved in needle biopsy and presents case studies where cryoablation effectively reduced desmoid tumor sizes. The doctors also discuss strategies for managing nociceptive and mechanical pain, such as intrathecal pain pumps, radiation therapy, and kyphoplasty. --- TIMESTAMPS 00:00 - Introduction 03:51 - Challenges in Sarcoma Management 13:06 - Precision Medicine in Treatment Planning 16:44 - The Role of Biopsy 20:51 - The Importance of Specialized Oncology Care 25:13 - Collaboration Throughout Treatment Course 31:03 - Cryoablation and Case Studies 35:13 - New Drug Development for Desmoid Tumors 39:06 - Limb Salvage Considerations 41:13 - Metastasis, Recurrence, and Pain Management 49:57 - Final Thoughts --- RESOURCES OGSIVEO (Nirogacestat): https://www.ogsiveo.com/ In this episode of The Back Table MSK Podcast, Dr. Alexa Levey discusses the importance of multidisciplinary treatment planning for sarcomas with Dr. Yvette Ho and Dr. Jessica Jones.


---


CHECK OUT OUR SPONSOR


Stryker Interventional Spine

https://www.strykerivs.com


---


SYNPOSIS


The conversation explores the necessity of a multidisciplinary approach and the challenges associated with managing both osseous and soft tissue sarcomas. Dr. Jones highlights recent advancements in precision medicine, including a novel drug, nirogacesta, for desmoid tumors. Dr. Ho addresses common misconceptions surrounding desmoid tumors, emphasizing their potential for significant tissue destruction, and shares insights from her experience in limb salvage surgery. Dr. Levey discusses the considerations involved in needle biopsy and presents case studies where cryoablation effectively reduced desmoid tumor sizes.

The doctors also discuss strategies for managing nociceptive and mechanical pain, such as intrathecal pain pumps, radiation therapy, and kyphoplasty.


---


TIMESTAMPS


00:00 - Introduction

03:51 - Challenges in Sarcoma Management

13:06 - Precision Medicine in Treatment Planning

16:44 - The Role of Biopsy

20:51 - The Importance of Specialized Oncology Care

25:13 - Collaboration Throughout Treatment Course

31:03 - Cryoablation and Case Studies

35:13 - New Drug Development for Desmoid Tumors

39:06 - Limb Salvage Considerations

41:13 - Metastasis, Recurrence, and Pain Management

49:57 - Final Thoughts


---


RESOURCES


OGSIVEO (Nirogacestat):

https://www.ogsiveo.com/

]]> 3307 BackTable Brief: Basivertebral Nerve Ablation II: Technique with Dr. Olivier Clerk-Lamalice Basivertebral nerve ablation is a potential solution for anterior column spine pain. Dr. Olivier Clerk-Lamalice outlines a typical ablation procedure and discusses alternative approaches for challenging target locations. The procedure generally uses a transpedicular approach with an 8-gauge introducer needle, visualized under fluoroscopy. The needle angle should ensure that the probe can later be placed in the center of the vertebral body. The basic technique is similar to that of vertebral augmentation, employing an aneural and avascular approach. A bipolar ablation probe is aimed 1-cm ventral to the posterior wall of the vertebral body to establish a safe ablation zone and avoid neural structures. The ablation is performed at 85°C for 15 minutes. It is important to ablate the nerve at the vertebral bodies both above and below the target level. For challenging targets, such as at L5, S1, high-riding pelvis, or in cases with prior transpedicular screw placement, the goal is to take the straightest path possible, which can require the transiliac approach.  TIMESTAMPS 00:00 - Standard Procedure Walkthrough  05:54 - Alternate Approaches for Challenging Targets CHECK OUT THE FULL EPISODE BackTable MSK Ep. 13- Basivertebral Nerve Ablation  https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation  Tue, 02 Jul 2024 07:00:00 -0000 full BackTable Basivertebral nerve ablation is a potential solution for anterior column spine pain. Dr. Olivier Clerk-Lamalice outlines a typical ablation procedure and discusses alternative approaches for challenging target locations. Basivertebral nerve ablation is a potential solution for anterior column spine pain. Dr. Olivier Clerk-Lamalice outlines a typical ablation procedure and discusses alternative approaches for challenging target locations. The procedure generally uses a transpedicular approach with an 8-gauge introducer needle, visualized under fluoroscopy. The needle angle should ensure that the probe can later be placed in the center of the vertebral body. The basic technique is similar to that of vertebral augmentation, employing an aneural and avascular approach. A bipolar ablation probe is aimed 1-cm ventral to the posterior wall of the vertebral body to establish a safe ablation zone and avoid neural structures. The ablation is performed at 85°C for 15 minutes. It is important to ablate the nerve at the vertebral bodies both above and below the target level. For challenging targets, such as at L5, S1, high-riding pelvis, or in cases with prior transpedicular screw placement, the goal is to take the straightest path possible, which can require the transiliac approach.  TIMESTAMPS 00:00 - Standard Procedure Walkthrough  05:54 - Alternate Approaches for Challenging Targets CHECK OUT THE FULL EPISODE BackTable MSK Ep. 13- Basivertebral Nerve Ablation  https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation  Basivertebral nerve ablation is a potential solution for anterior column spine pain. Dr. Olivier Clerk-Lamalice outlines a typical ablation procedure and discusses alternative approaches for challenging target locations.


The procedure generally uses a transpedicular approach with an 8-gauge introducer needle, visualized under fluoroscopy. The needle angle should ensure that the probe can later be placed in the center of the vertebral body. The basic technique is similar to that of vertebral augmentation, employing an aneural and avascular approach. A bipolar ablation probe is aimed 1-cm ventral to the posterior wall of the vertebral body to establish a safe ablation zone and avoid neural structures. The ablation is performed at 85°C for 15 minutes. It is important to ablate the nerve at the vertebral bodies both above and below the target level.


For challenging targets, such as at L5, S1, high-riding pelvis, or in cases with prior transpedicular screw placement, the goal is to take the straightest path possible, which can require the transiliac approach. 


TIMESTAMPS


00:00 - Standard Procedure Walkthrough 

05:54 - Alternate Approaches for Challenging Targets


CHECK OUT THE FULL EPISODE


BackTable MSK Ep. 13- Basivertebral Nerve Ablation 

https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation 



]]> 761 BackTable Brief: Basivertebral Nerve Ablation I: Procedure Basics with Dr. Olivier Clerk-Lamalice The basivertebral nerve has gained recognition over the past decade as a source of vertebrogenic pain. Dr. Olivier Clerk-Lamalice explains both the anatomy of the nerve and his treatment algorithm for basivertebral nerve ablation. The basivertebral nerve is intraosseous, non-myelinated, and located in the central portion of the vertebral body within the basivertebral canal. It does not regenerate after ablation. This nerve transmits afferent pain signals to the central spinal cord, and MRI is the primary diagnostic tool used for evaluation. During the physical exam, back pain originating from the anterior column is assessed through maneuvers such as sitting at a 15-degree angle, bending forward, and experiencing vibrations from car or plane travel. MRI findings are reviewed for Modic changes: Type 1, characterized by edematous endplates, is highly correlated with pain, while Type 2 shows early and later changes, with early changes generally being less painful. To confirm that a patient will benefit from basivertebral nerve ablation, an anesthetic discogram is performed to identify the specific disc level causing pain. Dr. Clerk-Lamalice performs the discogram for every patient, and improvements are tracked based on patient-reported pain scores. TIMESTAMPS 00:00 - Basivertebral Nerve Anatomy and Vertebrogenic Pain 04:15 - Modic Type 1 and 2 Definitions 05:51 - Utility of Anesthetic Discograms  CHECK OUT THE FULL EPISODE BackTable MSK Ep. 13- Basivertebral Nerve Ablation  https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation  Tue, 25 Jun 2024 07:00:00 -0000 full BackTable The basivertebral nerve has gained recognition over the past decade as a source of vertebrogenic pain. Dr. Olivier Clerk-Lamalice explains both the anatomy of the nerve and his treatment algorithm for basivertebral nerve ablation. The basivertebral nerve is intraosseous, non-myelinated, and located in the central portion of the vertebral body within the basivertebral canal. It does not regenerate after ablation. This nerve transmits afferent pain signals to the central spinal cord, and MRI is the primary diagnostic tool used for evaluation. During the physical exam, back pain originating from the anterior column is assessed through maneuvers such as sitting at a 15-degree angle, bending forward, and experiencing vibrations from car or plane travel. MRI findings are reviewed for Modic changes: Type 1, characterized by edematous endplates, is highly correlated with pain, while Type 2 shows early and later changes, with early changes generally being less painful. To confirm that a patient will benefit from basivertebral nerve ablation, an anesthetic discogram is performed to identify the specific disc level causing pain. Dr. Clerk-Lamalice performs the discogram for every patient, and improvements are tracked based on patient-reported pain scores. TIMESTAMPS 00:00 - Basivertebral Nerve Anatomy and Vertebrogenic Pain 04:15 - Modic Type 1 and 2 Definitions 05:51 - Utility of Anesthetic Discograms  CHECK OUT THE FULL EPISODE BackTable MSK Ep. 13- Basivertebral Nerve Ablation  https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation  The basivertebral nerve has gained recognition over the past decade as a source of vertebrogenic pain. Dr. Olivier Clerk-Lamalice explains both the anatomy of the nerve and his treatment algorithm for basivertebral nerve ablation.


The basivertebral nerve is intraosseous, non-myelinated, and located in the central portion of the vertebral body within the basivertebral canal. It does not regenerate after ablation. This nerve transmits afferent pain signals to the central spinal cord, and MRI is the primary diagnostic tool used for evaluation.


During the physical exam, back pain originating from the anterior column is assessed through maneuvers such as sitting at a 15-degree angle, bending forward, and experiencing vibrations from car or plane travel. MRI findings are reviewed for Modic changes: Type 1, characterized by edematous endplates, is highly correlated with pain, while Type 2 shows early and later changes, with early changes generally being less painful.


To confirm that a patient will benefit from basivertebral nerve ablation, an anesthetic discogram is performed to identify the specific disc level causing pain. Dr. Clerk-Lamalice performs the discogram for every patient, and improvements are tracked based on patient-reported pain scores.


TIMESTAMPS


00:00 - Basivertebral Nerve Anatomy and Vertebrogenic Pain

04:15 - Modic Type 1 and 2 Definitions

05:51 - Utility of Anesthetic Discograms 


CHECK OUT THE FULL EPISODE


BackTable MSK Ep. 13- Basivertebral Nerve Ablation 

https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation 



]]> 620 Ep. 53 AI Scribes: Enhancing Patient and Physician Interaction with Elie Toubiana Dr. Aditya Bagrodia sits down with Elie Toubiana, founder and CEO of ScribeMD.ai, to discuss the transformative potential of artificial intelligence (AI) in medical documentation. --- SYNPOSIS Their conversation covers the capabilities and benefits of using an AI-driven medical scribe that ensures HIPAA compliance, reduces physician burnout, and enhances patient interactions. Elie also shares his insights about the technology’s adaptability across various medical fields. Finally, Dr. Bagrodia and Elie discuss ethical considerations surrounding applications of AI in other aspects of healthcare, such as medical workup and diagnosis. --- TIMESTAMPS 00:00 - Introduction 06:00 - How ScribeMD AI Works 14:14 - Integration with EMR 20:31 - Legal Considerations with AI Technology 26:34 - Cost Implications of AI Scribes 38:46 - Future of AI in Medical Diagnosis 41:45 - Conclusion and Final Thoughts --- RESOURCES ScribeMD.ai https://www.scribemd.ai/ Fri, 21 Jun 2024 07:00:00 -0000 full BackTable Dr. Aditya Bagrodia sits down with Elie Toubiana, founder and CEO of ScribeMD.ai, to discuss the transformative potential of artificial intelligence (AI) in medical documentation. Dr. Aditya Bagrodia sits down with Elie Toubiana, founder and CEO of ScribeMD.ai, to discuss the transformative potential of artificial intelligence (AI) in medical documentation. --- SYNPOSIS Their conversation covers the capabilities and benefits of using an AI-driven medical scribe that ensures HIPAA compliance, reduces physician burnout, and enhances patient interactions. Elie also shares his insights about the technology’s adaptability across various medical fields. Finally, Dr. Bagrodia and Elie discuss ethical considerations surrounding applications of AI in other aspects of healthcare, such as medical workup and diagnosis. --- TIMESTAMPS 00:00 - Introduction 06:00 - How ScribeMD AI Works 14:14 - Integration with EMR 20:31 - Legal Considerations with AI Technology 26:34 - Cost Implications of AI Scribes 38:46 - Future of AI in Medical Diagnosis 41:45 - Conclusion and Final Thoughts --- RESOURCES ScribeMD.ai https://www.scribemd.ai/ Dr. Aditya Bagrodia sits down with Elie Toubiana, founder and CEO of ScribeMD.ai, to discuss the transformative potential of artificial intelligence (AI) in medical documentation.


---


SYNPOSIS


Their conversation covers the capabilities and benefits of using an AI-driven medical scribe that ensures HIPAA compliance, reduces physician burnout, and enhances patient interactions. Elie also shares his insights about the technology’s adaptability across various medical fields. Finally, Dr. Bagrodia and Elie discuss ethical considerations surrounding applications of AI in other aspects of healthcare, such as medical workup and diagnosis.


---


TIMESTAMPS


00:00 - Introduction

06:00 - How ScribeMD AI Works

14:14 - Integration with EMR

20:31 - Legal Considerations with AI Technology

26:34 - Cost Implications of AI Scribes

38:46 - Future of AI in Medical Diagnosis

41:45 - Conclusion and Final Thoughts


---


RESOURCES


ScribeMD.ai

https://www.scribemd.ai/

]]> 2683 Ep. 52 Sacroplasty II: Technique, Pearls, and Training Opportunities with Dr. Doug Beall Dr. Jacob Fleming and Dr. Douglas Beall dive into the intricacies of sacroplasty, including considerations for selecting cement volume, efficacy of small versus large needles, and biomechanics of the pelvis. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SYNPOSIS The doctors review evidence from the SAKOS trial on pain relief and highlight the complexities of billing. They also emphasize proactive treatments for aging populations suffering from fractures and the need for more training and propagation of sacroplasty techniques. Listeners are encouraged to stay informed about new educational opportunities and advancements in sacroplasty through ongoing updates and courses. --- TIMESTAMPS 00:00 - Introduction 02:33 - Expanding Sacroplasty Training and Curriculum 04:50 - Walkthrough of Sacroplasty Technique 10:36 - Mechanical Stabilization and Cement Volume 21:41 - Choosing Hardware and Needle Size 27:37 - Industry-Sponsored Trials and Bias 32:47 - Navigating Billing and Reimbursement 38:05 - Closing Thoughts on Sacroplasty and Osteoporotic Fractures --- RESOURCES BackTable VI Ep. 51- Sacroplasty: Principles & New Data in the Treatment of Sacral Insufficiency Fractures: https://www.backtable.com/shows/msk/podcasts/51/sacroplasty-i-principles-new-data-in-the-treatment-of-sacral-insufficiency-fractures Seattle Science Foundation Annual Image Guided Interventional Spine Procedures Course: https://ssf.cloud-cme.com/course/courseoverview?P=5&EID=1149 Dr. Doug Beall’s Twitter: @dougbeall Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation: https://www.amazon.com/Vertebral-Augmentation-Comprehensive-Vertebroplasty-Kyphoplasty/dp/1684200156 An Interim Analysis of the First 102 Patients Treated in the Prospective Vertebral Augmentation Sacroplasty Fracture Registry (Beall, 2023): https://www.jvir.org/article/S1051-0443(23)00356-1/fulltext Thu, 20 Jun 2024 07:00:00 -0000 full BackTable Dr. Jacob Fleming and Dr. Douglas Beall dive into the intricacies of sacroplasty, including considerations for selecting cement volume, efficacy of small versus large needles, and biomechanics of the pelvis. Dr. Jacob Fleming and Dr. Douglas Beall dive into the intricacies of sacroplasty, including considerations for selecting cement volume, efficacy of small versus large needles, and biomechanics of the pelvis. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SYNPOSIS The doctors review evidence from the SAKOS trial on pain relief and highlight the complexities of billing. They also emphasize proactive treatments for aging populations suffering from fractures and the need for more training and propagation of sacroplasty techniques. Listeners are encouraged to stay informed about new educational opportunities and advancements in sacroplasty through ongoing updates and courses. --- TIMESTAMPS 00:00 - Introduction 02:33 - Expanding Sacroplasty Training and Curriculum 04:50 - Walkthrough of Sacroplasty Technique 10:36 - Mechanical Stabilization and Cement Volume 21:41 - Choosing Hardware and Needle Size 27:37 - Industry-Sponsored Trials and Bias 32:47 - Navigating Billing and Reimbursement 38:05 - Closing Thoughts on Sacroplasty and Osteoporotic Fractures --- RESOURCES BackTable VI Ep. 51- Sacroplasty: Principles & New Data in the Treatment of Sacral Insufficiency Fractures: https://www.backtable.com/shows/msk/podcasts/51/sacroplasty-i-principles-new-data-in-the-treatment-of-sacral-insufficiency-fractures Seattle Science Foundation Annual Image Guided Interventional Spine Procedures Course: https://ssf.cloud-cme.com/course/courseoverview?P=5&EID=1149 Dr. Doug Beall’s Twitter: @dougbeall Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation: https://www.amazon.com/Vertebral-Augmentation-Comprehensive-Vertebroplasty-Kyphoplasty/dp/1684200156 An Interim Analysis of the First 102 Patients Treated in the Prospective Vertebral Augmentation Sacroplasty Fracture Registry (Beall, 2023): https://www.jvir.org/article/S1051-0443(23)00356-1/fulltext Dr. Jacob Fleming and Dr. Douglas Beall dive into the intricacies of sacroplasty, including considerations for selecting cement volume, efficacy of small versus large needles, and biomechanics of the pelvis.


---


CHECK OUT OUR SPONSOR


Stryker Interventional Spine

https://www.strykerivs.com


---


SYNPOSIS


The doctors review evidence from the SAKOS trial on pain relief and highlight the complexities of billing. They also emphasize proactive treatments for aging populations suffering from fractures and the need for more training and propagation of sacroplasty techniques. Listeners are encouraged to stay informed about new educational opportunities and advancements in sacroplasty through ongoing updates and courses.


---


TIMESTAMPS


00:00 - Introduction

02:33 - Expanding Sacroplasty Training and Curriculum

04:50 - Walkthrough of Sacroplasty Technique

10:36 - Mechanical Stabilization and Cement Volume

21:41 - Choosing Hardware and Needle Size

27:37 - Industry-Sponsored Trials and Bias

32:47 - Navigating Billing and Reimbursement

38:05 - Closing Thoughts on Sacroplasty and Osteoporotic Fractures


---


RESOURCES


BackTable VI Ep. 51- Sacroplasty: Principles & New Data in the Treatment of Sacral Insufficiency Fractures:

https://www.backtable.com/shows/msk/podcasts/51/sacroplasty-i-principles-new-data-in-the-treatment-of-sacral-insufficiency-fractures


Seattle Science Foundation Annual Image Guided Interventional Spine Procedures Course:

https://ssf.cloud-cme.com/course/courseoverview?P=5&EID=1149


Dr. Doug Beall’s Twitter: @dougbeall


Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation:

https://www.amazon.com/Vertebral-Augmentation-Comprehensive-Vertebroplasty-Kyphoplasty/dp/1684200156


An Interim Analysis of the First 102 Patients Treated in the Prospective Vertebral Augmentation Sacroplasty Fracture Registry (Beall, 2023):

https://www.jvir.org/article/S1051-0443(23)00356-1/fulltext

]]> 2543 Ep. 51 Sacroplasty I: Principles and New Data in the Treatment of Sacral Insufficiency Fractures with Dr. Doug Beall In this episode of the BackTable MSK Podcast, Dr. Jacob Fleming and Dr. Douglas Beall discuss the challenges and advancements in treating sacral insufficiency fractures (SIF), the importance of real-world data in evaluating treatment efficacy, and the need to increase awareness of sacral fractures and sacroplasty. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SYNPOSIS Dr. Beall emphasizes the underrecognition and undertreatment of sacral insufficiency fractures, pointing out the high mortality and chronic pain rates associated with non-treatment. He urges providers to consider this diagnosis, especially if the patient is describing symptoms of pain with position changes with standing, sitting, and laying, has pubic rami fractures, or reports a history of pelvic radiation. Even with imaging, the diagnosis can remain elusive, since it is not commonly recognized on x-ray and may not show obvious cortical disruption on CT or MRI. We also review the current literature on sacroplasty efficacy in lowering patient-reported pain scores and adverse events associated with treatment versus conservative management. Dr. Beall speaks about the importance of real-world data collection in the form of patient registries and the insight that these resulting studies have on applications of sacroplasty in specific patient populations. --- TIMESTAMPS 00:00 - Introduction 03:01 - Sacral Fractures and Sacroplasty 15:17 - Treatment Options for Sacral Fractures 17:34 - Consequences of Untreated Sacral Fractures 28:32 - Sacroplasty Registry and Current Research 38:08 - Imaging Modalities: CT vs. Fluoroscopy 40:49 - Complications of Sacroplasty: Extravasation 43:21 - Bone Quality and Fracture Healing 45:42 - Growing Awareness of Sacral Fractures and Treatment Options --- RESOURCES Spontaneous osteoporotic fracture of the sacrum. An unrecognized syndrome of the elderly (Lourie, 1982): https://pubmed.ncbi.nlm.nih.gov/7097924/ Percutaneous cementoplasty for pelvic bone metastasis (Marcy, 2000): https://pubmed.ncbi.nlm.nih.gov/11094996/ Safety and Efficacy of Sacroplasty for Sacral Fractures: A Systematic Review and Meta-Analysis (Chandra et al, 2019): https://pubmed.ncbi.nlm.nih.gov/31587952/ Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study (Frey et al, 2008): https://pubmed.ncbi.nlm.nih.gov/17981097/ Sacroplasty: A Ten-Year Analysis of Prospective Patients Treated with Percutaneous Sacroplasty: Literature Review and Technical Considerations (Frey et al, 2017): https://pubmed.ncbi.nlm.nih.gov/29149151/ Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation (Beall, 2020): https://www.thieme-connect.de/products/ebooks/book/10.1055/b000000226 An Interim Analysis of the First 102 Patients Treated in the Prospective Vertebral Augmentation Sacroplasty Fracture Registry (Beall et al, 2023): https://pubmed.ncbi.nlm.nih.gov/37207812/ Clinical Effect of Balloon Kyphoplasty in Elderly Patients with Multiple Osteoporotic Vertebral Fracture (Liu et al, 2019): ​https://journals.lww.com/njcp/fulltext/2019/22030/clinical_effect_of_balloon_kyphoplasty_in_elderly.1.aspx Wed, 19 Jun 2024 07:00:00 -0000 full BackTable Dr. Jacob Fleming and Dr. Douglas Beall discuss the challenges and advancements in treating sacral insufficiency fractures (SIF), the importance of real-world data in evaluating treatment efficacy, and the need to increase awareness of sacral fractures and sacroplasty. In this episode of the BackTable MSK Podcast, Dr. Jacob Fleming and Dr. Douglas Beall discuss the challenges and advancements in treating sacral insufficiency fractures (SIF), the importance of real-world data in evaluating treatment efficacy, and the need to increase awareness of sacral fractures and sacroplasty. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SYNPOSIS Dr. Beall emphasizes the underrecognition and undertreatment of sacral insufficiency fractures, pointing out the high mortality and chronic pain rates associated with non-treatment. He urges providers to consider this diagnosis, especially if the patient is describing symptoms of pain with position changes with standing, sitting, and laying, has pubic rami fractures, or reports a history of pelvic radiation. Even with imaging, the diagnosis can remain elusive, since it is not commonly recognized on x-ray and may not show obvious cortical disruption on CT or MRI. We also review the current literature on sacroplasty efficacy in lowering patient-reported pain scores and adverse events associated with treatment versus conservative management. Dr. Beall speaks about the importance of real-world data collection in the form of patient registries and the insight that these resulting studies have on applications of sacroplasty in specific patient populations. --- TIMESTAMPS 00:00 - Introduction 03:01 - Sacral Fractures and Sacroplasty 15:17 - Treatment Options for Sacral Fractures 17:34 - Consequences of Untreated Sacral Fractures 28:32 - Sacroplasty Registry and Current Research 38:08 - Imaging Modalities: CT vs. Fluoroscopy 40:49 - Complications of Sacroplasty: Extravasation 43:21 - Bone Quality and Fracture Healing 45:42 - Growing Awareness of Sacral Fractures and Treatment Options --- RESOURCES Spontaneous osteoporotic fracture of the sacrum. An unrecognized syndrome of the elderly (Lourie, 1982): https://pubmed.ncbi.nlm.nih.gov/7097924/ Percutaneous cementoplasty for pelvic bone metastasis (Marcy, 2000): https://pubmed.ncbi.nlm.nih.gov/11094996/ Safety and Efficacy of Sacroplasty for Sacral Fractures: A Systematic Review and Meta-Analysis (Chandra et al, 2019): https://pubmed.ncbi.nlm.nih.gov/31587952/ Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study (Frey et al, 2008): https://pubmed.ncbi.nlm.nih.gov/17981097/ Sacroplasty: A Ten-Year Analysis of Prospective Patients Treated with Percutaneous Sacroplasty: Literature Review and Technical Considerations (Frey et al, 2017): https://pubmed.ncbi.nlm.nih.gov/29149151/ Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation (Beall, 2020): https://www.thieme-connect.de/products/ebooks/book/10.1055/b000000226 An Interim Analysis of the First 102 Patients Treated in the Prospective Vertebral Augmentation Sacroplasty Fracture Registry (Beall et al, 2023): https://pubmed.ncbi.nlm.nih.gov/37207812/ Clinical Effect of Balloon Kyphoplasty in Elderly Patients with Multiple Osteoporotic Vertebral Fracture (Liu et al, 2019): ​https://journals.lww.com/njcp/fulltext/2019/22030/clinical_effect_of_balloon_kyphoplasty_in_elderly.1.aspx In this episode of the BackTable MSK Podcast, Dr. Jacob Fleming and Dr. Douglas Beall discuss the challenges and advancements in treating sacral insufficiency fractures (SIF), the importance of real-world data in evaluating treatment efficacy, and the need to increase awareness of sacral fractures and sacroplasty.


---


CHECK OUT OUR SPONSOR


Stryker Interventional Spine

https://www.strykerivs.com


---


SYNPOSIS


Dr. Beall emphasizes the underrecognition and undertreatment of sacral insufficiency fractures, pointing out the high mortality and chronic pain rates associated with non-treatment. He urges providers to consider this diagnosis, especially if the patient is describing symptoms of pain with position changes with standing, sitting, and laying, has pubic rami fractures, or reports a history of pelvic radiation. Even with imaging, the diagnosis can remain elusive, since it is not commonly recognized on x-ray and may not show obvious cortical disruption on CT or MRI.


We also review the current literature on sacroplasty efficacy in lowering patient-reported pain scores and adverse events associated with treatment versus conservative management. Dr. Beall speaks about the importance of real-world data collection in the form of patient registries and the insight that these resulting studies have on applications of sacroplasty in specific patient populations.


---


TIMESTAMPS


00:00 - Introduction

03:01 - Sacral Fractures and Sacroplasty

15:17 - Treatment Options for Sacral Fractures

17:34 - Consequences of Untreated Sacral Fractures

28:32 - Sacroplasty Registry and Current Research

38:08 - Imaging Modalities: CT vs. Fluoroscopy

40:49 - Complications of Sacroplasty: Extravasation

43:21 - Bone Quality and Fracture Healing

45:42 - Growing Awareness of Sacral Fractures and Treatment Options


---


RESOURCES


Spontaneous osteoporotic fracture of the sacrum. An unrecognized syndrome of the elderly (Lourie, 1982):

https://pubmed.ncbi.nlm.nih.gov/7097924/


Percutaneous cementoplasty for pelvic bone metastasis (Marcy, 2000):

https://pubmed.ncbi.nlm.nih.gov/11094996/


Safety and Efficacy of Sacroplasty for Sacral Fractures: A Systematic Review and Meta-Analysis (Chandra et al, 2019):

https://pubmed.ncbi.nlm.nih.gov/31587952/


Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study (Frey et al, 2008):

https://pubmed.ncbi.nlm.nih.gov/17981097/


Sacroplasty: A Ten-Year Analysis of Prospective Patients Treated with Percutaneous Sacroplasty: Literature Review and Technical Considerations (Frey et al, 2017):

https://pubmed.ncbi.nlm.nih.gov/29149151/


Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation (Beall, 2020):

https://www.thieme-connect.de/products/ebooks/book/10.1055/b000000226


An Interim Analysis of the First 102 Patients Treated in the Prospective Vertebral Augmentation Sacroplasty Fracture Registry (Beall et al, 2023):

https://pubmed.ncbi.nlm.nih.gov/37207812/


Clinical Effect of Balloon Kyphoplasty in Elderly Patients with Multiple Osteoporotic Vertebral Fracture (Liu et al, 2019):

​https://journals.lww.com/njcp/fulltext/2019/22030/clinical_effect_of_balloon_kyphoplasty_in_elderly.1.aspx

]]> 3163 BackTable Brief: Desmoid Tumors II with Dr. Jack Jennings Musculoskeletal radiologists can be highly involved in cryoablation for desmoid tumors. Interventional radiologist Dr. Jack Jennings from Washington University in St. Louis shares the finer points of his approach to this procedure.  Desmoid tumor cryoablation cases require varying numbers of cryoablation probes, dependant on tumor morphology. The usual number of probes ranges from 5 to 10. To mitigate the risk of rhabdomyolysis, which increases with more than 10 probes, Dr. Jennings typically divides the procedure into two sessions.  His patients are generally admitted for pain control, monitoring for rhabdomyolysis, and management of inflammatory responses, with steroids administered both intraoperatively and postoperatively. Imaging is conducted at 6 to 8 weeks after the procedure, with Initial imaging sometimes showing the tumor as larger due to the inflammatory reaction and ablation zone. It is important that a multidisciplinary sarcoma tumor board, consisting of medical oncologists, surgical oncologists, and musculoskeletal radiologists, assesses each case. The first consideration is whether the tumor can be resected, based on its proximity to adjacent tissue. Following this, patients are evaluated for candidacy in clinical trials and potential ablation therapy. This multidisciplinary approach leads to better medicine and patient outcomes, as treatment decisions are rarely straightforward and should not be made by a single practitioner. TIMESTAMPS 00:00 - Planning for Cryoablation Probes 02:32 - Clinical Management after Cryoablation 04:45 - Follow Up Imaging 05:52 - Challenging Cases 08:41 - Multidisciplinary Desmoid Tumor Treatment CHECK OUT THE FULL EPISODE BackTable MSK Ep. 7- Desmoid Tumors: IR’s Role in Diagnosis and Management https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation Tue, 04 Jun 2024 07:00:00 -0000 full BackTable Musculoskeletal radiologists can be highly involved in cryoablation for desmoid tumors. Interventional radiologist Dr. Jack Jennings from Washington University in St. Louis shares the finer points of his approach to this procedure. Musculoskeletal radiologists can be highly involved in cryoablation for desmoid tumors. Interventional radiologist Dr. Jack Jennings from Washington University in St. Louis shares the finer points of his approach to this procedure.  Desmoid tumor cryoablation cases require varying numbers of cryoablation probes, dependant on tumor morphology. The usual number of probes ranges from 5 to 10. To mitigate the risk of rhabdomyolysis, which increases with more than 10 probes, Dr. Jennings typically divides the procedure into two sessions.  His patients are generally admitted for pain control, monitoring for rhabdomyolysis, and management of inflammatory responses, with steroids administered both intraoperatively and postoperatively. Imaging is conducted at 6 to 8 weeks after the procedure, with Initial imaging sometimes showing the tumor as larger due to the inflammatory reaction and ablation zone. It is important that a multidisciplinary sarcoma tumor board, consisting of medical oncologists, surgical oncologists, and musculoskeletal radiologists, assesses each case. The first consideration is whether the tumor can be resected, based on its proximity to adjacent tissue. Following this, patients are evaluated for candidacy in clinical trials and potential ablation therapy. This multidisciplinary approach leads to better medicine and patient outcomes, as treatment decisions are rarely straightforward and should not be made by a single practitioner. TIMESTAMPS 00:00 - Planning for Cryoablation Probes 02:32 - Clinical Management after Cryoablation 04:45 - Follow Up Imaging 05:52 - Challenging Cases 08:41 - Multidisciplinary Desmoid Tumor Treatment CHECK OUT THE FULL EPISODE BackTable MSK Ep. 7- Desmoid Tumors: IR’s Role in Diagnosis and Management https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation Musculoskeletal radiologists can be highly involved in cryoablation for desmoid tumors. Interventional radiologist Dr. Jack Jennings from Washington University in St. Louis shares the finer points of his approach to this procedure. 


Desmoid tumor cryoablation cases require varying numbers of cryoablation probes, dependant on tumor morphology. The usual number of probes ranges from 5 to 10. To mitigate the risk of rhabdomyolysis, which increases with more than 10 probes, Dr. Jennings typically divides the procedure into two sessions. 


His patients are generally admitted for pain control, monitoring for rhabdomyolysis, and management of inflammatory responses, with steroids administered both intraoperatively and postoperatively. Imaging is conducted at 6 to 8 weeks after the procedure, with Initial imaging sometimes showing the tumor as larger due to the inflammatory reaction and ablation zone.


It is important that a multidisciplinary sarcoma tumor board, consisting of medical oncologists, surgical oncologists, and musculoskeletal radiologists, assesses each case. The first consideration is whether the tumor can be resected, based on its proximity to adjacent tissue. Following this, patients are evaluated for candidacy in clinical trials and potential ablation therapy. This multidisciplinary approach leads to better medicine and patient outcomes, as treatment decisions are rarely straightforward and should not be made by a single practitioner.


TIMESTAMPS


00:00 - Planning for Cryoablation Probes

02:32 - Clinical Management after Cryoablation

04:45 - Follow Up Imaging

05:52 - Challenging Cases

08:41 - Multidisciplinary Desmoid Tumor Treatment


CHECK OUT THE FULL EPISODE


BackTable MSK Ep. 7- Desmoid Tumors: IR’s Role in Diagnosis and Management

https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation

]]> 793 BackTable Brief: Desmoid Tumors I with Dr. Jack Jennings Desmoid tumors are a type of benign sarcoma that can be locally aggressive and extremely morbid. Dr. Jack Jennings from Washington University in St. Louis discusses his experience in treating this condition. Surgical resection is considered the gold standard for treatment; however, the aggressive nature of these tumors can make resection challenging. To address this, Dr. Jennings’ institution began offering ablation for non-surgical candidates, becoming a major referral center for these cancers. Cryoablation has become the preferred option. It is particularly effective for uncomplicated desmoid tumors that are likely to have clean surgical margins. Ideal tumors for cryoablation are those that do not involve nerves and are located extra-abdominally or in the extremities. Cryoablation allows for visualization of a low attenuation ice ball and the ability to sculpt the ablation zone based on the tumor geometry, with a goal of achieving a 10mm or greater margin around the tumor. Thermoprotective strategies are essential to protect nearby structures during cryoablation, such as nerves and bowel. Carbon dioxide gas can be used, along with hydrodissection and sometimes balloons. The bowel is particularly sensitive to ice, so careful planning is required to avoid complications. CT is typically used for intraprocedural imaging, with the addition of ultrasound to visualize  superficial targets or to avoid streak artifacts. Some facilities also employ MR guidance for this procedure. TIMESTAMPS 00:00 - Evolution of Treatment for Desmoid Tumors 02:52 - Planning for Ablation 05:38 - Thermoprotective Strategies 07:30 - Carbon Dioxide Use 09:05 - Imaging Modalities for Ablation CHECK OUT THE FULL EPISODE BackTable MSK Ep. 7- Desmoid Tumors: IR’s Role in Diagnosis and Management https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation  Tue, 28 May 2024 07:00:00 -0000 full BackTable Desmoid tumors are a type of benign sarcoma that can be locally aggressive and extremely morbid. Dr. Jack Jennings from Washington University in St. Louis discusses his experience in treating this condition. Desmoid tumors are a type of benign sarcoma that can be locally aggressive and extremely morbid. Dr. Jack Jennings from Washington University in St. Louis discusses his experience in treating this condition. Surgical resection is considered the gold standard for treatment; however, the aggressive nature of these tumors can make resection challenging. To address this, Dr. Jennings’ institution began offering ablation for non-surgical candidates, becoming a major referral center for these cancers. Cryoablation has become the preferred option. It is particularly effective for uncomplicated desmoid tumors that are likely to have clean surgical margins. Ideal tumors for cryoablation are those that do not involve nerves and are located extra-abdominally or in the extremities. Cryoablation allows for visualization of a low attenuation ice ball and the ability to sculpt the ablation zone based on the tumor geometry, with a goal of achieving a 10mm or greater margin around the tumor. Thermoprotective strategies are essential to protect nearby structures during cryoablation, such as nerves and bowel. Carbon dioxide gas can be used, along with hydrodissection and sometimes balloons. The bowel is particularly sensitive to ice, so careful planning is required to avoid complications. CT is typically used for intraprocedural imaging, with the addition of ultrasound to visualize  superficial targets or to avoid streak artifacts. Some facilities also employ MR guidance for this procedure. TIMESTAMPS 00:00 - Evolution of Treatment for Desmoid Tumors 02:52 - Planning for Ablation 05:38 - Thermoprotective Strategies 07:30 - Carbon Dioxide Use 09:05 - Imaging Modalities for Ablation CHECK OUT THE FULL EPISODE BackTable MSK Ep. 7- Desmoid Tumors: IR’s Role in Diagnosis and Management https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation  Desmoid tumors are a type of benign sarcoma that can be locally aggressive and extremely morbid. Dr. Jack Jennings from Washington University in St. Louis discusses his experience in treating this condition.


Surgical resection is considered the gold standard for treatment; however, the aggressive nature of these tumors can make resection challenging. To address this, Dr. Jennings’ institution began offering ablation for non-surgical candidates, becoming a major referral center for these cancers.


Cryoablation has become the preferred option. It is particularly effective for uncomplicated desmoid tumors that are likely to have clean surgical margins. Ideal tumors for cryoablation are those that do not involve nerves and are located extra-abdominally or in the extremities. Cryoablation allows for visualization of a low attenuation ice ball and the ability to sculpt the ablation zone based on the tumor geometry, with a goal of achieving a 10mm or greater margin around the tumor.


Thermoprotective strategies are essential to protect nearby structures during cryoablation, such as nerves and bowel. Carbon dioxide gas can be used, along with hydrodissection and sometimes balloons. The bowel is particularly sensitive to ice, so careful planning is required to avoid complications. CT is typically used for intraprocedural imaging, with the addition of ultrasound to visualize  superficial targets or to avoid streak artifacts. Some facilities also employ MR guidance for this procedure.


TIMESTAMPS


00:00 - Evolution of Treatment for Desmoid Tumors

02:52 - Planning for Ablation

05:38 - Thermoprotective Strategies

07:30 - Carbon Dioxide Use

09:05 - Imaging Modalities for Ablation


CHECK OUT THE FULL EPISODE


BackTable MSK Ep. 7- Desmoid Tumors: IR’s Role in Diagnosis and Management

https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation 



]]> 742 Ep. 50 Exploring GAE: Clinical Insights and Outcomes with Dr. Mark Little Tue, 21 May 2024 07:00:00 -0000 full BackTable 3125 Ep. 49 Chilling Solutions: Cryoneurolysis in Clinical Practice with Dr. Aron Chary In this episode, Dr. Aron Chary provides an in-depth look into endovascular and minimally invasive treatments for pain management, specifically focusing on cryoneurolysis. He shares his experience of implementing the technology for both benign and malignant conditions in an independent private practice setting. --- CHECK OUT OUR SPONSOR Boston Scientific Visual ICE Cryoablation System https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html --- SYNPOSIS The discussion covers various aspects, including collaboration with Boston Scientific for the VISUAL ICE cryoablation system, Dr. Chary’s personal journey from academics at Emory to private practice in Memphis, the effectiveness of cryoneurolysis in different areas such as genicular nerve and palliative care, and the operational dynamics between hospital and outpatient settings. The doctors delve into the procedural specifics, patient response, and outcomes with cryoneurolysis, including Dr. Chary’s efforts to navigate insurance and reimbursement challenges. --- TIMESTAMPS 00:00 - Introduction 07:04 - Evolution of Pain Intervention Techniques 11:08 - Building a Pain Intervention Service 16:16 - Versatility of Cryoablation in Pain Management 23:54 - Expectations and the Future of Pain Management Research 31:41 - Cryoneurolysis Insights and Patient Management 42:10 - Techniques in Celiac Cryoneurolysis 52:33 - Pain Management in the Outpatient Setting --- RESOURCES Percutaneous CT-Guided Cryoablation of the Celiac Plexus: A Retrospective Cohort Comparison with Ethanol: https://www.jvir.org/article/S1051-0443(20)30349-3/abstract BT VI Episode 199 - Advanced Minimally Invasive Pain Interventions with Dr. David Prologo: https://www.backtable.com/shows/vi/podcasts/199/advanced-minimally-invasive-pain-interventions BT VI Episode 433 - Kyphoplasty Evolution: Steering Toward Targeted Therapy with Dr. David Prologo: https://www.backtable.com/shows/vi/podcasts/433/kyphoplasty-evolution-steering-toward-targeted-therapy Boston Scientific, VISUAL ICE: https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html Tue, 30 Apr 2024 07:00:00 -0000 full BackTable In this episode, Dr. Aron Chary provides an in-depth look into endovascular and minimally invasive treatments for pain management, specifically focusing on cryoneurolysis. He shares his experience of implementing the technology for both benign and malignant conditions in an independent private practice setting. In this episode, Dr. Aron Chary provides an in-depth look into endovascular and minimally invasive treatments for pain management, specifically focusing on cryoneurolysis. He shares his experience of implementing the technology for both benign and malignant conditions in an independent private practice setting. --- CHECK OUT OUR SPONSOR Boston Scientific Visual ICE Cryoablation System https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html --- SYNPOSIS The discussion covers various aspects, including collaboration with Boston Scientific for the VISUAL ICE cryoablation system, Dr. Chary’s personal journey from academics at Emory to private practice in Memphis, the effectiveness of cryoneurolysis in different areas such as genicular nerve and palliative care, and the operational dynamics between hospital and outpatient settings. The doctors delve into the procedural specifics, patient response, and outcomes with cryoneurolysis, including Dr. Chary’s efforts to navigate insurance and reimbursement challenges. --- TIMESTAMPS 00:00 - Introduction 07:04 - Evolution of Pain Intervention Techniques 11:08 - Building a Pain Intervention Service 16:16 - Versatility of Cryoablation in Pain Management 23:54 - Expectations and the Future of Pain Management Research 31:41 - Cryoneurolysis Insights and Patient Management 42:10 - Techniques in Celiac Cryoneurolysis 52:33 - Pain Management in the Outpatient Setting --- RESOURCES Percutaneous CT-Guided Cryoablation of the Celiac Plexus: A Retrospective Cohort Comparison with Ethanol: https://www.jvir.org/article/S1051-0443(20)30349-3/abstract BT VI Episode 199 - Advanced Minimally Invasive Pain Interventions with Dr. David Prologo: https://www.backtable.com/shows/vi/podcasts/199/advanced-minimally-invasive-pain-interventions BT VI Episode 433 - Kyphoplasty Evolution: Steering Toward Targeted Therapy with Dr. David Prologo: https://www.backtable.com/shows/vi/podcasts/433/kyphoplasty-evolution-steering-toward-targeted-therapy Boston Scientific, VISUAL ICE: https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html In this episode, Dr. Aron Chary provides an in-depth look into endovascular and minimally invasive treatments for pain management, specifically focusing on cryoneurolysis. He shares his experience of implementing the technology for both benign and malignant conditions in an independent private practice setting.


---


CHECK OUT OUR SPONSOR


Boston Scientific Visual ICE Cryoablation System

https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html


---


SYNPOSIS


The discussion covers various aspects, including collaboration with Boston Scientific for the VISUAL ICE cryoablation system, Dr. Chary’s personal journey from academics at Emory to private practice in Memphis, the effectiveness of cryoneurolysis in different areas such as genicular nerve and palliative care, and the operational dynamics between hospital and outpatient settings. The doctors delve into the procedural specifics, patient response, and outcomes with cryoneurolysis, including Dr. Chary’s efforts to navigate insurance and reimbursement challenges.


---


TIMESTAMPS


00:00 - Introduction

07:04 - Evolution of Pain Intervention Techniques

11:08 - Building a Pain Intervention Service

16:16 - Versatility of Cryoablation in Pain Management

23:54 - Expectations and the Future of Pain Management Research

31:41 - Cryoneurolysis Insights and Patient Management

42:10 - Techniques in Celiac Cryoneurolysis

52:33 - Pain Management in the Outpatient Setting


---


RESOURCES


Percutaneous CT-Guided Cryoablation of the Celiac Plexus: A Retrospective Cohort Comparison with Ethanol:

https://www.jvir.org/article/S1051-0443(20)30349-3/abstract


BT VI Episode 199 - Advanced Minimally Invasive Pain Interventions with Dr. David Prologo:

https://www.backtable.com/shows/vi/podcasts/199/advanced-minimally-invasive-pain-interventions


BT VI Episode 433 - Kyphoplasty Evolution: Steering Toward Targeted Therapy with Dr. David Prologo:

https://www.backtable.com/shows/vi/podcasts/433/kyphoplasty-evolution-steering-toward-targeted-therapy


Boston Scientific, VISUAL ICE:

https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html

]]> 3527 Ep. 48 SCS for Neuropathy: Clinical Insights and Patient Impact with Dr. Blake Parsons In this episode, Dr. Blake Parsons talks through the role of spinal cord stimulation in treating vascular issues and diabetic neuropathy. He also discusses the growing presence of vascular specialists in clinics, the transition from procedural work to clinical involvement, and the significance of building a strong patient-doctor relationship. The doctors highlight the effectiveness of Nevro 10 kHz therapy in providing long-term pain relief and sensory improvements for patients struggling with painful diabetic neuropathy, even after conventional treatments fail. Additionally, they touch upon reimbursement updates, the rise of outpatient care, and the future of spinal cord stimulation - emphasizing its potential beyond just pain relief to include improvements in patients’ overall quality of life, reducing risks related to diabetic foot wounds, and incidental falls. The need for a multidisciplinary approach in treating vascular and neuropathic conditions is also discussed, along with the role of interventional radiologists in managing these complex cases. --- CHECK OUT OUR SPONSOR Nevro HFX Spinal Cord Stimulator https://www.hfxforpdn.com --- SHOW NOTES 00:00 - Introduction 06:00 - Demystifying Spinal Cord Stimulation for Pain Management 17:11 - Optimizing Patient Care: Trials, Techniques, and Insurance 26:03 - Leveraging Telehealth and Support Teams for Patient Success 30:22 - Challenges and Solutions in Managing Peripheral Neuropathy 35:19 - Collaboration and Referral Dynamics in Vascular and Interventional Radiology 39:19 - Exploring the Future of Neuropathy Treatment and Quality of Life Improvements 43:46 - Addressing the Challenges of Permanent Implant Procedures 48:46 - Role of Technology and AI in Patient Management 56:31 - Concluding Thoughts on Neuropathy Treatment and Practice Dynamics --- RESOURCES Nevro 10 kHz Therapy: https://nevro.com/English/en/providers/HFX-Advanced-Therapies/default.aspx Effect of High-frequency (10-kHz) Spinal Cord Stimulation in Patients With Painful Diabetic Neuropathy: A Randomized Clinical Trial (JAMA Neurology RCT 2021): https://pubmed.ncbi.nlm.nih.gov/33818600/ Long-term efficacy of high-frequency (10 kHz) spinal cord stimulation for the treatment of painful diabetic neuropathy: 24-Month results of a randomized controlled trial (SENZA-PDN RCT 2023): https://pubmed.ncbi.nlm.nih.gov/37536514/ Electrical spinal-cord stimulation for painful diabetic peripheral neuropathy (Lancet RCT 1996): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(96)02467-1/abstract Tue, 16 Apr 2024 07:00:00 -0000 full BackTable In this episode, Dr. Blake Parsons talks through the role of spinal cord stimulation in treating vascular issues and diabetic neuropathy. He also discusses the growing presence of vascular specialists in clinics, the transition from procedural work to clinical involvement, and the significance of building a strong patient-doctor relationship. In this episode, Dr. Blake Parsons talks through the role of spinal cord stimulation in treating vascular issues and diabetic neuropathy. He also discusses the growing presence of vascular specialists in clinics, the transition from procedural work to clinical involvement, and the significance of building a strong patient-doctor relationship. The doctors highlight the effectiveness of Nevro 10 kHz therapy in providing long-term pain relief and sensory improvements for patients struggling with painful diabetic neuropathy, even after conventional treatments fail. Additionally, they touch upon reimbursement updates, the rise of outpatient care, and the future of spinal cord stimulation - emphasizing its potential beyond just pain relief to include improvements in patients’ overall quality of life, reducing risks related to diabetic foot wounds, and incidental falls. The need for a multidisciplinary approach in treating vascular and neuropathic conditions is also discussed, along with the role of interventional radiologists in managing these complex cases. --- CHECK OUT OUR SPONSOR Nevro HFX Spinal Cord Stimulator https://www.hfxforpdn.com --- SHOW NOTES 00:00 - Introduction 06:00 - Demystifying Spinal Cord Stimulation for Pain Management 17:11 - Optimizing Patient Care: Trials, Techniques, and Insurance 26:03 - Leveraging Telehealth and Support Teams for Patient Success 30:22 - Challenges and Solutions in Managing Peripheral Neuropathy 35:19 - Collaboration and Referral Dynamics in Vascular and Interventional Radiology 39:19 - Exploring the Future of Neuropathy Treatment and Quality of Life Improvements 43:46 - Addressing the Challenges of Permanent Implant Procedures 48:46 - Role of Technology and AI in Patient Management 56:31 - Concluding Thoughts on Neuropathy Treatment and Practice Dynamics --- RESOURCES Nevro 10 kHz Therapy: https://nevro.com/English/en/providers/HFX-Advanced-Therapies/default.aspx Effect of High-frequency (10-kHz) Spinal Cord Stimulation in Patients With Painful Diabetic Neuropathy: A Randomized Clinical Trial (JAMA Neurology RCT 2021): https://pubmed.ncbi.nlm.nih.gov/33818600/ Long-term efficacy of high-frequency (10 kHz) spinal cord stimulation for the treatment of painful diabetic neuropathy: 24-Month results of a randomized controlled trial (SENZA-PDN RCT 2023): https://pubmed.ncbi.nlm.nih.gov/37536514/ Electrical spinal-cord stimulation for painful diabetic peripheral neuropathy (Lancet RCT 1996): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(96)02467-1/abstract In this episode, Dr. Blake Parsons talks through the role of spinal cord stimulation in treating vascular issues and diabetic neuropathy. He also discusses the growing presence of vascular specialists in clinics, the transition from procedural work to clinical involvement, and the significance of building a strong patient-doctor relationship.


The doctors highlight the effectiveness of Nevro 10 kHz therapy in providing long-term pain relief and sensory improvements for patients struggling with painful diabetic neuropathy, even after conventional treatments fail. Additionally, they touch upon reimbursement updates, the rise of outpatient care, and the future of spinal cord stimulation - emphasizing its potential beyond just pain relief to include improvements in patients’ overall quality of life, reducing risks related to diabetic foot wounds, and incidental falls. The need for a multidisciplinary approach in treating vascular and neuropathic conditions is also discussed, along with the role of interventional radiologists in managing these complex cases.


---


CHECK OUT OUR SPONSOR


Nevro HFX Spinal Cord Stimulator

https://www.hfxforpdn.com


---


SHOW NOTES


00:00 - Introduction

06:00 - Demystifying Spinal Cord Stimulation for Pain Management

17:11 - Optimizing Patient Care: Trials, Techniques, and Insurance

26:03 - Leveraging Telehealth and Support Teams for Patient Success

30:22 - Challenges and Solutions in Managing Peripheral Neuropathy

35:19 - Collaboration and Referral Dynamics in Vascular and Interventional Radiology

39:19 - Exploring the Future of Neuropathy Treatment and Quality of Life Improvements

43:46 - Addressing the Challenges of Permanent Implant Procedures

48:46 - Role of Technology and AI in Patient Management

56:31 - Concluding Thoughts on Neuropathy Treatment and Practice Dynamics


---


RESOURCES


Nevro 10 kHz Therapy:

https://nevro.com/English/en/providers/HFX-Advanced-Therapies/default.aspx


Effect of High-frequency (10-kHz) Spinal Cord Stimulation in Patients With Painful Diabetic Neuropathy: A Randomized Clinical Trial (JAMA Neurology RCT 2021):

https://pubmed.ncbi.nlm.nih.gov/33818600/


Long-term efficacy of high-frequency (10 kHz) spinal cord stimulation for the treatment of painful diabetic neuropathy: 24-Month results of a randomized controlled trial (SENZA-PDN RCT 2023):

https://pubmed.ncbi.nlm.nih.gov/37536514/


Electrical spinal-cord stimulation for painful diabetic peripheral neuropathy (Lancet RCT 1996):

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(96)02467-1/abstract

]]> 3626 Ep. 47 Kyphoplasty Evolution: Steering Toward Targeted Therapy with Dr. David Prologo In this episode of the BackTable MSK Podcast, Dr. Dana Dunleavy interviews Dr. David Prologo about his perspective on current advancements in MSK interventions, including steerable spine needles, thermocouples for radiofrequency ablation, and the growing importance of advocacy and longitudinal follow up for patients with chronic pain. Dr. Prologo is an interventional radiologist at Emory University. Dr. Prologo starts by describing the evolution of interventional radiology’s role in MSK interventions. He explains that establishing solid referral networks is crucial to building this service line, and he gives examples of how new interventionalists can highlight their skills to others. Then, he describes a new steerable needle that allows operators to safely enter the vertebral body with a transpedicular approach and subsequently navigate directly to the location of interest. This device is especially useful when lesions are located in tricky areas where the trajectory of a straight needle would have difficulty reaching. He also discusses different devices for bone tumor ablation and his preferred methods for targeting lesions that are located at varying locations in the spine. For lesions below T5, he uses fluoroscopy for better visualization of the axial plane. For lumbar lesions, he emphasizes the importance of correlating and cross-checking vertebral levels with pre-procedural MRI. Dr. Prologo also discusses lessons learned from his extensive experience in spine interventions, especially from prior complications. He explains how thermocouple monitoring can give real time feedback on internal temperature during radiofrequency ablation, the necessity of understanding the ablation zone, and the importance of longitudinal follow up. He cites specific cases of patients struggling with chronic pain and how he advocated for each case. --- CHECK OUT OUR SPONSOR Merit Spine https://www.merit.com/merit-spine/ --- SHOW NOTES 00:00 - Introduction 02:09 - Dr. Prologo’s Career and Leadership Roles 09:52 - Interventional Radiology’s Role in MSK Interventions 13:37 - A Primer for Steerable Vertebral Needles 21:40 - Increasing Standardization and Accessibility of Bone Tumor Ablation 26:37 - Advanced Pain Management in Interventional Radiology’ Book 30:24 - Thermocouples in Radiofrequency Ablation 35:45 - Prior Complications and Importance of Longitudinal Care 44:24 - SIR EDGE 2024 52:31 - Accessing Targets for Basivertebral Nerve Ablation 1:01:17 - The Role of Advocacy in Patient Care --- RESOURCES Osseoflex Steerable Needle: https://www.merit.com/product/osseoflex-sn-steerable-needle/ STAR Tumor Ablation System: https://www.merit.com/product/star-tumor-ablation-system/ Osteocool OsteoCool Radiofrequency Ablation System: https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/tumor-management/osteocool-ablation-system-rf.html OptaBlate Bone Tumor Ablation System: https://providers.strykerivs.com/products/optablate ‘Advanced Pain Management in Interventional Radiology’ by J. David Prologo and Charles E. Ray Jr: https://shop.thieme.com/Advanced-Pain-Management-in-Interventional-Radiology/9781684201402 Ablation zones and weight-bearing bones: points of caution for the palliative interventionalist: https://pubmed.ncbi.nlm.nih.gov/24745905/ SIR EDGE 2024: https://www.sirweb.org/learning-center/meetings/sir-edge/ ‘The Catching Point Transformation’ by J. David Prologo: https://www.catchingpoint.com/ Tue, 09 Apr 2024 07:00:00 -0000 full BackTable In this episode of the BackTable MSK Podcast, Dr. Dana Dunleavy interviews Dr. David Prologo about his perspective on current advancements in MSK interventions, including steerable spine needles, thermocouples for radiofrequency ablation, and the growing importance of advocacy and longitudinal follow up for patients with chronic pain. In this episode of the BackTable MSK Podcast, Dr. Dana Dunleavy interviews Dr. David Prologo about his perspective on current advancements in MSK interventions, including steerable spine needles, thermocouples for radiofrequency ablation, and the growing importance of advocacy and longitudinal follow up for patients with chronic pain. Dr. Prologo is an interventional radiologist at Emory University. Dr. Prologo starts by describing the evolution of interventional radiology’s role in MSK interventions. He explains that establishing solid referral networks is crucial to building this service line, and he gives examples of how new interventionalists can highlight their skills to others. Then, he describes a new steerable needle that allows operators to safely enter the vertebral body with a transpedicular approach and subsequently navigate directly to the location of interest. This device is especially useful when lesions are located in tricky areas where the trajectory of a straight needle would have difficulty reaching. He also discusses different devices for bone tumor ablation and his preferred methods for targeting lesions that are located at varying locations in the spine. For lesions below T5, he uses fluoroscopy for better visualization of the axial plane. For lumbar lesions, he emphasizes the importance of correlating and cross-checking vertebral levels with pre-procedural MRI. Dr. Prologo also discusses lessons learned from his extensive experience in spine interventions, especially from prior complications. He explains how thermocouple monitoring can give real time feedback on internal temperature during radiofrequency ablation, the necessity of understanding the ablation zone, and the importance of longitudinal follow up. He cites specific cases of patients struggling with chronic pain and how he advocated for each case. --- CHECK OUT OUR SPONSOR Merit Spine https://www.merit.com/merit-spine/ --- SHOW NOTES 00:00 - Introduction 02:09 - Dr. Prologo’s Career and Leadership Roles 09:52 - Interventional Radiology’s Role in MSK Interventions 13:37 - A Primer for Steerable Vertebral Needles 21:40 - Increasing Standardization and Accessibility of Bone Tumor Ablation 26:37 - Advanced Pain Management in Interventional Radiology’ Book 30:24 - Thermocouples in Radiofrequency Ablation 35:45 - Prior Complications and Importance of Longitudinal Care 44:24 - SIR EDGE 2024 52:31 - Accessing Targets for Basivertebral Nerve Ablation 1:01:17 - The Role of Advocacy in Patient Care --- RESOURCES Osseoflex Steerable Needle: https://www.merit.com/product/osseoflex-sn-steerable-needle/ STAR Tumor Ablation System: https://www.merit.com/product/star-tumor-ablation-system/ Osteocool OsteoCool Radiofrequency Ablation System: https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/tumor-management/osteocool-ablation-system-rf.html OptaBlate Bone Tumor Ablation System: https://providers.strykerivs.com/products/optablate ‘Advanced Pain Management in Interventional Radiology’ by J. David Prologo and Charles E. Ray Jr: https://shop.thieme.com/Advanced-Pain-Management-in-Interventional-Radiology/9781684201402 Ablation zones and weight-bearing bones: points of caution for the palliative interventionalist: https://pubmed.ncbi.nlm.nih.gov/24745905/ SIR EDGE 2024: https://www.sirweb.org/learning-center/meetings/sir-edge/ ‘The Catching Point Transformation’ by J. David Prologo: https://www.catchingpoint.com/ In this episode of the BackTable MSK Podcast, Dr. Dana Dunleavy interviews Dr. David Prologo about his perspective on current advancements in MSK interventions, including steerable spine needles, thermocouples for radiofrequency ablation, and the growing importance of advocacy and longitudinal follow up for patients with chronic pain. Dr. Prologo is an interventional radiologist at Emory University.


Dr. Prologo starts by describing the evolution of interventional radiology’s role in MSK interventions. He explains that establishing solid referral networks is crucial to building this service line, and he gives examples of how new interventionalists can highlight their skills to others. Then, he describes a new steerable needle that allows operators to safely enter the vertebral body with a transpedicular approach and subsequently navigate directly to the location of interest. This device is especially useful when lesions are located in tricky areas where the trajectory of a straight needle would have difficulty reaching. He also discusses different devices for bone tumor ablation and his preferred methods for targeting lesions that are located at varying locations in the spine. For lesions below T5, he uses fluoroscopy for better visualization of the axial plane. For lumbar lesions, he emphasizes the importance of correlating and cross-checking vertebral levels with pre-procedural MRI.


Dr. Prologo also discusses lessons learned from his extensive experience in spine interventions, especially from prior complications. He explains how thermocouple monitoring can give real time feedback on internal temperature during radiofrequency ablation, the necessity of understanding the ablation zone, and the importance of longitudinal follow up. He cites specific cases of patients struggling with chronic pain and how he advocated for each case.


---


CHECK OUT OUR SPONSOR


Merit Spine

https://www.merit.com/merit-spine/


---


SHOW NOTES


00:00 - Introduction

02:09 - Dr. Prologo’s Career and Leadership Roles

09:52 - Interventional Radiology’s Role in MSK Interventions

13:37 - A Primer for Steerable Vertebral Needles

21:40 - Increasing Standardization and Accessibility of Bone Tumor Ablation

26:37 - Advanced Pain Management in Interventional Radiology’ Book

30:24 - Thermocouples in Radiofrequency Ablation

35:45 - Prior Complications and Importance of Longitudinal Care

44:24 - SIR EDGE 2024

52:31 - Accessing Targets for Basivertebral Nerve Ablation

1:01:17 - The Role of Advocacy in Patient Care


---


RESOURCES


Osseoflex Steerable Needle:

https://www.merit.com/product/osseoflex-sn-steerable-needle/


STAR Tumor Ablation System:

https://www.merit.com/product/star-tumor-ablation-system/


Osteocool OsteoCool Radiofrequency Ablation System:

https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/tumor-management/osteocool-ablation-system-rf.html


OptaBlate Bone Tumor Ablation System:

https://providers.strykerivs.com/products/optablate


‘Advanced Pain Management in Interventional Radiology’ by J. David Prologo and Charles E. Ray Jr:

https://shop.thieme.com/Advanced-Pain-Management-in-Interventional-Radiology/9781684201402


Ablation zones and weight-bearing bones: points of caution for the palliative interventionalist:

https://pubmed.ncbi.nlm.nih.gov/24745905/


SIR EDGE 2024:

https://www.sirweb.org/learning-center/meetings/sir-edge/


‘The Catching Point Transformation’ by J. David Prologo:

https://www.catchingpoint.com/

]]> 4303 Ep. 46 Successful Bone Lesion Biopsies with Dr. Chris Beck On this episode of the BackTable MSK podcast, co-hosts Dr. Chris Beck and Dr. Aaron Fritts review the basics of bone lesion biopsy, including patient selection, imaging modalities, and procedural steps. They begin with summarizing indications for bone lesions, which are most common in the setting of metastatic disease. Patients usually get referred for biopsy when a bone lesion is caught on CT imaging of the chest, abdomen, and pelvis. The doctors emphasize that imaging multiple areas is needed to find the most easily accessible lesion, which is sometimes located within a solid organ, rather than within bone. While PET imaging can be useful for confirmation of sclerotic bone lesions, patients usually cannot receive PET scans without an established cancer diagnosis. Dr. Beck highlights the fact that lytic lesions with soft tissue components are technically easier to access than sclerotic lesions and result in higher yield. He occasionally uses a soft tissue biopsy needle for these lesions. For sclerotic lesions, he prefers the OnControl or Stryker bone biopsy coaxial systems. With the coaxial system, it can be hard to adjust the biopsy tract after you have already started drilling, but he recommends obtaining multiple cores at different angles of approach. He also advises listeners to choose the shortest needle possible, since this makes it easier to control and image the needle within the lesion.The doctors also discuss biopsy of tricky locations. Sternal lesions carry the risk of lung injury and pneumothorax, so when faced with these, Dr. Beck picks an oblique tract that has a longer trajectory. For lesions located in proximal extremities, he secures the limb to minimize movement. Next, disc biopsies are discussed. Patients usually present with discitis osteomyelitis from prior back surgery, IV drug use, or idiopathic causes. It is important to distinguish between infection of the disc space versus chronic degenerative disc disease, which can be identified by comparison with prior imaging and lab workup. For the lumbar spine disc biopsy, fluoroscopy is Dr. Beck’s preferred imaging modality, and he reviews imaging landmarks. Dr. Fritts usually biopsies both bone and disc. Finally, they discuss post-procedural complications to watch for, such as chest x-rays in checking for lung injury and neurological exams to assess for new deficits. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SHOW NOTES 00:00 - Introduction 03:12 - Referrals and Imaging Techniques for Bone Lesion Biopsy 07:09 - Procedural Steps of Bone Lesion Biopsy 12:32 - Choosing Biopsy Tools 23:22 - Approach to Tricky Biopsy Locations 28:19 - Workup and Indications for Disc Biopsy 32:08 - Fluoroscopy vs. CT for Disc Biopsy 40:15 - Handling Biopsy Samples 48:03 - Post-Procedure Care and Complications --- RESOURCES Arrow OnControl Powered Bone Biopsy System: https://irc.teleflex.com/oncontrolsystem/ Stryker Bone Biopsy Coaxial System: https://www.stryker.com/us/en/interventional-spine/products/bone-biopsy.html BD Trek Powered Bone Biopsy System: https://www.bd.com/en-us/products-and-solutions/products/product-families/bd-trek-powered-bone-biopsy-system Jamshidi Evolve Bone Marrow Needle: https://www.bd.com/en-us/products-and-solutions/products/product-families/jamshidi-evolve-bone-marrow-needle BD Illinois Sternal/Iliac Bone Marrow Aspiration Needles: https://www.bd.com/en-ca/products-and-solutions/products/product-families/illinois-sternal-iliac-bone-marrow-aspiration-needles BD Mission Disposable Core Biopsy Instrument: https://www.bd.com/en-us/products-and-solutions/products/product-families/mission-disposable-core-biopsy-instrument Disc Biopsy Visualization Website: https://www.pediatricir.com/disc-aspiration-for-discitis.html Tue, 02 Apr 2024 07:00:00 -0000 full BackTable On this episode of the BackTable MSK podcast, co-hosts Dr. Chris Beck and Dr. Aaron Fritts review the basics of bone lesion biopsy, including patient selection, imaging modalities, and procedural steps. On this episode of the BackTable MSK podcast, co-hosts Dr. Chris Beck and Dr. Aaron Fritts review the basics of bone lesion biopsy, including patient selection, imaging modalities, and procedural steps. They begin with summarizing indications for bone lesions, which are most common in the setting of metastatic disease. Patients usually get referred for biopsy when a bone lesion is caught on CT imaging of the chest, abdomen, and pelvis. The doctors emphasize that imaging multiple areas is needed to find the most easily accessible lesion, which is sometimes located within a solid organ, rather than within bone. While PET imaging can be useful for confirmation of sclerotic bone lesions, patients usually cannot receive PET scans without an established cancer diagnosis. Dr. Beck highlights the fact that lytic lesions with soft tissue components are technically easier to access than sclerotic lesions and result in higher yield. He occasionally uses a soft tissue biopsy needle for these lesions. For sclerotic lesions, he prefers the OnControl or Stryker bone biopsy coaxial systems. With the coaxial system, it can be hard to adjust the biopsy tract after you have already started drilling, but he recommends obtaining multiple cores at different angles of approach. He also advises listeners to choose the shortest needle possible, since this makes it easier to control and image the needle within the lesion.The doctors also discuss biopsy of tricky locations. Sternal lesions carry the risk of lung injury and pneumothorax, so when faced with these, Dr. Beck picks an oblique tract that has a longer trajectory. For lesions located in proximal extremities, he secures the limb to minimize movement. Next, disc biopsies are discussed. Patients usually present with discitis osteomyelitis from prior back surgery, IV drug use, or idiopathic causes. It is important to distinguish between infection of the disc space versus chronic degenerative disc disease, which can be identified by comparison with prior imaging and lab workup. For the lumbar spine disc biopsy, fluoroscopy is Dr. Beck’s preferred imaging modality, and he reviews imaging landmarks. Dr. Fritts usually biopsies both bone and disc. Finally, they discuss post-procedural complications to watch for, such as chest x-rays in checking for lung injury and neurological exams to assess for new deficits. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SHOW NOTES 00:00 - Introduction 03:12 - Referrals and Imaging Techniques for Bone Lesion Biopsy 07:09 - Procedural Steps of Bone Lesion Biopsy 12:32 - Choosing Biopsy Tools 23:22 - Approach to Tricky Biopsy Locations 28:19 - Workup and Indications for Disc Biopsy 32:08 - Fluoroscopy vs. CT for Disc Biopsy 40:15 - Handling Biopsy Samples 48:03 - Post-Procedure Care and Complications --- RESOURCES Arrow OnControl Powered Bone Biopsy System: https://irc.teleflex.com/oncontrolsystem/ Stryker Bone Biopsy Coaxial System: https://www.stryker.com/us/en/interventional-spine/products/bone-biopsy.html BD Trek Powered Bone Biopsy System: https://www.bd.com/en-us/products-and-solutions/products/product-families/bd-trek-powered-bone-biopsy-system Jamshidi Evolve Bone Marrow Needle: https://www.bd.com/en-us/products-and-solutions/products/product-families/jamshidi-evolve-bone-marrow-needle BD Illinois Sternal/Iliac Bone Marrow Aspiration Needles: https://www.bd.com/en-ca/products-and-solutions/products/product-families/illinois-sternal-iliac-bone-marrow-aspiration-needles BD Mission Disposable Core Biopsy Instrument: https://www.bd.com/en-us/products-and-solutions/products/product-families/mission-disposable-core-biopsy-instrument Disc Biopsy Visualization Website: https://www.pediatricir.com/disc-aspiration-for-discitis.html On this episode of the BackTable MSK podcast, co-hosts Dr. Chris Beck and Dr. Aaron Fritts review the basics of bone lesion biopsy, including patient selection, imaging modalities, and procedural steps.


They begin with summarizing indications for bone lesions, which are most common in the setting of metastatic disease. Patients usually get referred for biopsy when a bone lesion is caught on CT imaging of the chest, abdomen, and pelvis. The doctors emphasize that imaging multiple areas is needed to find the most easily accessible lesion, which is sometimes located within a solid organ, rather than within bone. While PET imaging can be useful for confirmation of sclerotic bone lesions, patients usually cannot receive PET scans without an established cancer diagnosis.


Dr. Beck highlights the fact that lytic lesions with soft tissue components are technically easier to access than sclerotic lesions and result in higher yield. He occasionally uses a soft tissue biopsy needle for these lesions. For sclerotic lesions, he prefers the OnControl or Stryker bone biopsy coaxial systems. With the coaxial system, it can be hard to adjust the biopsy tract after you have already started drilling, but he recommends obtaining multiple cores at different angles of approach. He also advises listeners to choose the shortest needle possible, since this makes it easier to control and image the needle within the lesion.The doctors also discuss biopsy of tricky locations. Sternal lesions carry the risk of lung injury and pneumothorax, so when faced with these, Dr. Beck picks an oblique tract that has a longer trajectory. For lesions located in proximal extremities, he secures the limb to minimize movement.


Next, disc biopsies are discussed. Patients usually present with discitis osteomyelitis from prior back surgery, IV drug use, or idiopathic causes. It is important to distinguish between infection of the disc space versus chronic degenerative disc disease, which can be identified by comparison with prior imaging and lab workup. For the lumbar spine disc biopsy, fluoroscopy is Dr. Beck’s preferred imaging modality, and he reviews imaging landmarks. Dr. Fritts usually biopsies both bone and disc.


Finally, they discuss post-procedural complications to watch for, such as chest x-rays in checking for lung injury and neurological exams to assess for new deficits.


---


CHECK OUT OUR SPONSOR


Stryker Interventional Spine

https://www.strykerivs.com


---


SHOW NOTES


00:00 - Introduction

03:12 - Referrals and Imaging Techniques for Bone Lesion Biopsy

07:09 - Procedural Steps of Bone Lesion Biopsy

12:32 - Choosing Biopsy Tools

23:22 - Approach to Tricky Biopsy Locations

28:19 - Workup and Indications for Disc Biopsy

32:08 - Fluoroscopy vs. CT for Disc Biopsy

40:15 - Handling Biopsy Samples

48:03 - Post-Procedure Care and Complications


---


RESOURCES


Arrow OnControl Powered Bone Biopsy System:

https://irc.teleflex.com/oncontrolsystem/


Stryker Bone Biopsy Coaxial System:

https://www.stryker.com/us/en/interventional-spine/products/bone-biopsy.html


BD Trek Powered Bone Biopsy System:

https://www.bd.com/en-us/products-and-solutions/products/product-families/bd-trek-powered-bone-biopsy-system


Jamshidi Evolve Bone Marrow Needle:

https://www.bd.com/en-us/products-and-solutions/products/product-families/jamshidi-evolve-bone-marrow-needle


BD Illinois Sternal/Iliac Bone Marrow Aspiration Needles:

https://www.bd.com/en-ca/products-and-solutions/products/product-families/illinois-sternal-iliac-bone-marrow-aspiration-needles


BD Mission Disposable Core Biopsy Instrument:

https://www.bd.com/en-us/products-and-solutions/products/product-families/mission-disposable-core-biopsy-instrument


Disc Biopsy Visualization Website:

https://www.pediatricir.com/disc-aspiration-for-discitis.html

]]> 3224 Ep. 45 The Future of Interventional Spine Training with Dr. Majid Khan In this episode of the Back Table MSK Podcast, guest host and interventional radiologist Dr. Dana Dunleavy speaks with Dr. Majid Khan about building an academic interventional spine program and the need for nonvascular spine intervention fellowships. Dr. Khan is neuroradiologist and Director of Non-Vascular Spine Intervention at Johns Hopkins University. Dr. Khan discusses his experience in spine interventions, and he believes that it has evolved into a subspecialty that now requires its own fellowship. He proposes a curriculum that involves integration of clinical care and learning from physical medicine and rehabilitation, pain management, radiology specialists. Then, Dr. Khan describes how he built his current department Johns Hopkins. This process required advocating for clinic time, negotiating for split time between interventional and diagnostic work, reaching out to referring specialists, and following up with patients. Throughout the episode, Dr. Majid also shares his perspectives on defining success in clinical and academic medicine, various ablation modalities, and the potential of neuromodulation in oncology. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SHOW NOTES 00:00 - Introduction 02:35 - Dr. Khan’s Journey and Training 07:37 - The Need for Nonvascular Spine Intervention Fellowships 09:27 - Importance of Clinical Preparation 15:17 - Multidisciplinary Training 21:10 - The Process of Building a Spine Interventional Practice 27:42 - Defining Success in Academic Medicine 33:43 - Various Ablation Modalities 41:27 - Devices for Mechanical Augmentation 50:18 - Basivertebral Nerve Ablation for Chronic Back Pain 52:25 - The Potential of Neuromodulation in Oncology 55:43 - Establishing an Evidence Base for Spine Interventions --- The BackTable MSK Podcast is a resource for practicing Musculoskeletal Specialists, covering tools, techniques, and expert guidance on medical and interventional care for musculoskeletal conditions. Get notified when new episodes drop! Subscribe to the BackTable MSK Podcast on your go-to podcast platform, and follow us on your social media platform of choice for regular updates. ► https://www.backtable.com/shows/msk/subscribe Tue, 19 Mar 2024 07:00:00 -0000 full BackTable In this episode of the Back Table MSK Podcast, guest host and interventional radiologist Dr. Dana Dunleavy speaks with Dr. Majid Khan about building an academic interventional spine program and the need for nonvascular spine intervention fellowships. Dr. Khan is neuroradiologist and Director of Non-Vascular Spine Intervention at Johns Hopkins University. In this episode of the Back Table MSK Podcast, guest host and interventional radiologist Dr. Dana Dunleavy speaks with Dr. Majid Khan about building an academic interventional spine program and the need for nonvascular spine intervention fellowships. Dr. Khan is neuroradiologist and Director of Non-Vascular Spine Intervention at Johns Hopkins University. Dr. Khan discusses his experience in spine interventions, and he believes that it has evolved into a subspecialty that now requires its own fellowship. He proposes a curriculum that involves integration of clinical care and learning from physical medicine and rehabilitation, pain management, radiology specialists. Then, Dr. Khan describes how he built his current department Johns Hopkins. This process required advocating for clinic time, negotiating for split time between interventional and diagnostic work, reaching out to referring specialists, and following up with patients. Throughout the episode, Dr. Majid also shares his perspectives on defining success in clinical and academic medicine, various ablation modalities, and the potential of neuromodulation in oncology. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SHOW NOTES 00:00 - Introduction 02:35 - Dr. Khan’s Journey and Training 07:37 - The Need for Nonvascular Spine Intervention Fellowships 09:27 - Importance of Clinical Preparation 15:17 - Multidisciplinary Training 21:10 - The Process of Building a Spine Interventional Practice 27:42 - Defining Success in Academic Medicine 33:43 - Various Ablation Modalities 41:27 - Devices for Mechanical Augmentation 50:18 - Basivertebral Nerve Ablation for Chronic Back Pain 52:25 - The Potential of Neuromodulation in Oncology 55:43 - Establishing an Evidence Base for Spine Interventions --- The BackTable MSK Podcast is a resource for practicing Musculoskeletal Specialists, covering tools, techniques, and expert guidance on medical and interventional care for musculoskeletal conditions. Get notified when new episodes drop! Subscribe to the BackTable MSK Podcast on your go-to podcast platform, and follow us on your social media platform of choice for regular updates. ► https://www.backtable.com/shows/msk/subscribe In this episode of the Back Table MSK Podcast, guest host and interventional radiologist Dr. Dana Dunleavy speaks with Dr. Majid Khan about building an academic interventional spine program and the need for nonvascular spine intervention fellowships. Dr. Khan is neuroradiologist and Director of Non-Vascular Spine Intervention at Johns Hopkins University.


Dr. Khan discusses his experience in spine interventions, and he believes that it has evolved into a subspecialty that now requires its own fellowship. He proposes a curriculum that involves integration of clinical care and learning from physical medicine and rehabilitation, pain management, radiology specialists. Then, Dr. Khan describes how he built his current department Johns Hopkins. This process required advocating for clinic time, negotiating for split time between interventional and diagnostic work, reaching out to referring specialists, and following up with patients.


Throughout the episode, Dr. Majid also shares his perspectives on defining success in clinical and academic medicine, various ablation modalities, and the potential of neuromodulation in oncology.


---


CHECK OUT OUR SPONSOR


Stryker Interventional Spine

https://www.strykerivs.com


---


SHOW NOTES


00:00 - Introduction

02:35 - Dr. Khan’s Journey and Training

07:37 - The Need for Nonvascular Spine Intervention Fellowships

09:27 - Importance of Clinical Preparation

15:17 - Multidisciplinary Training

21:10 - The Process of Building a Spine Interventional Practice

27:42 - Defining Success in Academic Medicine

33:43 - Various Ablation Modalities

41:27 - Devices for Mechanical Augmentation

50:18 - Basivertebral Nerve Ablation for Chronic Back Pain

52:25 - The Potential of Neuromodulation in Oncology

55:43 - Establishing an Evidence Base for Spine Interventions


---


The BackTable MSK Podcast is a resource for practicing Musculoskeletal Specialists, covering tools, techniques, and expert guidance on medical and interventional care for musculoskeletal conditions.


Get notified when new episodes drop! Subscribe to the BackTable MSK Podcast on your go-to podcast platform, and follow us on your social media platform of choice for regular updates.


► https://www.backtable.com/shows/msk/subscribe

]]> 3848 Ep. 44 ESNR Spine Full Hands-On Course with Dr. Joshua Hirsch In this BackTable MSK episode, Dr. Jacob Fleming speaks with Dr. Joshua Hirsch about the current state of spinal interventional radiology. Dr. Hirsch is an interventional neuroradiologist at Massachusetts General Hospital. Dr. Hirsch discusses the past and future of spinal interventional radiology. He describes his experience in automated percutaneous lumbar discectomy as well as chemonucleolysis with DiscoGel. He also mentions the previous use of chymopapain and the future use of biologics and weight bearing imaging in the spine. Overall, Dr. Hirsch emphasizes the importance of utilizing precise imaging, understanding different safety profiles of each treatment, and breaking down boundaries between specialties. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SHOW NOTES 00:00 - Introduction 03:05 - Discussion on Intradiscal Therapies 05:11 - The Evolution of Percutaneous Discal Treatments 10:39 - The Role of Chemonucleolysis and Lessons from Chymopapain 14:55 - Deciding on a Percutaneous Approach 18:00 - The Emergence of the Spine Interventionalist 21:29 - Utility of Weight Bearing Imaging 24:15 - ESNR Spine Interventional Neuroradiology Hands-On Course --- RESOURCES Efficacy of an ethyl alcohol gel in symptomatic disc herniation (DiscoGel): https://pubmed.ncbi.nlm.nih.gov/30527290/ Responsible, Safe, and Effective Use of Biologics in the Management of Low Back Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines: https://www.painphysicianjournal.com/current/pdf?article=NjEwMQ%3D%3D&journal=118 European Society of Neuroradiology (ESNR) Spine Interventional Neuroradiology Hands On Course (April 18-20, 2024: https://www.esnr.org/event-details/6903 Tue, 05 Mar 2024 08:00:00 -0000 full BackTable In this BackTable MSK episode, Dr. Jacob Fleming speaks with Dr. Joshua Hirsch about the current state of spinal interventional radiology. Dr. Hirsch is an interventional neuroradiologist at Massachusetts General Hospital. In this BackTable MSK episode, Dr. Jacob Fleming speaks with Dr. Joshua Hirsch about the current state of spinal interventional radiology. Dr. Hirsch is an interventional neuroradiologist at Massachusetts General Hospital. Dr. Hirsch discusses the past and future of spinal interventional radiology. He describes his experience in automated percutaneous lumbar discectomy as well as chemonucleolysis with DiscoGel. He also mentions the previous use of chymopapain and the future use of biologics and weight bearing imaging in the spine. Overall, Dr. Hirsch emphasizes the importance of utilizing precise imaging, understanding different safety profiles of each treatment, and breaking down boundaries between specialties. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SHOW NOTES 00:00 - Introduction 03:05 - Discussion on Intradiscal Therapies 05:11 - The Evolution of Percutaneous Discal Treatments 10:39 - The Role of Chemonucleolysis and Lessons from Chymopapain 14:55 - Deciding on a Percutaneous Approach 18:00 - The Emergence of the Spine Interventionalist 21:29 - Utility of Weight Bearing Imaging 24:15 - ESNR Spine Interventional Neuroradiology Hands-On Course --- RESOURCES Efficacy of an ethyl alcohol gel in symptomatic disc herniation (DiscoGel): https://pubmed.ncbi.nlm.nih.gov/30527290/ Responsible, Safe, and Effective Use of Biologics in the Management of Low Back Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines: https://www.painphysicianjournal.com/current/pdf?article=NjEwMQ%3D%3D&journal=118 European Society of Neuroradiology (ESNR) Spine Interventional Neuroradiology Hands On Course (April 18-20, 2024: https://www.esnr.org/event-details/6903 In this BackTable MSK episode, Dr. Jacob Fleming speaks with Dr. Joshua Hirsch about the current state of spinal interventional radiology. Dr. Hirsch is an interventional neuroradiologist at Massachusetts General Hospital.


Dr. Hirsch discusses the past and future of spinal interventional radiology. He describes his experience in automated percutaneous lumbar discectomy as well as chemonucleolysis with DiscoGel. He also mentions the previous use of chymopapain and the future use of biologics and weight bearing imaging in the spine. Overall, Dr. Hirsch emphasizes the importance of utilizing precise imaging, understanding different safety profiles of each treatment, and breaking down boundaries between specialties.


---


CHECK OUT OUR SPONSOR


Stryker Interventional Spine

https://www.strykerivs.com


---


SHOW NOTES


00:00 - Introduction

03:05 - Discussion on Intradiscal Therapies

05:11 - The Evolution of Percutaneous Discal Treatments

10:39 - The Role of Chemonucleolysis and Lessons from Chymopapain

14:55 - Deciding on a Percutaneous Approach

18:00 - The Emergence of the Spine Interventionalist

21:29 - Utility of Weight Bearing Imaging

24:15 - ESNR Spine Interventional Neuroradiology Hands-On Course


---


RESOURCES


Efficacy of an ethyl alcohol gel in symptomatic disc herniation (DiscoGel):

https://pubmed.ncbi.nlm.nih.gov/30527290/


Responsible, Safe, and Effective Use of Biologics in the Management of Low Back Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines:

https://www.painphysicianjournal.com/current/pdf?article=NjEwMQ%3D%3D&journal=118


European Society of Neuroradiology (ESNR) Spine Interventional Neuroradiology Hands On Course (April 18-20, 2024:

https://www.esnr.org/event-details/6903

]]> 1842 Ep. 43 Cutting Edge Techniques in MSK Oncology: Cryoablation and Beyond with Dr. Alan Sag In this BackTable MSK episode, host Dr. Jacob Fleming interviews Dr. Alan Sag about techniques and advancements in bone cryoablation. Dr. Sag is an interventional radiologist at Duke University Medical Center. To start, Dr. Sag discusses his current practice and collaboration with orthopedic surgeons. He highlights IlluminOss, a new photodynamic bone stabilization system that uses similar concepts to endovascular balloons. Then, the doctors move onto discussing cryoablation, which was recently cleared by the FDA for use in pain palliation in bone metastases. Dr. Sag describes the procedural steps of cryoablation, pneumodissection with carbon dioxide, when to use polymethylmethacrylate (PMMA) augmentation, the value of same session biopsy, and education for referrers and patients. Cryoneurolysis and intrathecal pain pumps are also discussed, as they can offer additional pain relief for patients and reduce opioid dependence. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SHOW NOTES 00:00 - Introduction 03:20 - Collaboration with Orthopedic Surgery 08:57 - FDA Clearance for Cryoablation 14:47 - Cement Augmentation after Cryoablation 19:22 - Approach to the Cryoablation Procedure 26:57 - The Value of Same Session Biopsy 29:11 - Coordinating Cross-Specialty Oncologic Care 33:30 - Side Effects of Cryoablation 38:03 - Cryoneurolysis for Pain Reduction 45:40 - Skin Safety During Cryoablation 50:58 - Preferred Imaging Modalities 57:28 - Neuromodulation with Intrathecal Pain Pumps --- RESOURCES Symposium on Clinical Interventional Oncology (CIO): https://www.hmpglobalevents.com/cio BackTable VI Ep. 221- Building a Musculoskeletal Oncology Service Line with Dr. Alan Sag: https://www.backtable.com/shows/vi/podcasts/221/building-a-musculoskeletal-interventional-oncology-service IlluminOss Photodynamic Bone Stabilization System: https://www.illuminoss.com/eu BackTable VI Ep. 401- The MOTION Study: Cryoablation for Painful Bony Metastases with Dr. Jack Jennings: https://www.backtable.com/shows/vi/podcasts/401/the-motion-study-cryoablation-for-painful-bone-metastases BackTable VI Ep. 284- Ortho/IR Collaboration in Private Practice with Dr. Tony Brown & Dr. Daniel Lerman: https://www.backtable.com/shows/vi/podcasts/284/ortho-ir-collaboration-in-private-practice BackTable MSK Ep. 25- Advanced Minimally Invasive Pain Interventions with Dr. David Prologo: https://www.backtable.com/shows/msk/podcasts/25/advanced-minimally-invasive-pain-interventions Pneumodissection for Skin Protection in Image-Guided Cryoablation of Superficial Musculoskeletal Tumors: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5499669/ BackTable MSK 40- Innovating Pain Management: The Role of Spinal Cord Stimulators in Outpatient Care with Dr. Doug Beall https://www.backtable.com/shows/msk/podcasts/40/innovating-pain-management-the-role-of-spinal-cord-stimulators-in-outpatient-care Tue, 27 Feb 2024 08:00:00 -0000 full BackTable In this BackTable MSK episode, host Dr. Jacob Fleming interviews Dr. Alan Sag about techniques and advancements in bone cryoablation. Dr. Sag is an interventional radiologist at Duke University Medical Center. In this BackTable MSK episode, host Dr. Jacob Fleming interviews Dr. Alan Sag about techniques and advancements in bone cryoablation. Dr. Sag is an interventional radiologist at Duke University Medical Center. To start, Dr. Sag discusses his current practice and collaboration with orthopedic surgeons. He highlights IlluminOss, a new photodynamic bone stabilization system that uses similar concepts to endovascular balloons. Then, the doctors move onto discussing cryoablation, which was recently cleared by the FDA for use in pain palliation in bone metastases. Dr. Sag describes the procedural steps of cryoablation, pneumodissection with carbon dioxide, when to use polymethylmethacrylate (PMMA) augmentation, the value of same session biopsy, and education for referrers and patients. Cryoneurolysis and intrathecal pain pumps are also discussed, as they can offer additional pain relief for patients and reduce opioid dependence. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SHOW NOTES 00:00 - Introduction 03:20 - Collaboration with Orthopedic Surgery 08:57 - FDA Clearance for Cryoablation 14:47 - Cement Augmentation after Cryoablation 19:22 - Approach to the Cryoablation Procedure 26:57 - The Value of Same Session Biopsy 29:11 - Coordinating Cross-Specialty Oncologic Care 33:30 - Side Effects of Cryoablation 38:03 - Cryoneurolysis for Pain Reduction 45:40 - Skin Safety During Cryoablation 50:58 - Preferred Imaging Modalities 57:28 - Neuromodulation with Intrathecal Pain Pumps --- RESOURCES Symposium on Clinical Interventional Oncology (CIO): https://www.hmpglobalevents.com/cio BackTable VI Ep. 221- Building a Musculoskeletal Oncology Service Line with Dr. Alan Sag: https://www.backtable.com/shows/vi/podcasts/221/building-a-musculoskeletal-interventional-oncology-service IlluminOss Photodynamic Bone Stabilization System: https://www.illuminoss.com/eu BackTable VI Ep. 401- The MOTION Study: Cryoablation for Painful Bony Metastases with Dr. Jack Jennings: https://www.backtable.com/shows/vi/podcasts/401/the-motion-study-cryoablation-for-painful-bone-metastases BackTable VI Ep. 284- Ortho/IR Collaboration in Private Practice with Dr. Tony Brown & Dr. Daniel Lerman: https://www.backtable.com/shows/vi/podcasts/284/ortho-ir-collaboration-in-private-practice BackTable MSK Ep. 25- Advanced Minimally Invasive Pain Interventions with Dr. David Prologo: https://www.backtable.com/shows/msk/podcasts/25/advanced-minimally-invasive-pain-interventions Pneumodissection for Skin Protection in Image-Guided Cryoablation of Superficial Musculoskeletal Tumors: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5499669/ BackTable MSK 40- Innovating Pain Management: The Role of Spinal Cord Stimulators in Outpatient Care with Dr. Doug Beall https://www.backtable.com/shows/msk/podcasts/40/innovating-pain-management-the-role-of-spinal-cord-stimulators-in-outpatient-care In this BackTable MSK episode, host Dr. Jacob Fleming interviews Dr. Alan Sag about techniques and advancements in bone cryoablation. Dr. Sag is an interventional radiologist at Duke University Medical Center.


To start, Dr. Sag discusses his current practice and collaboration with orthopedic surgeons. He highlights IlluminOss, a new photodynamic bone stabilization system that uses similar concepts to endovascular balloons. Then, the doctors move onto discussing cryoablation, which was recently cleared by the FDA for use in pain palliation in bone metastases. Dr. Sag describes the procedural steps of cryoablation, pneumodissection with carbon dioxide, when to use polymethylmethacrylate (PMMA) augmentation, the value of same session biopsy, and education for referrers and patients.


Cryoneurolysis and intrathecal pain pumps are also discussed, as they can offer additional pain relief for patients and reduce opioid dependence.


---


CHECK OUT OUR SPONSOR


Stryker Interventional Spine

https://www.strykerivs.com


---


SHOW NOTES


00:00 - Introduction

03:20 - Collaboration with Orthopedic Surgery

08:57 - FDA Clearance for Cryoablation

14:47 - Cement Augmentation after Cryoablation

19:22 - Approach to the Cryoablation Procedure

26:57 - The Value of Same Session Biopsy

29:11 - Coordinating Cross-Specialty Oncologic Care

33:30 - Side Effects of Cryoablation

38:03 - Cryoneurolysis for Pain Reduction

45:40 - Skin Safety During Cryoablation

50:58 - Preferred Imaging Modalities

57:28 - Neuromodulation with Intrathecal Pain Pumps


---


RESOURCES


Symposium on Clinical Interventional Oncology (CIO):

https://www.hmpglobalevents.com/cio


BackTable VI Ep. 221- Building a Musculoskeletal Oncology Service Line with Dr. Alan Sag:

https://www.backtable.com/shows/vi/podcasts/221/building-a-musculoskeletal-interventional-oncology-service


IlluminOss Photodynamic Bone Stabilization System:

https://www.illuminoss.com/eu


BackTable VI Ep. 401- The MOTION Study: Cryoablation for Painful Bony Metastases with Dr. Jack Jennings:

https://www.backtable.com/shows/vi/podcasts/401/the-motion-study-cryoablation-for-painful-bone-metastases


BackTable VI Ep. 284- Ortho/IR Collaboration in Private Practice with Dr. Tony Brown & Dr. Daniel Lerman:

https://www.backtable.com/shows/vi/podcasts/284/ortho-ir-collaboration-in-private-practice


BackTable MSK Ep. 25- Advanced Minimally Invasive Pain Interventions with Dr. David Prologo:

https://www.backtable.com/shows/msk/podcasts/25/advanced-minimally-invasive-pain-interventions


Pneumodissection for Skin Protection in Image-Guided Cryoablation of Superficial Musculoskeletal Tumors:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5499669/


BackTable MSK 40- Innovating Pain Management: The Role of Spinal Cord Stimulators in Outpatient Care with Dr. Doug Beall

https://www.backtable.com/shows/msk/podcasts/40/innovating-pain-management-the-role-of-spinal-cord-stimulators-in-outpatient-care

]]> 4012 Ep. 42 SIO 2024: The Bright Future of IO with Dr. Muneeb Ahmed In this episode, Dr. Jacob Fleming hosts an on-site interview with Dr. Muneeb Ahmed, president of the Society of Interventional Oncology (SIO) at the annual conference. Dr. Ahmed also serves as the Chief of IR at Beth Israel Deaconess Medical Center. They discuss the development of interventional oncology (IO) as a subspecialty of interventional radiology and how the SIO conference has rapidly grown in the past few years. Dr. Ahmed highlights the annual conference as a way to expose trainees to interventional oncology early in their careers. The doctors focus on the MSK masterclass and the upcoming first breast cryoablation masterclass. Dr. Ahmed emphasizes that master class topics are chosen based on what the IO community needs, and they aim to provide comprehensive training so doctors can implement the procedures and increase patient access. Additional discussion highlights include the advancement of robotics, the growth of IO across the globe, and exciting new research presented at SIO 2024. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SHOW NOTES 00:00 - Introduction 03:40 - The Growth and Development of SIO 07:20 - Breast Cryoablation Master Class 11:53 - Teaching Across Different Practice Settings 17:21 - Interventional Oncology Around the World 20:59 - New Research Presented at SIO 2024 22:59 - The Role of Robotics in Interventional Oncology 27:15 - Closing Remarks and Invitation to Join SIO --- RESOURCES Society of Interventional Oncology (SIO): https://www.sio-central.org/ European Society of Neuroradiology (ESNR): https://www.esnr.org/ Society of Breast Imaging (SBI): https://www.sbi-online.org/ Tue, 20 Feb 2024 08:00:00 -0000 full BackTable In this episode, Dr. Jacob Fleming hosts an on-site interview with Dr. Muneeb Ahmed, president of the Society of Interventional Oncology (SIO) at the annual conference. Dr. Ahmed also serves as the Chief of IR at Beth Israel Deaconess Medical Center. In this episode, Dr. Jacob Fleming hosts an on-site interview with Dr. Muneeb Ahmed, president of the Society of Interventional Oncology (SIO) at the annual conference. Dr. Ahmed also serves as the Chief of IR at Beth Israel Deaconess Medical Center. They discuss the development of interventional oncology (IO) as a subspecialty of interventional radiology and how the SIO conference has rapidly grown in the past few years. Dr. Ahmed highlights the annual conference as a way to expose trainees to interventional oncology early in their careers. The doctors focus on the MSK masterclass and the upcoming first breast cryoablation masterclass. Dr. Ahmed emphasizes that master class topics are chosen based on what the IO community needs, and they aim to provide comprehensive training so doctors can implement the procedures and increase patient access. Additional discussion highlights include the advancement of robotics, the growth of IO across the globe, and exciting new research presented at SIO 2024. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SHOW NOTES 00:00 - Introduction 03:40 - The Growth and Development of SIO 07:20 - Breast Cryoablation Master Class 11:53 - Teaching Across Different Practice Settings 17:21 - Interventional Oncology Around the World 20:59 - New Research Presented at SIO 2024 22:59 - The Role of Robotics in Interventional Oncology 27:15 - Closing Remarks and Invitation to Join SIO --- RESOURCES Society of Interventional Oncology (SIO): https://www.sio-central.org/ European Society of Neuroradiology (ESNR): https://www.esnr.org/ Society of Breast Imaging (SBI): https://www.sbi-online.org/ In this episode, Dr. Jacob Fleming hosts an on-site interview with Dr. Muneeb Ahmed, president of the Society of Interventional Oncology (SIO) at the annual conference. Dr. Ahmed also serves as the Chief of IR at Beth Israel Deaconess Medical Center.


They discuss the development of interventional oncology (IO) as a subspecialty of interventional radiology and how the SIO conference has rapidly grown in the past few years. Dr. Ahmed highlights the annual conference as a way to expose trainees to interventional oncology early in their careers. The doctors focus on the MSK masterclass and the upcoming first breast cryoablation masterclass. Dr. Ahmed emphasizes that master class topics are chosen based on what the IO community needs, and they aim to provide comprehensive training so doctors can implement the procedures and increase patient access.


Additional discussion highlights include the advancement of robotics, the growth of IO across the globe, and exciting new research presented at SIO 2024.


---


CHECK OUT OUR SPONSOR


Stryker Interventional Spine

https://www.strykerivs.com


---


SHOW NOTES


00:00 - Introduction

03:40 - The Growth and Development of SIO

07:20 - Breast Cryoablation Master Class

11:53 - Teaching Across Different Practice Settings

17:21 - Interventional Oncology Around the World

20:59 - New Research Presented at SIO 2024

22:59 - The Role of Robotics in Interventional Oncology

27:15 - Closing Remarks and Invitation to Join SIO


---


RESOURCES


Society of Interventional Oncology (SIO):

https://www.sio-central.org/


European Society of Neuroradiology (ESNR):

https://www.esnr.org/


Society of Breast Imaging (SBI):

https://www.sbi-online.org/

]]> 1902 Ep. 41 Sustainable Healthcare: The Power of Clinician Advocacy with Erich Osterberg In this episode of the BackTable MSK Podcast, guest host Dr. Dana Dunleavy interviews Professor Erich Osterberg, a climate scientist and geologist. Osterberg is a Professor of Climate Science at Dartmouth College. His current work is centered around ways to reduce carbon emissions associated with the practice of medicine. Through his experience with advising local decision makers, he has seen a shift from top-down initiatives to bottom-up action in industries such as healthcare. He highlights the power of medical professionals in demanding sustainable initiatives and reducing emission. He also discusses how various industries such as the military, face environmental challenges, as well as discover new opportunities as climate change occurs. The growth of renewable energy has stimulated change and new investments from the financial and political sectors. Osterberg focuses on working directly with people who are the most vulnerable to climate change. He urges listeners to start initiatives, get carbon audits, and be part of the shift towards sustainability. --- SHOW NOTES 00:00 - Introduction 07:31 - Challenges and New Opportunities with Climate Change 12:49 - Healthcare’s Impact on the Environment 15:33 - Identifying Ways to Take Action Tue, 06 Feb 2024 08:00:00 -0000 full BackTable In this episode of the BackTable MSK Podcast, guest host Dr. Dana Dunleavy interviews Professor Eric Osterberg, a climate scientist and geologist. Dr. Osterberg is a Professor of Climate Science at Dartmouth College. His current work is centered around ways to reduce carbon emissions associated with the practice of medicine. In this episode of the BackTable MSK Podcast, guest host Dr. Dana Dunleavy interviews Professor Erich Osterberg, a climate scientist and geologist. Osterberg is a Professor of Climate Science at Dartmouth College. His current work is centered around ways to reduce carbon emissions associated with the practice of medicine. Through his experience with advising local decision makers, he has seen a shift from top-down initiatives to bottom-up action in industries such as healthcare. He highlights the power of medical professionals in demanding sustainable initiatives and reducing emission. He also discusses how various industries such as the military, face environmental challenges, as well as discover new opportunities as climate change occurs. The growth of renewable energy has stimulated change and new investments from the financial and political sectors. Osterberg focuses on working directly with people who are the most vulnerable to climate change. He urges listeners to start initiatives, get carbon audits, and be part of the shift towards sustainability. --- SHOW NOTES 00:00 - Introduction 07:31 - Challenges and New Opportunities with Climate Change 12:49 - Healthcare’s Impact on the Environment 15:33 - Identifying Ways to Take Action In this episode of the BackTable MSK Podcast, guest host Dr. Dana Dunleavy interviews Professor Erich Osterberg, a climate scientist and geologist. Osterberg is a Professor of Climate Science at Dartmouth College. His current work is centered around ways to reduce carbon emissions associated with the practice of medicine.


Through his experience with advising local decision makers, he has seen a shift from top-down initiatives to bottom-up action in industries such as healthcare. He highlights the power of medical professionals in demanding sustainable initiatives and reducing emission. He also discusses how various industries such as the military, face environmental challenges, as well as discover new opportunities as climate change occurs. The growth of renewable energy has stimulated change and new investments from the financial and political sectors.


Osterberg focuses on working directly with people who are the most vulnerable to climate change. He urges listeners to start initiatives, get carbon audits, and be part of the shift towards sustainability.


---


SHOW NOTES


00:00 - Introduction

07:31 - Challenges and New Opportunities with Climate Change

12:49 - Healthcare’s Impact on the Environment

15:33 - Identifying Ways to Take Action

]]> 1164 Ep. 40 Innovating Pain Management: The Role of Spinal Cord Stimulators in Outpatient Care with Dr. Douglas Beall In this episode, guest host Dr. Dana Dunleavy and guest Dr. Douglas Beall delve into the transformative potential of neuromodulation in the treatment of chronic pain, particularly for painful diabetic neuropathy (PDN). Dr. Beall is an interventional musculoskeletal radiologist practicing at Oklahoma Spine in Edmond, Oklahoma. Dr. Beall recounts his journey, from his beginnings in the military to his experiences with navigating institutional resistance to his clinical practice, and finally the process of moving to private practice. He discusses the positive impact of spinal cord stimulation on patients with PDN and reflects on its effectiveness in reducing pain and improving neurologic function. He underscores the crucial role of interventional radiologists in managing PDN, while also advocating for the integration of these specialists in pain management clinics. Dr. Beall argues that interventional radiologists possess unique skill sets adept for neuromodulation, which opens up new treatment possibilities in the process. He shares insights on the evolution of spinal cord stimulation technology, reimbursement considerations, and the importance of clinical trials in refining treatment approaches. The episode ends with an invitation for interested physicians to participate in professional forums and learn more about this burgeoning field. --- CHECK OUT OUR SPONSOR Nevro HFX Spinal Cord Stimulator https://www.hfxforpdn.com --- SHOW NOTES 00:00 - Introduction 02:30 - Challenges and Triumphs of a Solo Practice 14:44 - Evolution of Neuromodulation in Practice 17:05 - Impact of Neuromodulation on Painful Diabetic Neuropathy 31:53 - Unique Mechanism of High Frequency Neuromodulation 46:02 - Role of Interventional Radiologists in Neuromodulation 54:11 - Future of Neuromodulation in Interventional Radiology --- RESOURCES Douglas Beall, MD Research Gate Profile: https://www.researchgate.net/scientific-contributions/Douglas-P-Beall-39583252 Long-term efficacy of high-frequency (10 kHz) spinal cord stimulation for the treatment of painful diabetic neuropathy: 24-Month results of a randomized controlled trial: https://pubmed.ncbi.nlm.nih.gov/37536514/ High-Frequency 10-kHz Spinal Cord Stimulation Improves Health-Related Quality of Life in Patients With Refractory Painful Diabetic Neuropathy: 12-Month Results From a Randomized Controlled Trial: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9256824/ Neuromodulation Interventions for the Treatment of Painful Diabetic Neuropathy: a Systematic Review: https://link.springer.com/article/10.1007/s11916-022-01035-9 High-frequency spinal cord stimulation at 10 kHz for the treatment of painful diabetic neuropathy: design of a multicenter, randomized controlled trial (SENZA-PDN): https://link.springer.com/article/10.1186/s13063-019-4007-y Mon, 29 Jan 2024 08:00:00 -0000 full BackTable In this episode, guest host Dr. Dana Dunleavy and guest Dr. Douglas Beall delve into the transformative potential of neuromodulation in the treatment of chronic pain, particularly for painful diabetic neuropathy (PDN). In this episode, guest host Dr. Dana Dunleavy and guest Dr. Douglas Beall delve into the transformative potential of neuromodulation in the treatment of chronic pain, particularly for painful diabetic neuropathy (PDN). Dr. Beall is an interventional musculoskeletal radiologist practicing at Oklahoma Spine in Edmond, Oklahoma. Dr. Beall recounts his journey, from his beginnings in the military to his experiences with navigating institutional resistance to his clinical practice, and finally the process of moving to private practice. He discusses the positive impact of spinal cord stimulation on patients with PDN and reflects on its effectiveness in reducing pain and improving neurologic function. He underscores the crucial role of interventional radiologists in managing PDN, while also advocating for the integration of these specialists in pain management clinics. Dr. Beall argues that interventional radiologists possess unique skill sets adept for neuromodulation, which opens up new treatment possibilities in the process. He shares insights on the evolution of spinal cord stimulation technology, reimbursement considerations, and the importance of clinical trials in refining treatment approaches. The episode ends with an invitation for interested physicians to participate in professional forums and learn more about this burgeoning field. --- CHECK OUT OUR SPONSOR Nevro HFX Spinal Cord Stimulator https://www.hfxforpdn.com --- SHOW NOTES 00:00 - Introduction 02:30 - Challenges and Triumphs of a Solo Practice 14:44 - Evolution of Neuromodulation in Practice 17:05 - Impact of Neuromodulation on Painful Diabetic Neuropathy 31:53 - Unique Mechanism of High Frequency Neuromodulation 46:02 - Role of Interventional Radiologists in Neuromodulation 54:11 - Future of Neuromodulation in Interventional Radiology --- RESOURCES Douglas Beall, MD Research Gate Profile: https://www.researchgate.net/scientific-contributions/Douglas-P-Beall-39583252 Long-term efficacy of high-frequency (10 kHz) spinal cord stimulation for the treatment of painful diabetic neuropathy: 24-Month results of a randomized controlled trial: https://pubmed.ncbi.nlm.nih.gov/37536514/ High-Frequency 10-kHz Spinal Cord Stimulation Improves Health-Related Quality of Life in Patients With Refractory Painful Diabetic Neuropathy: 12-Month Results From a Randomized Controlled Trial: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9256824/ Neuromodulation Interventions for the Treatment of Painful Diabetic Neuropathy: a Systematic Review: https://link.springer.com/article/10.1007/s11916-022-01035-9 High-frequency spinal cord stimulation at 10 kHz for the treatment of painful diabetic neuropathy: design of a multicenter, randomized controlled trial (SENZA-PDN): https://link.springer.com/article/10.1186/s13063-019-4007-y In this episode, guest host Dr. Dana Dunleavy and guest Dr. Douglas Beall delve into the transformative potential of neuromodulation in the treatment of chronic pain, particularly for painful diabetic neuropathy (PDN). Dr. Beall is an interventional musculoskeletal radiologist practicing at Oklahoma Spine in Edmond, Oklahoma.


Dr. Beall recounts his journey, from his beginnings in the military to his experiences with navigating institutional resistance to his clinical practice, and finally the process of moving to private practice. He discusses the positive impact of spinal cord stimulation on patients with PDN and reflects on its effectiveness in reducing pain and improving neurologic function. He underscores the crucial role of interventional radiologists in managing PDN, while also advocating for the integration of these specialists in pain management clinics. Dr. Beall argues that interventional radiologists possess unique skill sets adept for neuromodulation, which opens up new treatment possibilities in the process. He shares insights on the evolution of spinal cord stimulation technology, reimbursement considerations, and the importance of clinical trials in refining treatment approaches. The episode ends with an invitation for interested physicians to participate in professional forums and learn more about this burgeoning field.


---


CHECK OUT OUR SPONSOR


Nevro HFX Spinal Cord Stimulator

https://www.hfxforpdn.com


---


SHOW NOTES


00:00 - Introduction

02:30 - Challenges and Triumphs of a Solo Practice

14:44 - Evolution of Neuromodulation in Practice

17:05 - Impact of Neuromodulation on Painful Diabetic Neuropathy

31:53 - Unique Mechanism of High Frequency Neuromodulation

46:02 - Role of Interventional Radiologists in Neuromodulation

54:11 - Future of Neuromodulation in Interventional Radiology


---


RESOURCES


Douglas Beall, MD Research Gate Profile:

https://www.researchgate.net/scientific-contributions/Douglas-P-Beall-39583252


Long-term efficacy of high-frequency (10 kHz) spinal cord stimulation for the treatment of painful diabetic neuropathy: 24-Month results of a randomized controlled trial:

https://pubmed.ncbi.nlm.nih.gov/37536514/


High-Frequency 10-kHz Spinal Cord Stimulation Improves Health-Related Quality of Life in Patients With Refractory Painful Diabetic Neuropathy: 12-Month Results From a Randomized Controlled Trial:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9256824/


Neuromodulation Interventions for the Treatment of Painful Diabetic Neuropathy: a Systematic Review:

https://link.springer.com/article/10.1007/s11916-022-01035-9


High-frequency spinal cord stimulation at 10 kHz for the treatment of painful diabetic neuropathy: design of a multicenter, randomized controlled trial (SENZA-PDN):

https://link.springer.com/article/10.1186/s13063-019-4007-y

]]> 3948 Ep. 39 Bone Marrow Biopsy Tools and Techniques with Dr. Christopher Beck In this episode of the Back Table MSK podcast, co-hosts and interventional radiologists Dr. Aaron Fritts and Dr. Chris Beck have an in-depth discussion about bone marrow biopsies, including their preferred techniques and devices, potential complications, and management of patient expectations. To start, they cover the typical referral pathway for biopsies, the majority of which involve hematology/oncology indications. Preoperatively, managing patient expectations is important to communicate, especially regarding sedation and pain control. The IRs also walk through the biopsy steps, anatomy of the ilium, and confirmatory imaging with CT and fluoroscopy. They also share their experiences with different biopsy needles such as the OnControl, Jamshid, and Trek systems. There are advantages to using a system that comes with a powered drill, but these can also increase patient anxiety. Additionally, it is important to consider the bone density of the patient when selecting the tool. A manual system may offer sufficient force for demineralized or osteoporotic bone. The hosts also discuss potential unintended outcomes of the procedure, including dry taps and entry into joints or sacral foramina. Finally, they review post-procedural care and patient emergence from sedation. --- SHOW NOTES 00:00 Introduction 03:36 Indications for Biopsy 05:40 Patient Consent and Sedation 13:58 Procedural Steps and Confirmatory Imaging 27:04 Comparison of Different Biopsy Tools 36:11 Dealing with Complications 41:00 Post-Procedural Care --- RESOURCES BackTable VI Episode 381- Anesthesia vs. Moderate Sedation: A Spectrum of Care with Dr. Vishal Kumar: https://www.backtable.com/shows/vi/podcasts/381/anesthesia-vs-moderate-sedation-a-spectrum-of-care OnControl Powered Bone Biopsy System: https://oncontrolsystem.com/ Jamshidi Evolve Bone Marrow Needle: https://www.bd.com/en-us/products-and-solutions/products/product-families/jamshidi-evolve-bone-marrow-needle Trek Powered Bone Biopsy System: https://www.bd.com/en-us/products-and-solutions/products/product-families/bd-trek-powered-bone-biopsy-system Wed, 17 Jan 2024 08:00:00 -0000 full BackTable In this episode of the Back Table MSK podcast, co-hosts and interventional radiologists Dr. Aaron Fritts and Dr. Chris Beck have an in-depth discussion about bone marrow biopsies, including their preferred techniques and devices, potential complications, and management of patient expectations. In this episode of the Back Table MSK podcast, co-hosts and interventional radiologists Dr. Aaron Fritts and Dr. Chris Beck have an in-depth discussion about bone marrow biopsies, including their preferred techniques and devices, potential complications, and management of patient expectations. To start, they cover the typical referral pathway for biopsies, the majority of which involve hematology/oncology indications. Preoperatively, managing patient expectations is important to communicate, especially regarding sedation and pain control. The IRs also walk through the biopsy steps, anatomy of the ilium, and confirmatory imaging with CT and fluoroscopy. They also share their experiences with different biopsy needles such as the OnControl, Jamshid, and Trek systems. There are advantages to using a system that comes with a powered drill, but these can also increase patient anxiety. Additionally, it is important to consider the bone density of the patient when selecting the tool. A manual system may offer sufficient force for demineralized or osteoporotic bone. The hosts also discuss potential unintended outcomes of the procedure, including dry taps and entry into joints or sacral foramina. Finally, they review post-procedural care and patient emergence from sedation. --- SHOW NOTES 00:00 Introduction 03:36 Indications for Biopsy 05:40 Patient Consent and Sedation 13:58 Procedural Steps and Confirmatory Imaging 27:04 Comparison of Different Biopsy Tools 36:11 Dealing with Complications 41:00 Post-Procedural Care --- RESOURCES BackTable VI Episode 381- Anesthesia vs. Moderate Sedation: A Spectrum of Care with Dr. Vishal Kumar: https://www.backtable.com/shows/vi/podcasts/381/anesthesia-vs-moderate-sedation-a-spectrum-of-care OnControl Powered Bone Biopsy System: https://oncontrolsystem.com/ Jamshidi Evolve Bone Marrow Needle: https://www.bd.com/en-us/products-and-solutions/products/product-families/jamshidi-evolve-bone-marrow-needle Trek Powered Bone Biopsy System: https://www.bd.com/en-us/products-and-solutions/products/product-families/bd-trek-powered-bone-biopsy-system In this episode of the Back Table MSK podcast, co-hosts and interventional radiologists Dr. Aaron Fritts and Dr. Chris Beck have an in-depth discussion about bone marrow biopsies, including their preferred techniques and devices, potential complications, and management of patient expectations.


To start, they cover the typical referral pathway for biopsies, the majority of which involve hematology/oncology indications. Preoperatively, managing patient expectations is important to communicate, especially regarding sedation and pain control. The IRs also walk through the biopsy steps, anatomy of the ilium, and confirmatory imaging with CT and fluoroscopy.


They also share their experiences with different biopsy needles such as the OnControl, Jamshid, and Trek systems. There are advantages to using a system that comes with a powered drill, but these can also increase patient anxiety. Additionally, it is important to consider the bone density of the patient when selecting the tool. A manual system may offer sufficient force for demineralized or osteoporotic bone. The hosts also discuss potential unintended outcomes of the procedure, including dry taps and entry into joints or sacral foramina. Finally, they review post-procedural care and patient emergence from sedation.


---


SHOW NOTES


00:00 Introduction

03:36 Indications for Biopsy

05:40 Patient Consent and Sedation

13:58 Procedural Steps and Confirmatory Imaging

27:04 Comparison of Different Biopsy Tools

36:11 Dealing with Complications

41:00 Post-Procedural Care


---


RESOURCES


BackTable VI Episode 381- Anesthesia vs. Moderate Sedation: A Spectrum of Care with Dr. Vishal Kumar:

https://www.backtable.com/shows/vi/podcasts/381/anesthesia-vs-moderate-sedation-a-spectrum-of-care


OnControl Powered Bone Biopsy System:

https://oncontrolsystem.com/


Jamshidi Evolve Bone Marrow Needle:

https://www.bd.com/en-us/products-and-solutions/products/product-families/jamshidi-evolve-bone-marrow-needle


Trek Powered Bone Biopsy System:

https://www.bd.com/en-us/products-and-solutions/products/product-families/bd-trek-powered-bone-biopsy-system

]]> 2978 Ep. 38 The MOTION Study: Cryoablation for Painful Bone Metastases with Dr. Jack Jennings In this episode of the BackTable Podcast, host Dr. Jacob Fleming and guest Dr. Jack Jennings discuss advancements in interventional oncology, specifically regarding cryoablation for bone metastases. Dr. Jennings is an interventional musculoskeletal radiologist at Washington University School of Medicine and President of the American Society of Spine Radiology. They discuss the results of the MOTION Study, the benefits of industry collaboration, and the future of robotic guidance systems in interventional procedures. They also explain techniques like hydrodissection and pneumodissection in detail. With constant advancements in technology such as guidance navigation systems to reduce pain from bone metastases, it is crucial for interventional radiologists to adapt to these changes. At the end of the episode the doctors give a shout out to the upcoming Society of Interventional Oncology (SIO) 2024 meeting and the enriching opportunities that it offers for interventional radiologists. --- CHECK OUT OUR SPONSOR Boston Scientific Visual ICE Cryoablation System https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html --- SHOW NOTES 00:00 - Introduction 02:25 - Overview of the MOTION Study 04:23 - Benefits and Challenges of Cryoablation 09:37 - Results of the MOTION Study 12:13 - Future of Interventional Oncology 19:38 - Role of Imaging Guidance in Cryoablation 23:07 - Future of Robotic Guidance Systems 31:40 - Importance of Industry Partnerships --- RESOURCES Society of Interventional Oncology Annual Meeting, Long Beach, CA January 25th-29th: https://www.sio-central.org/Events/Annual-Scientific-Meeting/Registration Interventional Oncology MOTION Multicenter Study: https://www.bostonscientific.com/en-EU/medical-specialties/interventional-radiology/interventional-oncology/latest-evidence/motion-study.html Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial: https://pubmed.ncbi.nlm.nih.gov/23065947/ Cryoablation Needles from Boston Scientific: https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice/visual-ice-cryoablation-needles.htm Fri, 05 Jan 2024 09:00:00 -0000 full BackTable In this episode of the BackTable Podcast, host Dr. Jacob Fleming and guest Dr. Jack Jennings discuss advancements in interventional oncology, specifically regarding cryoablation for bone metastases. In this episode of the BackTable Podcast, host Dr. Jacob Fleming and guest Dr. Jack Jennings discuss advancements in interventional oncology, specifically regarding cryoablation for bone metastases. Dr. Jennings is an interventional musculoskeletal radiologist at Washington University School of Medicine and President of the American Society of Spine Radiology. They discuss the results of the MOTION Study, the benefits of industry collaboration, and the future of robotic guidance systems in interventional procedures. They also explain techniques like hydrodissection and pneumodissection in detail. With constant advancements in technology such as guidance navigation systems to reduce pain from bone metastases, it is crucial for interventional radiologists to adapt to these changes. At the end of the episode the doctors give a shout out to the upcoming Society of Interventional Oncology (SIO) 2024 meeting and the enriching opportunities that it offers for interventional radiologists. --- CHECK OUT OUR SPONSOR Boston Scientific Visual ICE Cryoablation System https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html --- SHOW NOTES 00:00 - Introduction 02:25 - Overview of the MOTION Study 04:23 - Benefits and Challenges of Cryoablation 09:37 - Results of the MOTION Study 12:13 - Future of Interventional Oncology 19:38 - Role of Imaging Guidance in Cryoablation 23:07 - Future of Robotic Guidance Systems 31:40 - Importance of Industry Partnerships --- RESOURCES Society of Interventional Oncology Annual Meeting, Long Beach, CA January 25th-29th: https://www.sio-central.org/Events/Annual-Scientific-Meeting/Registration Interventional Oncology MOTION Multicenter Study: https://www.bostonscientific.com/en-EU/medical-specialties/interventional-radiology/interventional-oncology/latest-evidence/motion-study.html Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial: https://pubmed.ncbi.nlm.nih.gov/23065947/ Cryoablation Needles from Boston Scientific: https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice/visual-ice-cryoablation-needles.htm In this episode of the BackTable Podcast, host Dr. Jacob Fleming and guest Dr. Jack Jennings discuss advancements in interventional oncology, specifically regarding cryoablation for bone metastases. Dr. Jennings is an interventional musculoskeletal radiologist at Washington University School of Medicine and President of the American Society of Spine Radiology.


They discuss the results of the MOTION Study, the benefits of industry collaboration, and the future of robotic guidance systems in interventional procedures. They also explain techniques like hydrodissection and pneumodissection in detail. With constant advancements in technology such as guidance navigation systems to reduce pain from bone metastases, it is crucial for interventional radiologists to adapt to these changes. At the end of the episode the doctors give a shout out to the upcoming Society of Interventional Oncology (SIO) 2024 meeting and the enriching opportunities that it offers for interventional radiologists.


---


CHECK OUT OUR SPONSOR


Boston Scientific Visual ICE Cryoablation System

https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html


---


SHOW NOTES


00:00 - Introduction

02:25 - Overview of the MOTION Study

04:23 - Benefits and Challenges of Cryoablation

09:37 - Results of the MOTION Study

12:13 - Future of Interventional Oncology

19:38 - Role of Imaging Guidance in Cryoablation

23:07 - Future of Robotic Guidance Systems

31:40 - Importance of Industry Partnerships


---


RESOURCES


Society of Interventional Oncology Annual Meeting, Long Beach, CA January 25th-29th:

https://www.sio-central.org/Events/Annual-Scientific-Meeting/Registration


Interventional Oncology MOTION Multicenter Study:

https://www.bostonscientific.com/en-EU/medical-specialties/interventional-radiology/interventional-oncology/latest-evidence/motion-study.html


Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial:

https://pubmed.ncbi.nlm.nih.gov/23065947/


Cryoablation Needles from Boston Scientific:

https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice/visual-ice-cryoablation-needles.htm

]]> 2263 Ep. 37 Cryoneurolysis Pearls and Pitfalls with Dr. Alexa Levey In this episode of the BackTable Podcast, host Dr. Jacob Fleming and Dr. Alexa Levey have an in-depth discussion about the current uses and potential future applications of cryoneurolysis in interventional radiology. Dr. Levey is an interventional radiologist at the Memorial Hermann Health System in Houston, TX. The doctors discuss how cryoneurolysis differs from radiofrequency (RF) ablation, highlighting the increased precision and gentleness to surrounding tissues. Dr. Levey describes the specifics of stellate ganglion procedures and cryoneurolysis techniques. They delve into the importance of research and collaboration in advancing the field, as well as the necessity of being patient-centered. They also address the need for financial discussions in medicine and the prospect for cryoneurolysis as desmoid tumor treatments. Additionally, Dr. Levey shares her journey in building a career as a female in a male-dominated space and emphasizes the importance of physician availability to patients and colleagues. --- CHECK OUT OUR SPONSOR Boston Scientific Visual ICE Cryoablation System https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html --- SHOW NOTES 00:00 - Introduction to RF Ablation and Cryoneurolysis 03:20 - Dr. Alexa Levey’s Journey and Inspiration 07:00 - Building a Pain Practice 14:03 - Advantages of Cryoneurolysis over RF 21:09 - Patient Selection and Planning for Cryoneurolysis 32:02 - Understanding Patient’s Condition and Treatment Options 36:21 - Role of Stellate Ganglion Procedures in PTSD and Anxiety Management 37:48 - Challenges and Impact of Long COVID 41:34 - The Future of Cryoneurolysis in Medical Practice 54:55 - Future of Cryo Treatment in Medical Practice --- RESOURCES Safety and Effectiveness of Stellate Ganglion Cryoablation in Complex Regional Pain Syndrome: https://doi.org/10.1016/j.jvir.2023.09.030 Treating phantom limb pain: cryoablation of the posterior tibial nerve: https://pubmed.ncbi.nlm.nih.gov/35801126/ Stellate Ganglion Block for Psychiatric Disorders: A Systematic Review of the Clinical Research Landscape: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8664306/ The Efficacy of the Stellate Ganglion Block as a Treatment Modality for Posttraumatic Stress Disorder Among Active Duty Combat Veterans: A Pilot Program Evaluation: https://pubmed.ncbi.nlm.nih.gov/33242072/ Stellate Ganglion Block in the Treatment of Post-traumatic Stress Disorder: A Review of Historical and Recent Literature: https://pubmed.ncbi.nlm.nih.gov/27739175/ Stellate ganglion block reduces symptoms of Long COVID: A case series: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8653406/ Stellate Ganglion Block Relieves Long COVID-19 Symptoms in 86% of Patients: A Retrospective Cohort Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10498998/ Mon, 18 Dec 2023 06:00:00 -0000 full BackTable In this episode of the BackTable Podcast, host Dr. Jacob Fleming and Dr. Alexa Levey have an in-depth discussion about the current uses and potential future applications of cryoneurolysis in interventional radiology. In this episode of the BackTable Podcast, host Dr. Jacob Fleming and Dr. Alexa Levey have an in-depth discussion about the current uses and potential future applications of cryoneurolysis in interventional radiology. Dr. Levey is an interventional radiologist at the Memorial Hermann Health System in Houston, TX. The doctors discuss how cryoneurolysis differs from radiofrequency (RF) ablation, highlighting the increased precision and gentleness to surrounding tissues. Dr. Levey describes the specifics of stellate ganglion procedures and cryoneurolysis techniques. They delve into the importance of research and collaboration in advancing the field, as well as the necessity of being patient-centered. They also address the need for financial discussions in medicine and the prospect for cryoneurolysis as desmoid tumor treatments. Additionally, Dr. Levey shares her journey in building a career as a female in a male-dominated space and emphasizes the importance of physician availability to patients and colleagues. --- CHECK OUT OUR SPONSOR Boston Scientific Visual ICE Cryoablation System https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html --- SHOW NOTES 00:00 - Introduction to RF Ablation and Cryoneurolysis 03:20 - Dr. Alexa Levey’s Journey and Inspiration 07:00 - Building a Pain Practice 14:03 - Advantages of Cryoneurolysis over RF 21:09 - Patient Selection and Planning for Cryoneurolysis 32:02 - Understanding Patient’s Condition and Treatment Options 36:21 - Role of Stellate Ganglion Procedures in PTSD and Anxiety Management 37:48 - Challenges and Impact of Long COVID 41:34 - The Future of Cryoneurolysis in Medical Practice 54:55 - Future of Cryo Treatment in Medical Practice --- RESOURCES Safety and Effectiveness of Stellate Ganglion Cryoablation in Complex Regional Pain Syndrome: https://doi.org/10.1016/j.jvir.2023.09.030 Treating phantom limb pain: cryoablation of the posterior tibial nerve: https://pubmed.ncbi.nlm.nih.gov/35801126/ Stellate Ganglion Block for Psychiatric Disorders: A Systematic Review of the Clinical Research Landscape: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8664306/ The Efficacy of the Stellate Ganglion Block as a Treatment Modality for Posttraumatic Stress Disorder Among Active Duty Combat Veterans: A Pilot Program Evaluation: https://pubmed.ncbi.nlm.nih.gov/33242072/ Stellate Ganglion Block in the Treatment of Post-traumatic Stress Disorder: A Review of Historical and Recent Literature: https://pubmed.ncbi.nlm.nih.gov/27739175/ Stellate ganglion block reduces symptoms of Long COVID: A case series: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8653406/ Stellate Ganglion Block Relieves Long COVID-19 Symptoms in 86% of Patients: A Retrospective Cohort Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10498998/ In this episode of the BackTable Podcast, host Dr. Jacob Fleming and Dr. Alexa Levey have an in-depth discussion about the current uses and potential future applications of cryoneurolysis in interventional radiology. Dr. Levey is an interventional radiologist at the Memorial Hermann Health System in Houston, TX.


The doctors discuss how cryoneurolysis differs from radiofrequency (RF) ablation, highlighting the increased precision and gentleness to surrounding tissues. Dr. Levey describes the specifics of stellate ganglion procedures and cryoneurolysis techniques. They delve into the importance of research and collaboration in advancing the field, as well as the necessity of being patient-centered. They also address the need for financial discussions in medicine and the prospect for cryoneurolysis as desmoid tumor treatments. Additionally, Dr. Levey shares her journey in building a career as a female in a male-dominated space and emphasizes the importance of physician availability to patients and colleagues.


---


CHECK OUT OUR SPONSOR


Boston Scientific Visual ICE Cryoablation System

https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html


---


SHOW NOTES


00:00 - Introduction to RF Ablation and Cryoneurolysis

03:20 - Dr. Alexa Levey’s Journey and Inspiration

07:00 - Building a Pain Practice

14:03 - Advantages of Cryoneurolysis over RF

21:09 - Patient Selection and Planning for Cryoneurolysis

32:02 - Understanding Patient’s Condition and Treatment Options

36:21 - Role of Stellate Ganglion Procedures in PTSD and Anxiety Management

37:48 - Challenges and Impact of Long COVID

41:34 - The Future of Cryoneurolysis in Medical Practice

54:55 - Future of Cryo Treatment in Medical Practice


---


RESOURCES


Safety and Effectiveness of Stellate Ganglion Cryoablation in Complex Regional Pain Syndrome:

https://doi.org/10.1016/j.jvir.2023.09.030


Treating phantom limb pain: cryoablation of the posterior tibial nerve:

https://pubmed.ncbi.nlm.nih.gov/35801126/


Stellate Ganglion Block for Psychiatric Disorders: A Systematic Review of the Clinical Research Landscape:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8664306/


The Efficacy of the Stellate Ganglion Block as a Treatment Modality for Posttraumatic Stress Disorder Among Active Duty Combat Veterans: A Pilot Program Evaluation:

https://pubmed.ncbi.nlm.nih.gov/33242072/


Stellate Ganglion Block in the Treatment of Post-traumatic Stress Disorder: A Review of Historical and Recent Literature:

https://pubmed.ncbi.nlm.nih.gov/27739175/


Stellate ganglion block reduces symptoms of Long COVID: A case series:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8653406/


Stellate Ganglion Block Relieves Long COVID-19 Symptoms in 86% of Patients: A Retrospective Cohort Study:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10498998/

]]> 3838 Ep. 36 MSK IR in Private Practice: Challenges and Opportunities with Dr. Glade Roper In this BackTable MSK episode, host Dr. Jacob Fleming discusses the future of musculoskeletal radiology with Dr. Glade Roper of VIP Specialists in Visalia, California. Dr. Roper is an MSK radiologist who specializes in minimally invasive procedures. The doctors explore the potential of musculoskeletal interventional radiology in private practice, with emphasis on the role of device companies’ training, marketing, and the role of minimally invasive procedures in a patient’s treatment algorithm. They also cover procedural topics such as endoscopic disc procedures and peripheral nerve stimulation. Dr. Roper highlights both the advantages and challenges of starting an outpatient-based lab (OBL). Throughout the episode, Dr. Roper shares the story of how he decided to pursue MSK radiology and his perspective on balancing his medical practice with his family life. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/Tnhqyf --- SHOW NOTES 0:00 - Introduction to the Podcast 3:00 - Dr. Roper’s Career Path in MSK Radiology 9:10 - Practicing in the OBL and ASC Settings 18:19 - Clinic Presence and Collaboration with Advanced Practice Providers 22:18 - Practice Marketing and Referral Patterns 32:18 - New Developments in Endoscopic Spine and Neuromodulation Procedures 43:30 - Patient Access to Procedures 52:58 - The Future of MSK Radiology Training Pathways --- RESOURCES Dr. Glade Roper’s Twitter: https://twitter.com/darthglader BackTable VI Ep. 211- Extraspinal Augmentation and the Future of Vertebral Augmentation with Dr. Douglas Beall: https://www.backtable.com/shows/vi/podcasts/211/extraspinal-augmentation-the-future-of-vertebral-augmentation Disc-FX: https://www.elliquence.com/education/patients/disc-fx-overview/ ReActiv8 Neuromodulation: https://mainstaymedical.com/ Wed, 06 Dec 2023 06:00:00 -0000 full BackTable In this BackTable MSK episode, host Dr. Jacob Fleming discusses the future of musculoskeletal radiology with Dr. Glade Roper of VIP Specialists in Visalia, California. Dr. Roper is an MSK radiologist who specializes in minimally invasive procedures. In this BackTable MSK episode, host Dr. Jacob Fleming discusses the future of musculoskeletal radiology with Dr. Glade Roper of VIP Specialists in Visalia, California. Dr. Roper is an MSK radiologist who specializes in minimally invasive procedures. The doctors explore the potential of musculoskeletal interventional radiology in private practice, with emphasis on the role of device companies’ training, marketing, and the role of minimally invasive procedures in a patient’s treatment algorithm. They also cover procedural topics such as endoscopic disc procedures and peripheral nerve stimulation. Dr. Roper highlights both the advantages and challenges of starting an outpatient-based lab (OBL). Throughout the episode, Dr. Roper shares the story of how he decided to pursue MSK radiology and his perspective on balancing his medical practice with his family life. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/Tnhqyf --- SHOW NOTES 0:00 - Introduction to the Podcast 3:00 - Dr. Roper’s Career Path in MSK Radiology 9:10 - Practicing in the OBL and ASC Settings 18:19 - Clinic Presence and Collaboration with Advanced Practice Providers 22:18 - Practice Marketing and Referral Patterns 32:18 - New Developments in Endoscopic Spine and Neuromodulation Procedures 43:30 - Patient Access to Procedures 52:58 - The Future of MSK Radiology Training Pathways --- RESOURCES Dr. Glade Roper’s Twitter: https://twitter.com/darthglader BackTable VI Ep. 211- Extraspinal Augmentation and the Future of Vertebral Augmentation with Dr. Douglas Beall: https://www.backtable.com/shows/vi/podcasts/211/extraspinal-augmentation-the-future-of-vertebral-augmentation Disc-FX: https://www.elliquence.com/education/patients/disc-fx-overview/ ReActiv8 Neuromodulation: https://mainstaymedical.com/ In this BackTable MSK episode, host Dr. Jacob Fleming discusses the future of musculoskeletal radiology with Dr. Glade Roper of VIP Specialists in Visalia, California. Dr. Roper is an MSK radiologist who specializes in minimally invasive procedures.


The doctors explore the potential of musculoskeletal interventional radiology in private practice, with emphasis on the role of device companies’ training, marketing, and the role of minimally invasive procedures in a patient’s treatment algorithm. They also cover procedural topics such as endoscopic disc procedures and peripheral nerve stimulation. Dr. Roper highlights both the advantages and challenges of starting an outpatient-based lab (OBL). Throughout the episode, Dr. Roper shares the story of how he decided to pursue MSK radiology and his perspective on balancing his medical practice with his family life.


---


CHECK OUT OUR SPONSOR


Stryker Interventional Spine

https://www.strykerivs.com


---


EARN CME


Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/Tnhqyf


---


SHOW NOTES


0:00 - Introduction to the Podcast

3:00 - Dr. Roper’s Career Path in MSK Radiology

9:10 - Practicing in the OBL and ASC Settings

18:19 - Clinic Presence and Collaboration with Advanced Practice Providers

22:18 - Practice Marketing and Referral Patterns

32:18 - New Developments in Endoscopic Spine and Neuromodulation Procedures

43:30 - Patient Access to Procedures

52:58 - The Future of MSK Radiology Training Pathways


---


RESOURCES


Dr. Glade Roper’s Twitter:

https://twitter.com/darthglader


BackTable VI Ep. 211- Extraspinal Augmentation and the Future of Vertebral Augmentation with Dr. Douglas Beall:

https://www.backtable.com/shows/vi/podcasts/211/extraspinal-augmentation-the-future-of-vertebral-augmentation


Disc-FX:

https://www.elliquence.com/education/patients/disc-fx-overview/


ReActiv8 Neuromodulation:

https://mainstaymedical.com/

]]> 4567 Ep. 35 Q Collar: Protecting the Brain from Impact with Taylor Rapp and Dr. Wayne Olan In this episode, host Dr. Dana Dunleavy interviews NFL player Taylor Rapp and neurointerventional radiologist Dr. Wayne Olan about the role of the Q collar in safeguarding the brain from impact. --- SHOW NOTES Taylor Rapp, a native of Washington state, pursued his college education at the University of Washington, where he also played football. He was later drafted by the LA Rams and played for them for a few years. Recently, Taylor made a move to Buffalo, NY, and now plays safety for the Buffalo Bills. He recounts his brain injury and severe concussion in 2021 while he was playing for the LA Rams. Later on, he heard about the Q collar from his agent and subsequently incorporated it into his gear in the following season. Dr. Olan discusses the origin of the Q collar, which was initially developed in the military to protect and minimize brain movement. He highlights a study from St. Xavier High School in Cincinnati and Cincinnati Children’s Hospital where the role of the Q collar was examined utilizing Diffusion Tensor Imaging (DTI), a type of MRI technique that specifically examines the white matter tract. Within a cohort of 500 athletes, 77% of athletes who wore the Q collage showed no evidence of shear injury whereas 73% of athletes who did not wear the collar showed gray-white matter shearing injury. He further discusses the mechanism by which the Q collar protects the brain from injury. It stabilizes the brain and minimizes movement by decreasing venous return to the brain by 30%, which he compares to wearing a necktie. He makes an important distinction that the Q collar does not occlude venous return, therefore, does not have significant clinical adverse effects. They end the episode by advocating for the significance of educating younger athletes about the risks of contact sports and enhancing safety across all sports. --- RESOURCES Neck Collar with Mild Jugular Vein Compression Study: https://pubmed.ncbi.nlm.nih.gov/28437225/ Wed, 22 Nov 2023 06:00:00 -0000 full BackTable In this episode, host Dr. Dana Dunleavy interviews NFL player Taylor Rapp and neurointerventional radiologist Dr. Wayne Olan about the role of the Q collar in safeguarding the brain from impact. --- SHOW NOTES Taylor Rapp, a native of Washington state, pursued his college education at the University of Washington, where he also played football. He was later drafted by the LA Rams and played for them for a few years. Recently, Taylor made a move to Buffalo, NY, and now plays safety for the Buffalo Bills. He recounts his brain injury and severe concussion in 2021 while he was playing for the LA Rams. Later on, he heard about the Q collar from his agent and subsequently incorporated it into his gear in the following season. Dr. Olan discusses the origin of the Q collar, which was initially developed in the military to protect and minimize brain movement. He highlights a study from St. Xavier High School in Cincinnati and Cincinnati Children’s Hospital where the role of the Q collar was examined utilizing Diffusion Tensor Imaging (DTI), a type of MRI technique that specifically examines the white matter tract. Within a cohort of 500 athletes, 77% of athletes who wore the Q collage showed no evidence of shear injury whereas 73% of athletes who did not wear the collar showed gray-white matter shearing injury. He further discusses the mechanism by which the Q collar protects the brain from injury. It stabilizes the brain and minimizes movement by decreasing venous return to the brain by 30%, which he compares to wearing a necktie. He makes an important distinction that the Q collar does not occlude venous return, therefore, does not have significant clinical adverse effects. They end the episode by advocating for the significance of educating younger athletes about the risks of contact sports and enhancing safety across all sports. --- RESOURCES Neck Collar with Mild Jugular Vein Compression Study: https://pubmed.ncbi.nlm.nih.gov/28437225/ In this episode, host Dr. Dana Dunleavy interviews NFL player Taylor Rapp and neurointerventional radiologist Dr. Wayne Olan about the role of the Q collar in safeguarding the brain from impact.


---


SHOW NOTES


Taylor Rapp, a native of Washington state, pursued his college education at the University of Washington, where he also played football. He was later drafted by the LA Rams and played for them for a few years. Recently, Taylor made a move to Buffalo, NY, and now plays safety for the Buffalo Bills. He recounts his brain injury and severe concussion in 2021 while he was playing for the LA Rams. Later on, he heard about the Q collar from his agent and subsequently incorporated it into his gear in the following season.


Dr. Olan discusses the origin of the Q collar, which was initially developed in the military to protect and minimize brain movement. He highlights a study from St. Xavier High School in Cincinnati and Cincinnati Children’s Hospital where the role of the Q collar was examined utilizing Diffusion Tensor Imaging (DTI), a type of MRI technique that specifically examines the white matter tract. Within a cohort of 500 athletes, 77% of athletes who wore the Q collage showed no evidence of shear injury whereas 73% of athletes who did not wear the collar showed gray-white matter shearing injury. He further discusses the mechanism by which the Q collar protects the brain from injury. It stabilizes the brain and minimizes movement by decreasing venous return to the brain by 30%, which he compares to wearing a necktie. He makes an important distinction that the Q collar does not occlude venous return, therefore, does not have significant clinical adverse effects.


They end the episode by advocating for the significance of educating younger athletes about the risks of contact sports and enhancing safety across all sports.


---


RESOURCES


Neck Collar with Mild Jugular Vein Compression Study:

https://pubmed.ncbi.nlm.nih.gov/28437225/

]]> 2495 Ep. 34 Legends of MSK: Advancing Musculoskeletal Ultrasound with Dr. Jon Jacobson In this episode, host Dr. Jacob Fleming and Dr. Jason Cox interview musculoskeletal radiologist Dr. Jon Jacobson about the current uses and future role of musculoskeletal (MSK) ultrasound. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SHOW NOTES To begin, Dr. Jacobson provides insight into his professional journey, from training at Henry Ford Hospital to his current practice at Lenox Hill in New York City. He reflects on the formative period of his career spent under the mentorship of Dr. Marnix Van Holsbeeck, who played a key role in his training over MSK ultrasound. Dr. Jacobson also discusses his specific areas of interest, in particular, microvascular imaging, especially in the context of assessing blood flow following the treatment of rheumatoid arthritis. He underscores the need for further research and exploration on this topic. Next, Dr. Jacobson explores the significance of MSK ultrasound education across various specialties, emphasizing the mutual learning that takes place across different specialties. Dr. Jacobson has led an annual MSK ultrasound course in San Diego for nearly two decades. He believes that MSK ultrasound has the potential to be scaled up to a level comparable to MSK imaging with CT and MRI. He emphasizes the important role that a skilled technologist plays in this process. He advocates for investing in training efficient and experienced technologists. This includes designating a lead technologist with expertise who can train other newer technologists. Dr. Jacobson further addresses ultrasound-guided interventions such as joint, bursa, and tendon sheath injections. The conversation also delves into the different paradigms of interventional radiology, which can sometimes be viewed as the provision of a clinical service versus the performance of order-based procedures. Finally, Dr. Jacobson elaborates on his collaboration with a nonprofit organization called Imaging the World. Their primary mission centers around ultrasound in Uganda, with a particular emphasis on advancing shoulder ultrasound capabilities in remote and underserved areas, both in terms of diagnosis and treatment. Dr. Jacobson provides training to physical therapists and technologists in ultrasound procedures and ultrasound-guided injections. The next phase of these nonprofit’s efforts is directed towards underserved rural communities in North America. --- RESOURCES Musculoskeletal Ultrasound Education https://www.jacobsonmskus.com/ Wed, 08 Nov 2023 06:00:00 -0000 full BackTable In this episode, host Dr. Jacob Fleming and Dr. Jason Cox interview musculoskeletal radiologist Dr. Jon Jacobson about the current uses and future role of musculoskeletal (MSK) ultrasound. In this episode, host Dr. Jacob Fleming and Dr. Jason Cox interview musculoskeletal radiologist Dr. Jon Jacobson about the current uses and future role of musculoskeletal (MSK) ultrasound. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SHOW NOTES To begin, Dr. Jacobson provides insight into his professional journey, from training at Henry Ford Hospital to his current practice at Lenox Hill in New York City. He reflects on the formative period of his career spent under the mentorship of Dr. Marnix Van Holsbeeck, who played a key role in his training over MSK ultrasound. Dr. Jacobson also discusses his specific areas of interest, in particular, microvascular imaging, especially in the context of assessing blood flow following the treatment of rheumatoid arthritis. He underscores the need for further research and exploration on this topic. Next, Dr. Jacobson explores the significance of MSK ultrasound education across various specialties, emphasizing the mutual learning that takes place across different specialties. Dr. Jacobson has led an annual MSK ultrasound course in San Diego for nearly two decades. He believes that MSK ultrasound has the potential to be scaled up to a level comparable to MSK imaging with CT and MRI. He emphasizes the important role that a skilled technologist plays in this process. He advocates for investing in training efficient and experienced technologists. This includes designating a lead technologist with expertise who can train other newer technologists. Dr. Jacobson further addresses ultrasound-guided interventions such as joint, bursa, and tendon sheath injections. The conversation also delves into the different paradigms of interventional radiology, which can sometimes be viewed as the provision of a clinical service versus the performance of order-based procedures. Finally, Dr. Jacobson elaborates on his collaboration with a nonprofit organization called Imaging the World. Their primary mission centers around ultrasound in Uganda, with a particular emphasis on advancing shoulder ultrasound capabilities in remote and underserved areas, both in terms of diagnosis and treatment. Dr. Jacobson provides training to physical therapists and technologists in ultrasound procedures and ultrasound-guided injections. The next phase of these nonprofit’s efforts is directed towards underserved rural communities in North America. --- RESOURCES Musculoskeletal Ultrasound Education https://www.jacobsonmskus.com/ In this episode, host Dr. Jacob Fleming and Dr. Jason Cox interview musculoskeletal radiologist Dr. Jon Jacobson about the current uses and future role of musculoskeletal (MSK) ultrasound.


---


CHECK OUT OUR SPONSOR


Stryker Interventional Spine

https://www.strykerivs.com


---


SHOW NOTES


To begin, Dr. Jacobson provides insight into his professional journey, from training at Henry Ford Hospital to his current practice at Lenox Hill in New York City. He reflects on the formative period of his career spent under the mentorship of Dr. Marnix Van Holsbeeck, who played a key role in his training over MSK ultrasound. Dr. Jacobson also discusses his specific areas of interest, in particular, microvascular imaging, especially in the context of assessing blood flow following the treatment of rheumatoid arthritis. He underscores the need for further research and exploration on this topic.


Next, Dr. Jacobson explores the significance of MSK ultrasound education across various specialties, emphasizing the mutual learning that takes place across different specialties. Dr. Jacobson has led an annual MSK ultrasound course in San Diego for nearly two decades. He believes that MSK ultrasound has the potential to be scaled up to a level comparable to MSK imaging with CT and MRI. He emphasizes the important role that a skilled technologist plays in this process. He advocates for investing in training efficient and experienced technologists. This includes designating a lead technologist with expertise who can train other newer technologists.


Dr. Jacobson further addresses ultrasound-guided interventions such as joint, bursa, and tendon sheath injections. The conversation also delves into the different paradigms of interventional radiology, which can sometimes be viewed as the provision of a clinical service versus the performance of order-based procedures.


Finally, Dr. Jacobson elaborates on his collaboration with a nonprofit organization called Imaging the World. Their primary mission centers around ultrasound in Uganda, with a particular emphasis on advancing shoulder ultrasound capabilities in remote and underserved areas, both in terms of diagnosis and treatment. Dr. Jacobson provides training to physical therapists and technologists in ultrasound procedures and ultrasound-guided injections. The next phase of these nonprofit’s efforts is directed towards underserved rural communities in North America.


---


RESOURCES


Musculoskeletal Ultrasound Education

https://www.jacobsonmskus.com/

]]> 2951 Ep. 33 New Frontiers in Spinal Tumor Ablation and Augmentation with Dr. Dana Dunleavy In this episode, host Dr. Jacob Fleming interviews Dr. Dana Dunleavy about spinal tumor ablation and vertebral augmentation. Dana is an interventional radiologist and Director of Windsong Interventional & Vascular Services. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SHOW NOTES Dana begins the discussion by reflecting on his upbringing in a small country town. His parents, his mother a midwife and his father a contractor, shaped his early experiences. His exposure to medicine began through his mother, particularly in witnessing childbirths. As he navigated his way through medical school, he contemplated various specialties, including orthopedic surgery, interventional radiology, and neurosurgery. He discovered incredible mentors in radiology and ultimately found his place in the field of interventional radiology. During his residency at Johns Hopkins, he sought externships in interventional spine and had the opportunity to immerse himself in this field for one month. He underscores the significance of participating in tumor boards and being a valuable contributor to the team in terms of diagnosis and treatment. He also emphasizes the value of calling consults when performing biopsies and the importance of meeting with the patient face-to-face and engaging in a thorough discussion of the treatment plan. Next, Dana delves deeper into the topics of bone tumor ablation and mechanical augmentation. He notes the importance of having a comprehensive understanding of the patient's anatomy and being well-versed in interventional tools. Cement extravasation is a feared complication of vertebral augmentation, so Dana discusses the role of implants as a means to establish structural support and mitigate the risk of cement leakage. In addition, he talks about his approach in combining ablation with mechanical augmentation so that the augmentation provides a structure after the ablation. Lastly, he discusses the use of advanced technology such as cone beam CT in trajectory planning. He shares his hybrid approach to performing bone biopsies, utilizing fluoroscopy during access and cone beam CT to ascertain accurate trajectory. Wed, 18 Oct 2023 05:05:00 -0000 full BackTable In this episode, host Dr. Jacob Fleming interviews Dr. Dana Dunleavy about spinal tumor ablation and vertebral augmentation. Dana is an interventional radiologist and Director of Windsong Interventional & Vascular Services. In this episode, host Dr. Jacob Fleming interviews Dr. Dana Dunleavy about spinal tumor ablation and vertebral augmentation. Dana is an interventional radiologist and Director of Windsong Interventional & Vascular Services. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SHOW NOTES Dana begins the discussion by reflecting on his upbringing in a small country town. His parents, his mother a midwife and his father a contractor, shaped his early experiences. His exposure to medicine began through his mother, particularly in witnessing childbirths. As he navigated his way through medical school, he contemplated various specialties, including orthopedic surgery, interventional radiology, and neurosurgery. He discovered incredible mentors in radiology and ultimately found his place in the field of interventional radiology. During his residency at Johns Hopkins, he sought externships in interventional spine and had the opportunity to immerse himself in this field for one month. He underscores the significance of participating in tumor boards and being a valuable contributor to the team in terms of diagnosis and treatment. He also emphasizes the value of calling consults when performing biopsies and the importance of meeting with the patient face-to-face and engaging in a thorough discussion of the treatment plan. Next, Dana delves deeper into the topics of bone tumor ablation and mechanical augmentation. He notes the importance of having a comprehensive understanding of the patient's anatomy and being well-versed in interventional tools. Cement extravasation is a feared complication of vertebral augmentation, so Dana discusses the role of implants as a means to establish structural support and mitigate the risk of cement leakage. In addition, he talks about his approach in combining ablation with mechanical augmentation so that the augmentation provides a structure after the ablation. Lastly, he discusses the use of advanced technology such as cone beam CT in trajectory planning. He shares his hybrid approach to performing bone biopsies, utilizing fluoroscopy during access and cone beam CT to ascertain accurate trajectory. In this episode, host Dr. Jacob Fleming interviews Dr. Dana Dunleavy about spinal tumor ablation and vertebral augmentation. Dana is an interventional radiologist and Director of Windsong Interventional & Vascular Services.


---


CHECK OUT OUR SPONSOR


Stryker Interventional Spine

https://www.strykerivs.com


---


SHOW NOTES


Dana begins the discussion by reflecting on his upbringing in a small country town. His parents, his mother a midwife and his father a contractor, shaped his early experiences. His exposure to medicine began through his mother, particularly in witnessing childbirths. As he navigated his way through medical school, he contemplated various specialties, including orthopedic surgery, interventional radiology, and neurosurgery. He discovered incredible mentors in radiology and ultimately found his place in the field of interventional radiology. During his residency at Johns Hopkins, he sought externships in interventional spine and had the opportunity to immerse himself in this field for one month.


He underscores the significance of participating in tumor boards and being a valuable contributor to the team in terms of diagnosis and treatment. He also emphasizes the value of calling consults when performing biopsies and the importance of meeting with the patient face-to-face and engaging in a thorough discussion of the treatment plan.


Next, Dana delves deeper into the topics of bone tumor ablation and mechanical augmentation. He notes the importance of having a comprehensive understanding of the patient's anatomy and being well-versed in interventional tools. Cement extravasation is a feared complication of vertebral augmentation, so Dana discusses the role of implants as a means to establish structural support and mitigate the risk of cement leakage. In addition, he talks about his approach in combining ablation with mechanical augmentation so that the augmentation provides a structure after the ablation.


Lastly, he discusses the use of advanced technology such as cone beam CT in trajectory planning. He shares his hybrid approach to performing bone biopsies, utilizing fluoroscopy during access and cone beam CT to ascertain accurate trajectory.

]]> 3768 Ep. 32 Moving the Needle: Percutaneous Treatment of Tendon Injuries with Dr. William Morrison In this episode, Dr. Jacob Fleming interviews Dr. William Morrison, the medical director of Trace Orthopedics. Trace Orthopedics is developing a minimally invasive implantable device for tendon repairs. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SHOW NOTES William's passion for radiology traces back to his early love for art. In the initial stages of his career, he conceived the idea of a curved, steerable needle to navigate this L5-S1 space for discographies. After bringing the needle to market, its adoption was hampered by cost factors and the challenge clinicians faced in transitioning from traditional straight needles to the new design. Despite the initial challenges and disappointment with the needle's limited uptake, the product found a valuable application in celiac plexus blocks for pancreatic cancer and has shown to reduce surgical risks and complications compared to the traditional approach. After taking several years off from his innovation journey, William’s personal experience with a partial rotator cuff tear drove him back into action. At that time, the available treatment options were strictly rehabilitation-focused, severely limiting his activity. He crafted a device in his garage using materials from Home Depot to percutaneously anchor tendons. Taking his prototype to Jefferson, where the idea gained endorsement, he proceeded to obtain a patent and established the Trace Orthopedics company. The implanted device has the ability to withstand greater force compared to commonly used suture anchors and is a minimally invasive procedure that is both efficient and single-step. William's invention has garnered interest from various medical specialties. With FDA approval in sight, the device is expected to hit the market within the next year. During their last remarks, William addresses the persistent challenge of public awareness regarding the full scope of minimally invasive interventional practices within radiology when discussing potential investments. According to William, radiology currently stands at a critical juncture where the significance of imaging and research in driving product development has never been more crucial. --- RESOURCES Trace Orthopedics: https://www.traceorthopedics.com/ Wed, 04 Oct 2023 05:05:00 -0000 full BackTable In this episode, Dr. Jacob Fleming interviews Dr. William Morrison, the medical director of Trace Orthopedics. Trace Orthopedics is developing a minimally invasive implantable device for tendon repairs. In this episode, Dr. Jacob Fleming interviews Dr. William Morrison, the medical director of Trace Orthopedics. Trace Orthopedics is developing a minimally invasive implantable device for tendon repairs. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SHOW NOTES William's passion for radiology traces back to his early love for art. In the initial stages of his career, he conceived the idea of a curved, steerable needle to navigate this L5-S1 space for discographies. After bringing the needle to market, its adoption was hampered by cost factors and the challenge clinicians faced in transitioning from traditional straight needles to the new design. Despite the initial challenges and disappointment with the needle's limited uptake, the product found a valuable application in celiac plexus blocks for pancreatic cancer and has shown to reduce surgical risks and complications compared to the traditional approach. After taking several years off from his innovation journey, William’s personal experience with a partial rotator cuff tear drove him back into action. At that time, the available treatment options were strictly rehabilitation-focused, severely limiting his activity. He crafted a device in his garage using materials from Home Depot to percutaneously anchor tendons. Taking his prototype to Jefferson, where the idea gained endorsement, he proceeded to obtain a patent and established the Trace Orthopedics company. The implanted device has the ability to withstand greater force compared to commonly used suture anchors and is a minimally invasive procedure that is both efficient and single-step. William's invention has garnered interest from various medical specialties. With FDA approval in sight, the device is expected to hit the market within the next year. During their last remarks, William addresses the persistent challenge of public awareness regarding the full scope of minimally invasive interventional practices within radiology when discussing potential investments. According to William, radiology currently stands at a critical juncture where the significance of imaging and research in driving product development has never been more crucial. --- RESOURCES Trace Orthopedics: https://www.traceorthopedics.com/ In this episode, Dr. Jacob Fleming interviews Dr. William Morrison, the medical director of Trace Orthopedics. Trace Orthopedics is developing a minimally invasive implantable device for tendon repairs.


---


CHECK OUT OUR SPONSOR


Stryker Interventional Spine

https://www.strykerivs.com


---


SHOW NOTES


William's passion for radiology traces back to his early love for art. In the initial stages of his career, he conceived the idea of a curved, steerable needle to navigate this L5-S1 space for discographies. After bringing the needle to market, its adoption was hampered by cost factors and the challenge clinicians faced in transitioning from traditional straight needles to the new design. Despite the initial challenges and disappointment with the needle's limited uptake, the product found a valuable application in celiac plexus blocks for pancreatic cancer and has shown to reduce surgical risks and complications compared to the traditional approach.


After taking several years off from his innovation journey, William’s personal experience with a partial rotator cuff tear drove him back into action. At that time, the available treatment options were strictly rehabilitation-focused, severely limiting his activity. He crafted a device in his garage using materials from Home Depot to percutaneously anchor tendons. Taking his prototype to Jefferson, where the idea gained endorsement, he proceeded to obtain a patent and established the Trace Orthopedics company. The implanted device has the ability to withstand greater force compared to commonly used suture anchors and is a minimally invasive procedure that is both efficient and single-step. William's invention has garnered interest from various medical specialties. With FDA approval in sight, the device is expected to hit the market within the next year.


During their last remarks, William addresses the persistent challenge of public awareness regarding the full scope of minimally invasive interventional practices within radiology when discussing potential investments. According to William, radiology currently stands at a critical juncture where the significance of imaging and research in driving product development has never been more crucial.


---


RESOURCES


Trace Orthopedics:

https://www.traceorthopedics.com/

]]> 2296 Ep. 31 Legends of MSK: Dr. Marnix Van Holsbeeck In this episode, host Dr. Jason Cox interviews Dr. Marnix van Holsbeeck, who is considered to be one of the godfathers of musculoskeletal ultrasound. --- SHOW NOTES Dr. Holsbeeck begins by reflecting on his early life in Belgium. Raised in a family of medical professionals, he started his career as a general practitioner at the age of 24, all while pursuing a comprehensive radiology training. His introduction to musculoskeletal ultrasound occurred during his tenure at his father's practice, where he discovered not only his affinity for radiology but also his deep passion for patient interaction. He soon realized that conducting ultrasound was the perfect intersection of both of his passions for radiology and patient care. He then provides a history of the origins of musculoskeletal ultrasound, dating back to its inception in 1979-1980. He shares his experiences from his time in gastroenterology, where ultrasound was beginning to be utilized for diagnosing gallbladder stones. It was during this time that he became captivated by the ability to correlate a patient's medical history with the findings of the ultrasound. Dr. Holsbeeck also elaborates on his journey on musculoskeletal ultrasound, recounting the numerous single-contrast arthrograms he conducted in conjunction with ultrasound during his training. As a practicing general practitioner, he recollects performing therapeutic joint injections and he recognized the need for image-guided procedures, specifically ultrasound-guided therapeutic joint injections. This approach offered superior precision and visualization of the joint space, further enhancing patient care. He also shares the development of the Musculoskeletal Ultrasound program at Henry Ford in Detroit, Michigan, upon his arrival in 1989. He initially began using ultrasound in the Emergency Department with regards to abscess aspiration and drainage. This approach was subsequently integrated into the field of orthopedics. Dr. Holsbeeck highlights the pivotal role of ultrasound in the diagnosis of tendon tears, underscoring its capacity to promptly assess whether surgical intervention is warranted for the patient. --- RESOURCES Musculoskeletal Ultrasound Society: https://www.musoc.com/ Wed, 13 Sep 2023 05:05:00 -0000 full BackTable In this episode, host Dr. Jason Cox interviews Dr. Marnix van Holsbeeck, who is considered to be one of the godfathers of musculoskeletal ultrasound. In this episode, host Dr. Jason Cox interviews Dr. Marnix van Holsbeeck, who is considered to be one of the godfathers of musculoskeletal ultrasound. --- SHOW NOTES Dr. Holsbeeck begins by reflecting on his early life in Belgium. Raised in a family of medical professionals, he started his career as a general practitioner at the age of 24, all while pursuing a comprehensive radiology training. His introduction to musculoskeletal ultrasound occurred during his tenure at his father's practice, where he discovered not only his affinity for radiology but also his deep passion for patient interaction. He soon realized that conducting ultrasound was the perfect intersection of both of his passions for radiology and patient care. He then provides a history of the origins of musculoskeletal ultrasound, dating back to its inception in 1979-1980. He shares his experiences from his time in gastroenterology, where ultrasound was beginning to be utilized for diagnosing gallbladder stones. It was during this time that he became captivated by the ability to correlate a patient's medical history with the findings of the ultrasound. Dr. Holsbeeck also elaborates on his journey on musculoskeletal ultrasound, recounting the numerous single-contrast arthrograms he conducted in conjunction with ultrasound during his training. As a practicing general practitioner, he recollects performing therapeutic joint injections and he recognized the need for image-guided procedures, specifically ultrasound-guided therapeutic joint injections. This approach offered superior precision and visualization of the joint space, further enhancing patient care. He also shares the development of the Musculoskeletal Ultrasound program at Henry Ford in Detroit, Michigan, upon his arrival in 1989. He initially began using ultrasound in the Emergency Department with regards to abscess aspiration and drainage. This approach was subsequently integrated into the field of orthopedics. Dr. Holsbeeck highlights the pivotal role of ultrasound in the diagnosis of tendon tears, underscoring its capacity to promptly assess whether surgical intervention is warranted for the patient. --- RESOURCES Musculoskeletal Ultrasound Society: https://www.musoc.com/ In this episode, host Dr. Jason Cox interviews Dr. Marnix van Holsbeeck, who is considered to be one of the godfathers of musculoskeletal ultrasound.


---


SHOW NOTES


Dr. Holsbeeck begins by reflecting on his early life in Belgium. Raised in a family of medical professionals, he started his career as a general practitioner at the age of 24, all while pursuing a comprehensive radiology training. His introduction to musculoskeletal ultrasound occurred during his tenure at his father's practice, where he discovered not only his affinity for radiology but also his deep passion for patient interaction. He soon realized that conducting ultrasound was the perfect intersection of both of his passions for radiology and patient care.


He then provides a history of the origins of musculoskeletal ultrasound, dating back to its inception in 1979-1980. He shares his experiences from his time in gastroenterology, where ultrasound was beginning to be utilized for diagnosing gallbladder stones. It was during this time that he became captivated by the ability to correlate a patient's medical history with the findings of the ultrasound.


Dr. Holsbeeck also elaborates on his journey on musculoskeletal ultrasound, recounting the numerous single-contrast arthrograms he conducted in conjunction with ultrasound during his training. As a practicing general practitioner, he recollects performing therapeutic joint injections and he recognized the need for image-guided procedures, specifically ultrasound-guided therapeutic joint injections. This approach offered superior precision and visualization of the joint space, further enhancing patient care.


He also shares the development of the Musculoskeletal Ultrasound program at Henry Ford in Detroit, Michigan, upon his arrival in 1989. He initially began using ultrasound in the Emergency Department with regards to abscess aspiration and drainage. This approach was subsequently integrated into the field of orthopedics. Dr. Holsbeeck highlights the pivotal role of ultrasound in the diagnosis of tendon tears, underscoring its capacity to promptly assess whether surgical intervention is warranted for the patient.


---


RESOURCES


Musculoskeletal Ultrasound Society:

https://www.musoc.com/

]]> 3362 Ep. 30 Image-Guided Headache Interventions with Dan Nguyen In this episode, guest host Dr. Jacob Fleming interviews Dr. Dan Nguyen about MSK and neurologic pain interventions, specifically how he evaluates and treats different types of headaches at his practice. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/em9n8O --- SHOW NOTES Dr. Nguyen left academia and the East Coast 6 years ago, where he trained in neurointerventional radiology and pain intervention to open his own practice in Oklahoma City after visiting Dr. Beall. He now has a clinic where he sees musculoskeletal and neurologic pain patients. He enjoys the long term relationships he has built with many patients in his practice. He still does a degree of diagnostic work so as not to lose his skills. Next, Dr. Nguyen discusses how he evaluates and treats headaches as a neurological pain interventionalist. Understanding the neuroanatomy of the face is key. He tries to understand the presentation of the patient’s headaches, whether it is located above the eyebrow, near the ear or at the jaw. He treats cervicogenic headache, trigeminal neuralgia and occipital neuralgia with a diagnostic block, radiofrequency ablation and neuromodulation. He also treats migrainous headaches. After determining whether the pain is musculogenic or neurogenic, he does a trigger point injection or a test injection of the nerve, followed by RFA and neuromodulation. Dr. Nguyen tells us his approach to trigeminal neuralgia workup. There are three branches, and the Gasserian ganglion (trigeminal ganglion) lies deep to the foramen ovale. To approach it, he usually tries to target the most peripheral nerve branch. For V1, he evaluates the supraorbital, supratrochlear nerves, which you can see with ultrasound. For V2, he evaluates the infraorbital with ultrasound. The foramen rotundundum requires CT guidance to access. For V3 he evaluates the mental and alveolar nerves or the foramen ovale. He does diagnostic blocks, and if this provides relief to the patient they discuss radiofrequency ablation. He advises operators to take the longest path to the nerve to ensure the ablative needle is fully buried under the skin to avoid burns. He also discusses the rare outcome of anesthesia dolorosa which can cause facial numbness and pain after ablation of the Gasserian ganglion. He says that for most of his patients, they accept this potential risk due to the more likely possibility of relief from the excruciating pain they experience with trigeminal neuralgia. --- RESOURCES Dr. Nguyen Twitter: @neuroradiology Narouze: Interventional Management of Head and Face Pain https://link.springer.com/book/10.1007/978-1-4614-8951-1 American Society of Spine Radiology: https://assrannualmeeting.org American Society of Neuroradiology: https://www.asnr.org/annualmeeting/ Wed, 06 Sep 2023 05:05:00 -0000 full BackTable In this episode, guest host Dr. Jacob Fleming interviews Dr. Dan Nguyen about MSK and neurologic pain interventions, specifically how he evaluates and treats different types of headaches at his practice. In this episode, guest host Dr. Jacob Fleming interviews Dr. Dan Nguyen about MSK and neurologic pain interventions, specifically how he evaluates and treats different types of headaches at his practice. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/em9n8O --- SHOW NOTES Dr. Nguyen left academia and the East Coast 6 years ago, where he trained in neurointerventional radiology and pain intervention to open his own practice in Oklahoma City after visiting Dr. Beall. He now has a clinic where he sees musculoskeletal and neurologic pain patients. He enjoys the long term relationships he has built with many patients in his practice. He still does a degree of diagnostic work so as not to lose his skills. Next, Dr. Nguyen discusses how he evaluates and treats headaches as a neurological pain interventionalist. Understanding the neuroanatomy of the face is key. He tries to understand the presentation of the patient’s headaches, whether it is located above the eyebrow, near the ear or at the jaw. He treats cervicogenic headache, trigeminal neuralgia and occipital neuralgia with a diagnostic block, radiofrequency ablation and neuromodulation. He also treats migrainous headaches. After determining whether the pain is musculogenic or neurogenic, he does a trigger point injection or a test injection of the nerve, followed by RFA and neuromodulation. Dr. Nguyen tells us his approach to trigeminal neuralgia workup. There are three branches, and the Gasserian ganglion (trigeminal ganglion) lies deep to the foramen ovale. To approach it, he usually tries to target the most peripheral nerve branch. For V1, he evaluates the supraorbital, supratrochlear nerves, which you can see with ultrasound. For V2, he evaluates the infraorbital with ultrasound. The foramen rotundundum requires CT guidance to access. For V3 he evaluates the mental and alveolar nerves or the foramen ovale. He does diagnostic blocks, and if this provides relief to the patient they discuss radiofrequency ablation. He advises operators to take the longest path to the nerve to ensure the ablative needle is fully buried under the skin to avoid burns. He also discusses the rare outcome of anesthesia dolorosa which can cause facial numbness and pain after ablation of the Gasserian ganglion. He says that for most of his patients, they accept this potential risk due to the more likely possibility of relief from the excruciating pain they experience with trigeminal neuralgia. --- RESOURCES Dr. Nguyen Twitter: @neuroradiology Narouze: Interventional Management of Head and Face Pain https://link.springer.com/book/10.1007/978-1-4614-8951-1 American Society of Spine Radiology: https://assrannualmeeting.org American Society of Neuroradiology: https://www.asnr.org/annualmeeting/ In this episode, guest host Dr. Jacob Fleming interviews Dr. Dan Nguyen about MSK and neurologic pain interventions, specifically how he evaluates and treats different types of headaches at his practice.


---


EARN CME


Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/em9n8O


---


SHOW NOTES


Dr. Nguyen left academia and the East Coast 6 years ago, where he trained in neurointerventional radiology and pain intervention to open his own practice in Oklahoma City after visiting Dr. Beall. He now has a clinic where he sees musculoskeletal and neurologic pain patients. He enjoys the long term relationships he has built with many patients in his practice. He still does a degree of diagnostic work so as not to lose his skills.


Next, Dr. Nguyen discusses how he evaluates and treats headaches as a neurological pain interventionalist. Understanding the neuroanatomy of the face is key. He tries to understand the presentation of the patient’s headaches, whether it is located above the eyebrow, near the ear or at the jaw. He treats cervicogenic headache, trigeminal neuralgia and occipital neuralgia with a diagnostic block, radiofrequency ablation and neuromodulation. He also treats migrainous headaches. After determining whether the pain is musculogenic or neurogenic, he does a trigger point injection or a test injection of the nerve, followed by RFA and neuromodulation.


Dr. Nguyen tells us his approach to trigeminal neuralgia workup. There are three branches, and the Gasserian ganglion (trigeminal ganglion) lies deep to the foramen ovale. To approach it, he usually tries to target the most peripheral nerve branch. For V1, he evaluates the supraorbital, supratrochlear nerves, which you can see with ultrasound. For V2, he evaluates the infraorbital with ultrasound. The foramen rotundundum requires CT guidance to access. For V3 he evaluates the mental and alveolar nerves or the foramen ovale. He does diagnostic blocks, and if this provides relief to the patient they discuss radiofrequency ablation. He advises operators to take the longest path to the nerve to ensure the ablative needle is fully buried under the skin to avoid burns. He also discusses the rare outcome of anesthesia dolorosa which can cause facial numbness and pain after ablation of the Gasserian ganglion. He says that for most of his patients, they accept this potential risk due to the more likely possibility of relief from the excruciating pain they experience with trigeminal neuralgia.


---


RESOURCES


Dr. Nguyen Twitter:

@neuroradiology


Narouze: Interventional Management of Head and Face Pain

https://link.springer.com/book/10.1007/978-1-4614-8951-1


American Society of Spine Radiology:

https://assrannualmeeting.org


American Society of Neuroradiology:

https://www.asnr.org/annualmeeting/

]]> 3304 Ep. 29 Pain and Veins: A Unique OBL Practice with Dr. Keerthi Prasad In this episode, guest host Dr. Shamit Desai interviews Dr. Keerthi Prasad about his path to starting an IR practice alongside interventional pain specialists. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/TQUUf1 --- SHOW NOTES This unique collaboration started after Dr. Prasad finished fellowship. He describes the support and investment that his anesthesiologist partners provided in helping him launch IR service lines in their existing practice. On the pain management side, he primarily performs vertebral augmentation, DRG stimulation, and nerve blocks. He has also expanded his services into vein care, since venous disease is often concomitant with PAD, wound care, and pain. Dr. Prasad emphasizes the value of focusing on specific procedures and disease states in order to provide the best and most up to date clinical care possible. This can also set you apart from other competitors and help patients identify you as their vascular specialist. Dr. Prasad delves into the infrastructure of their centers. Their high volume of patients requires close coordination of all office and medical staff. To retain highly trained medical staff, he recommends investing in their training, minimizing office politics, and granting sufficient autonomy. Since 2016, the Centers for Pain Control and Vein Care has expanded to multiple locations in northwest Indiana. Dr. Prasad closes the episode by speaking about practice marketing and forming new referral networks. He emphasizes the importance of identifying if there is a true clinical need to perform each procedure and following up with patients and referring doctors. --- RESOURCES Centers for Pain Control and Vein Care: https://www.discover-cpc.com/ Wed, 30 Aug 2023 05:05:00 -0000 full BackTable In this episode, guest host Dr. Shamit Desai interviews Dr. Keerthi Prasad about his path to starting an IR practice alongside interventional pain specialists. In this episode, guest host Dr. Shamit Desai interviews Dr. Keerthi Prasad about his path to starting an IR practice alongside interventional pain specialists. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/TQUUf1 --- SHOW NOTES This unique collaboration started after Dr. Prasad finished fellowship. He describes the support and investment that his anesthesiologist partners provided in helping him launch IR service lines in their existing practice. On the pain management side, he primarily performs vertebral augmentation, DRG stimulation, and nerve blocks. He has also expanded his services into vein care, since venous disease is often concomitant with PAD, wound care, and pain. Dr. Prasad emphasizes the value of focusing on specific procedures and disease states in order to provide the best and most up to date clinical care possible. This can also set you apart from other competitors and help patients identify you as their vascular specialist. Dr. Prasad delves into the infrastructure of their centers. Their high volume of patients requires close coordination of all office and medical staff. To retain highly trained medical staff, he recommends investing in their training, minimizing office politics, and granting sufficient autonomy. Since 2016, the Centers for Pain Control and Vein Care has expanded to multiple locations in northwest Indiana. Dr. Prasad closes the episode by speaking about practice marketing and forming new referral networks. He emphasizes the importance of identifying if there is a true clinical need to perform each procedure and following up with patients and referring doctors. --- RESOURCES Centers for Pain Control and Vein Care: https://www.discover-cpc.com/ In this episode, guest host Dr. Shamit Desai interviews Dr. Keerthi Prasad about his path to starting an IR practice alongside interventional pain specialists.


---


EARN CME


Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/TQUUf1


---


SHOW NOTES


This unique collaboration started after Dr. Prasad finished fellowship. He describes the support and investment that his anesthesiologist partners provided in helping him launch IR service lines in their existing practice. On the pain management side, he primarily performs vertebral augmentation, DRG stimulation, and nerve blocks. He has also expanded his services into vein care, since venous disease is often concomitant with PAD, wound care, and pain. Dr. Prasad emphasizes the value of focusing on specific procedures and disease states in order to provide the best and most up to date clinical care possible. This can also set you apart from other competitors and help patients identify you as their vascular specialist.


Dr. Prasad delves into the infrastructure of their centers. Their high volume of patients requires close coordination of all office and medical staff. To retain highly trained medical staff, he recommends investing in their training, minimizing office politics, and granting sufficient autonomy.


Since 2016, the Centers for Pain Control and Vein Care has expanded to multiple locations in northwest Indiana. Dr. Prasad closes the episode by speaking about practice marketing and forming new referral networks. He emphasizes the importance of identifying if there is a true clinical need to perform each procedure and following up with patients and referring doctors.


---


RESOURCES


Centers for Pain Control and Vein Care:

https://www.discover-cpc.com/

]]> 2495 Ep. 28 IR/NIR Neurosurgery Collaboration: Expanding the Blueprint with Dr. Wayne Olan In this episode, guest host and interventional radiologist Dr. Dana Dunleavy interviews neurointerventional radiologist Dr. Wayne Olan about growing neuroIR and IR through a neurosurgery department. Wayne serves as the Director of Interventional and Endovascular Neurosurgery at George Washington University Medical Center. --- SHOW NOTES First, Wayne tells us more about his training, journey in academia, and role in building robust neuroIR and IR service lines through his leadership of the neurosurgery department at his institution. Wayne also shares how powerful being involved in interdisciplinary clinics can be in growing the scale, reach, and impact of minimally-invasive image guided interventions. These collaborations include neuroIR/neurosurgery for neuro clinic and IR/ gynecology for fibroid clinic. Dana and Wayne then discuss how neuroIR and IR has evolved over the years, highlighting watershed moments and key innovations. They discuss sacroiliac joint interventions in detail and how MSK has become one of IR’s newest subspecialties. Wayne shares his history of playing and coaching lacrosse, and he also tells us about the Q-Collar and his role in serving on the company’s board of medical advisors. The device has been shown to protect the athletes’ brains from concussive and subconcussive impacts by increasing internal jugular vein pressure. We conclude the episode with some parting wisdom from Wayne regarding career paths, navigating reimbursements and insurance as a neuroIR or IR, and finding joy and purpose at and outside of work. --- RESOURCES SI-Bone, iFuse TORQ Device: https://si-bone.com/providers/solutions/trauma/ifuse-torq SI-Bone, iFuse Triangle Device: https://si-bone.com/providers/solutions/ifuse Stryker, Spine Jack Device: https://www.stryker.com/us/en/interventional-spine/products/spinejack-system.html Q-Collar Company web-page: https://q30.com/ Q-Collar Studies / Research Briefing: https://q30.com/pages/fda-reviewed Boston University CTE Clinic: https://www.bu.edu/cte/ Wed, 23 Aug 2023 05:05:00 -0000 full BackTable In this episode, guest host and interventional radiologist Dr. Dana Dunleavy interviews neurointerventional radiologist Dr. Wayne Olan about growing neuroIR and IR through a neurosurgery department. Wayne serves as the Director of Interventional and Endovascular Neurosurgery at George Washington University Medical Center. In this episode, guest host and interventional radiologist Dr. Dana Dunleavy interviews neurointerventional radiologist Dr. Wayne Olan about growing neuroIR and IR through a neurosurgery department. Wayne serves as the Director of Interventional and Endovascular Neurosurgery at George Washington University Medical Center. --- SHOW NOTES First, Wayne tells us more about his training, journey in academia, and role in building robust neuroIR and IR service lines through his leadership of the neurosurgery department at his institution. Wayne also shares how powerful being involved in interdisciplinary clinics can be in growing the scale, reach, and impact of minimally-invasive image guided interventions. These collaborations include neuroIR/neurosurgery for neuro clinic and IR/ gynecology for fibroid clinic. Dana and Wayne then discuss how neuroIR and IR has evolved over the years, highlighting watershed moments and key innovations. They discuss sacroiliac joint interventions in detail and how MSK has become one of IR’s newest subspecialties. Wayne shares his history of playing and coaching lacrosse, and he also tells us about the Q-Collar and his role in serving on the company’s board of medical advisors. The device has been shown to protect the athletes’ brains from concussive and subconcussive impacts by increasing internal jugular vein pressure. We conclude the episode with some parting wisdom from Wayne regarding career paths, navigating reimbursements and insurance as a neuroIR or IR, and finding joy and purpose at and outside of work. --- RESOURCES SI-Bone, iFuse TORQ Device: https://si-bone.com/providers/solutions/trauma/ifuse-torq SI-Bone, iFuse Triangle Device: https://si-bone.com/providers/solutions/ifuse Stryker, Spine Jack Device: https://www.stryker.com/us/en/interventional-spine/products/spinejack-system.html Q-Collar Company web-page: https://q30.com/ Q-Collar Studies / Research Briefing: https://q30.com/pages/fda-reviewed Boston University CTE Clinic: https://www.bu.edu/cte/ In this episode, guest host and interventional radiologist Dr. Dana Dunleavy interviews neurointerventional radiologist Dr. Wayne Olan about growing neuroIR and IR through a neurosurgery department. Wayne serves as the Director of Interventional and Endovascular Neurosurgery at George Washington University Medical Center.


---


SHOW NOTES


First, Wayne tells us more about his training, journey in academia, and role in building robust neuroIR and IR service lines through his leadership of the neurosurgery department at his institution. Wayne also shares how powerful being involved in interdisciplinary clinics can be in growing the scale, reach, and impact of minimally-invasive image guided interventions. These collaborations include neuroIR/neurosurgery for neuro clinic and IR/ gynecology for fibroid clinic.


Dana and Wayne then discuss how neuroIR and IR has evolved over the years, highlighting watershed moments and key innovations. They discuss sacroiliac joint interventions in detail and how MSK has become one of IR’s newest subspecialties.


Wayne shares his history of playing and coaching lacrosse, and he also tells us about the Q-Collar and his role in serving on the company’s board of medical advisors. The device has been shown to protect the athletes’ brains from concussive and subconcussive impacts by increasing internal jugular vein pressure.


We conclude the episode with some parting wisdom from Wayne regarding career paths, navigating reimbursements and insurance as a neuroIR or IR, and finding joy and purpose at and outside of work.


---


RESOURCES


SI-Bone, iFuse TORQ Device:

https://si-bone.com/providers/solutions/trauma/ifuse-torq


SI-Bone, iFuse Triangle Device:

https://si-bone.com/providers/solutions/ifuse


Stryker, Spine Jack Device:

https://www.stryker.com/us/en/interventional-spine/products/spinejack-system.html


Q-Collar Company web-page:

https://q30.com/


Q-Collar Studies / Research Briefing:

https://q30.com/pages/fda-reviewed


Boston University CTE Clinic:

https://www.bu.edu/cte/

]]> 4315 Ep. 27 Palliative Care in IR with Dr. Sean Tutton In this episode, host Dr. Eric Keller interviews Dr. Sean Tutton about palliative care as an interventionalist, how he became interested in palliative care, and why he believes it is a crucial aspect of patient care in interventional radiology. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/OYDxfn --- SHOW NOTES The role of palliative care is to talk with patients about their goals, make them comfortable, optimize medical management, help patients understand their diagnosis, and coordinate care. Though palliative care involvement does not mean a patient is close to death, many palliative care patients will enroll in hospice at some point. Once in hospice, life-prolonging therapies are no longer pursued. Hospice care is a benefit of Medicare. It has support such as home care, and it can be expensive but is covered by the government. Due to this, there are guidelines that need to be adhered to. Frequently, palliative interventional pain procedures such as a celiac plexus block or neurolysis may not be covered so patients may have to come off hospice to get the procedure, then go back on. Next, we talk about how an IR can start to incorporate these ideals and practices into their daily work. Dr. Tutton emphasizes that you don’t need to do the fellowship. You can start rounding with palliative care, go to their conferences, and establish relationships. Having residents and fellows rotate with palliative care is a great way for future IRs to learn how to practice with a palliative care mindset, and also to educate palliative care on the minimally invasive options that IR can offer to patients such as nerve blocks and ablations. By adopting palliative care ideals as an interventionalist, you can help your patients achieve better pain control, improve their cognition and reduce narcotics use. Dr. Tutton recommends all IRs understand the medical management of post-op pain for any procedure they perform. He provides a standard medication regimen for a patient having an ablation. He uses Tylenol 1g pre-op and gabapentin 300-600mg 48-72hrs before the procedure and intraoperative steroids and NSAIDs such as Decadron 8-10mg and Toradol 10-30mg. All of these have level 1 data, help reduce narcotic requirements, and help with post-op nausea and pain. He discharges patients on a Medrol dose pack, ibuprofen, Tylenol, and gabapentin for a couple of days. Doing a nerve block can help as well, he frequently does ankle, digital, intercostal, and hypogastric blocks for his MSK and palliative interventions. --- RESOURCES Ep.199: Advanced Minimally Invasive Pain Interventions with Dr. Prologo https://www.backtable.com/shows/vi/podcasts/199/advanced-minimally-invasive-pain-interventions Ep. 68: RF Ablation for Bone Metastases with Dr. Levy and Dr. Bagla https://www.backtable.com/shows/vi/podcasts/68/rf-ablation-therapy-for-bone-metastases Wed, 16 Aug 2023 05:05:00 -0000 full BackTable In this episode, host Dr. Eric Keller interviews Dr. Sean Tutton about palliative care as an interventionalist, how he became interested in palliative care, and why he believes it is a crucial aspect of patient care in interventional radiology. In this episode, host Dr. Eric Keller interviews Dr. Sean Tutton about palliative care as an interventionalist, how he became interested in palliative care, and why he believes it is a crucial aspect of patient care in interventional radiology. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/OYDxfn --- SHOW NOTES The role of palliative care is to talk with patients about their goals, make them comfortable, optimize medical management, help patients understand their diagnosis, and coordinate care. Though palliative care involvement does not mean a patient is close to death, many palliative care patients will enroll in hospice at some point. Once in hospice, life-prolonging therapies are no longer pursued. Hospice care is a benefit of Medicare. It has support such as home care, and it can be expensive but is covered by the government. Due to this, there are guidelines that need to be adhered to. Frequently, palliative interventional pain procedures such as a celiac plexus block or neurolysis may not be covered so patients may have to come off hospice to get the procedure, then go back on. Next, we talk about how an IR can start to incorporate these ideals and practices into their daily work. Dr. Tutton emphasizes that you don’t need to do the fellowship. You can start rounding with palliative care, go to their conferences, and establish relationships. Having residents and fellows rotate with palliative care is a great way for future IRs to learn how to practice with a palliative care mindset, and also to educate palliative care on the minimally invasive options that IR can offer to patients such as nerve blocks and ablations. By adopting palliative care ideals as an interventionalist, you can help your patients achieve better pain control, improve their cognition and reduce narcotics use. Dr. Tutton recommends all IRs understand the medical management of post-op pain for any procedure they perform. He provides a standard medication regimen for a patient having an ablation. He uses Tylenol 1g pre-op and gabapentin 300-600mg 48-72hrs before the procedure and intraoperative steroids and NSAIDs such as Decadron 8-10mg and Toradol 10-30mg. All of these have level 1 data, help reduce narcotic requirements, and help with post-op nausea and pain. He discharges patients on a Medrol dose pack, ibuprofen, Tylenol, and gabapentin for a couple of days. Doing a nerve block can help as well, he frequently does ankle, digital, intercostal, and hypogastric blocks for his MSK and palliative interventions. --- RESOURCES Ep.199: Advanced Minimally Invasive Pain Interventions with Dr. Prologo https://www.backtable.com/shows/vi/podcasts/199/advanced-minimally-invasive-pain-interventions Ep. 68: RF Ablation for Bone Metastases with Dr. Levy and Dr. Bagla https://www.backtable.com/shows/vi/podcasts/68/rf-ablation-therapy-for-bone-metastases In this episode, host Dr. Eric Keller interviews Dr. Sean Tutton about palliative care as an interventionalist, how he became interested in palliative care, and why he believes it is a crucial aspect of patient care in interventional radiology.


---


CHECK OUT OUR SPONSOR


RADPAD® Radiation Protection

https://www.radpad.com/


---


EARN CME


Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/OYDxfn


---


SHOW NOTES


The role of palliative care is to talk with patients about their goals, make them comfortable, optimize medical management, help patients understand their diagnosis, and coordinate care. Though palliative care involvement does not mean a patient is close to death, many palliative care patients will enroll in hospice at some point. Once in hospice, life-prolonging therapies are no longer pursued. Hospice care is a benefit of Medicare. It has support such as home care, and it can be expensive but is covered by the government. Due to this, there are guidelines that need to be adhered to. Frequently, palliative interventional pain procedures such as a celiac plexus block or neurolysis may not be covered so patients may have to come off hospice to get the procedure, then go back on.


Next, we talk about how an IR can start to incorporate these ideals and practices into their daily work. Dr. Tutton emphasizes that you don’t need to do the fellowship. You can start rounding with palliative care, go to their conferences, and establish relationships. Having residents and fellows rotate with palliative care is a great way for future IRs to learn how to practice with a palliative care mindset, and also to educate palliative care on the minimally invasive options that IR can offer to patients such as nerve blocks and ablations. By adopting palliative care ideals as an interventionalist, you can help your patients achieve better pain control, improve their cognition and reduce narcotics use.


Dr. Tutton recommends all IRs understand the medical management of post-op pain for any procedure they perform. He provides a standard medication regimen for a patient having an ablation. He uses Tylenol 1g pre-op and gabapentin 300-600mg 48-72hrs before the procedure and intraoperative steroids and NSAIDs such as Decadron 8-10mg and Toradol 10-30mg. All of these have level 1 data, help reduce narcotic requirements, and help with post-op nausea and pain. He discharges patients on a Medrol dose pack, ibuprofen, Tylenol, and gabapentin for a couple of days. Doing a nerve block can help as well, he frequently does ankle, digital, intercostal, and hypogastric blocks for his MSK and palliative interventions.


---


RESOURCES


Ep.199: Advanced Minimally Invasive Pain Interventions with Dr. Prologo

https://www.backtable.com/shows/vi/podcasts/199/advanced-minimally-invasive-pain-interventions


Ep. 68: RF Ablation for Bone Metastases with Dr. Levy and Dr. Bagla

https://www.backtable.com/shows/vi/podcasts/68/rf-ablation-therapy-for-bone-metastases

]]> 3093 Ep. 26 Building a GAE Practice in the OBL with Dr. David Wood Dr. David Wood, interventional radiologist and chief medical officer of Advantage IR, tells us about his experiences with geniculate artery embolization (GAE) practice building in the office-based lab (OBL). --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/oIF49Q --- SHOW NOTES In this episode, host Dr. Michael Barraza interviews Dr. David Wood, interventional radiologist and chief medical officer of Advantage IR, about building office based labs (OBLs), the untapped potential of the geniculate artery embolization (GAE) market, and how to build patient referrals for new OBLs. We begin by discussing why Dr. Wood chose to do geniculate artery embolization (GAE) in his OBLs. He says that GAE makes a great procedure for an office setting because it is relatively easy, only requiring a C arm with digital subtraction angiography (DSA). It is also a quick procedure with little side effects and low rates of complications. He says that patients who get GAE are a unique patient population because they know they have arthritis, and have exhausted conservative measures or declined treatment options that they have been offered, which are often quite invasive. Dr. Wood says his GAE patients are mostly self-referred. He has marketing liaisons for local clinics, but what he has found most effective is TV commercials in English and Spanish, because this reaches the populations that need the most help. His patient population for GAEs consists mostly of self referred patients, as well as referrals from PCPs and occasionally orthopedic or sports medicine providers. Regarding how Dr. Wood evaluates which patients to treat, he says that he began by using the point of maximal tenderness as described by Sandeep Bagla and required MRI before patient selection. He now uses primarily X-ray and only treats pain rated at least 5 out of 10. He does not do GAE in patients who have had knee surgery or with a history of significant PAD or calcification seen on preoperative X-ray. He generally tells patients they can expect up to a 70% improvement of pain after geniculate artery embolization. --- RESOURCES BackTable Ep. 27: Geniculate Artery Embolization for OA with Dr. Sandeep Bagla and Dr. Ari Isaacson https://www.backtable.com/shows/vi/podcasts/27/geniculate-artery-embolization-for-osteoarthritis BackTable Ep. 85: Genicular Artery Embolization for OA with Dr. Jafar Golzarian https://www.backtable.com/shows/vi/podcasts/85/genicular-artery-embolization-for-oa Bagla GAE Publication: https://pubmed.ncbi.nlm.nih.gov/31837946/ Padia GAE Publication: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8542160/ Wed, 09 Aug 2023 05:05:00 -0000 full BackTable Dr. David Wood, interventional radiologist and chief medical officer of Advantage IR, tells us about his experiences with geniculate artery embolization (GAE) practice building in the office-based lab (OBL). Dr. David Wood, interventional radiologist and chief medical officer of Advantage IR, tells us about his experiences with geniculate artery embolization (GAE) practice building in the office-based lab (OBL). --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/oIF49Q --- SHOW NOTES In this episode, host Dr. Michael Barraza interviews Dr. David Wood, interventional radiologist and chief medical officer of Advantage IR, about building office based labs (OBLs), the untapped potential of the geniculate artery embolization (GAE) market, and how to build patient referrals for new OBLs. We begin by discussing why Dr. Wood chose to do geniculate artery embolization (GAE) in his OBLs. He says that GAE makes a great procedure for an office setting because it is relatively easy, only requiring a C arm with digital subtraction angiography (DSA). It is also a quick procedure with little side effects and low rates of complications. He says that patients who get GAE are a unique patient population because they know they have arthritis, and have exhausted conservative measures or declined treatment options that they have been offered, which are often quite invasive. Dr. Wood says his GAE patients are mostly self-referred. He has marketing liaisons for local clinics, but what he has found most effective is TV commercials in English and Spanish, because this reaches the populations that need the most help. His patient population for GAEs consists mostly of self referred patients, as well as referrals from PCPs and occasionally orthopedic or sports medicine providers. Regarding how Dr. Wood evaluates which patients to treat, he says that he began by using the point of maximal tenderness as described by Sandeep Bagla and required MRI before patient selection. He now uses primarily X-ray and only treats pain rated at least 5 out of 10. He does not do GAE in patients who have had knee surgery or with a history of significant PAD or calcification seen on preoperative X-ray. He generally tells patients they can expect up to a 70% improvement of pain after geniculate artery embolization. --- RESOURCES BackTable Ep. 27: Geniculate Artery Embolization for OA with Dr. Sandeep Bagla and Dr. Ari Isaacson https://www.backtable.com/shows/vi/podcasts/27/geniculate-artery-embolization-for-osteoarthritis BackTable Ep. 85: Genicular Artery Embolization for OA with Dr. Jafar Golzarian https://www.backtable.com/shows/vi/podcasts/85/genicular-artery-embolization-for-oa Bagla GAE Publication: https://pubmed.ncbi.nlm.nih.gov/31837946/ Padia GAE Publication: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8542160/ Dr. David Wood, interventional radiologist and chief medical officer of Advantage IR, tells us about his experiences with geniculate artery embolization (GAE) practice building in the office-based lab (OBL).


---


EARN CME


Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/oIF49Q


---


SHOW NOTES


In this episode, host Dr. Michael Barraza interviews Dr. David Wood, interventional radiologist and chief medical officer of Advantage IR, about building office based labs (OBLs), the untapped potential of the geniculate artery embolization (GAE) market, and how to build patient referrals for new OBLs.


We begin by discussing why Dr. Wood chose to do geniculate artery embolization (GAE) in his OBLs. He says that GAE makes a great procedure for an office setting because it is relatively easy, only requiring a C arm with digital subtraction angiography (DSA). It is also a quick procedure with little side effects and low rates of complications. He says that patients who get GAE are a unique patient population because they know they have arthritis, and have exhausted conservative measures or declined treatment options that they have been offered, which are often quite invasive.


Dr. Wood says his GAE patients are mostly self-referred. He has marketing liaisons for local clinics, but what he has found most effective is TV commercials in English and Spanish, because this reaches the populations that need the most help. His patient population for GAEs consists mostly of self referred patients, as well as referrals from PCPs and occasionally orthopedic or sports medicine providers.


Regarding how Dr. Wood evaluates which patients to treat, he says that he began by using the point of maximal tenderness as described by Sandeep Bagla and required MRI before patient selection. He now uses primarily X-ray and only treats pain rated at least 5 out of 10. He does not do GAE in patients who have had knee surgery or with a history of significant PAD or calcification seen on preoperative X-ray. He generally tells patients they can expect up to a 70% improvement of pain after geniculate artery embolization.


---


RESOURCES


BackTable Ep. 27: Geniculate Artery Embolization for OA with Dr. Sandeep Bagla and Dr. Ari Isaacson

https://www.backtable.com/shows/vi/podcasts/27/geniculate-artery-embolization-for-osteoarthritis


BackTable Ep. 85: Genicular Artery Embolization for OA with Dr. Jafar Golzarian

https://www.backtable.com/shows/vi/podcasts/85/genicular-artery-embolization-for-oa


Bagla GAE Publication:

https://pubmed.ncbi.nlm.nih.gov/31837946/


Padia GAE Publication:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8542160/

]]> 3937 Ep. 25 Advanced Minimally Invasive Pain Interventions with Dr. David Prologo We talk with interventional radiologist Dr. David Prologo about minimally invasive pain interventions, multidisciplinary pain management, and how he built a successful pain practice. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/GzA4Iu --- SHOW NOTES In this episode, host Dr. Michael Barraza interviews Dr. David Prologo, director of interventional radiology at Emory about minimally invasive pain interventions, multidisciplinary pain management, and how he created a booming practice that is well known by patients and providers nationally. Dr. Prologo begins by discussing his training in obesity medicine and how his interests in pain management developed. He discusses his book, The Catching Point, which explores weight loss culture and the fault of society and medical providers in placing the blame on patients and the new options available in IR for weight loss. He says his interest in pain management was similar to his interest in obesity medicine. He was curious about how he could use his tools and skills as an IR to treat obesity and pain with minimally invasive procedures. Next, they discuss how IR fits into the multidisciplinary team that plays a role in pain management. He explains that the combination of technology and an IRs position in the hospital makes them ideal for the job. He says a key is to maintain relationships with all other specialties by focusing initially on procedures that other specialties don't perform, in order to build rapport. He also notes that the procedures he performs result in rapid pain reduction and greatly decrease length of stay which is a huge incentive for hospitals and other specialties to seek out IR and make referrals. Finally, the two discuss the types of patients Dr. Prologo treats, and the procedures he does. He divides patient population into neoplastic versus non neoplastic pain, and spine versus non spine pain. He sees 90% of patients in clinic for procedure planning. Dr. Prologo emphasizes the importance of advocating for patients and continuing to see them even if they do not need an IR procedure. He discusses his 8, 3, 3, 3 method for percutaneous cryoneurolysis and discusses the various outcomes he is able to achieve in pain reduction. Dr. Prologo minimizes non responders by doing test blocks, understanding central desensitization, and selecting patients for procedures appropriately. --- RESOURCES Interventional Cryoneurolysis: An Illustrative Approach: https://pubmed.ncbi.nlm.nih.gov/33308581/ Focused Cryo: https://gra.org/company/213/Focused_Cryo.html Nantes criteria for pudendal neuralgia: https://pubmed.ncbi.nlm.nih.gov/17828787/ The Catching Point https://www.catchingpoint.com David Prologo Website: https://www.drprologo.com/about Wed, 02 Aug 2023 05:05:00 -0000 full BackTable We talk with interventional radiologist Dr. David Prologo about minimally invasive pain interventions, multidisciplinary pain management, and how he built a successful pain practice. We talk with interventional radiologist Dr. David Prologo about minimally invasive pain interventions, multidisciplinary pain management, and how he built a successful pain practice. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/GzA4Iu --- SHOW NOTES In this episode, host Dr. Michael Barraza interviews Dr. David Prologo, director of interventional radiology at Emory about minimally invasive pain interventions, multidisciplinary pain management, and how he created a booming practice that is well known by patients and providers nationally. Dr. Prologo begins by discussing his training in obesity medicine and how his interests in pain management developed. He discusses his book, The Catching Point, which explores weight loss culture and the fault of society and medical providers in placing the blame on patients and the new options available in IR for weight loss. He says his interest in pain management was similar to his interest in obesity medicine. He was curious about how he could use his tools and skills as an IR to treat obesity and pain with minimally invasive procedures. Next, they discuss how IR fits into the multidisciplinary team that plays a role in pain management. He explains that the combination of technology and an IRs position in the hospital makes them ideal for the job. He says a key is to maintain relationships with all other specialties by focusing initially on procedures that other specialties don't perform, in order to build rapport. He also notes that the procedures he performs result in rapid pain reduction and greatly decrease length of stay which is a huge incentive for hospitals and other specialties to seek out IR and make referrals. Finally, the two discuss the types of patients Dr. Prologo treats, and the procedures he does. He divides patient population into neoplastic versus non neoplastic pain, and spine versus non spine pain. He sees 90% of patients in clinic for procedure planning. Dr. Prologo emphasizes the importance of advocating for patients and continuing to see them even if they do not need an IR procedure. He discusses his 8, 3, 3, 3 method for percutaneous cryoneurolysis and discusses the various outcomes he is able to achieve in pain reduction. Dr. Prologo minimizes non responders by doing test blocks, understanding central desensitization, and selecting patients for procedures appropriately. --- RESOURCES Interventional Cryoneurolysis: An Illustrative Approach: https://pubmed.ncbi.nlm.nih.gov/33308581/ Focused Cryo: https://gra.org/company/213/Focused_Cryo.html Nantes criteria for pudendal neuralgia: https://pubmed.ncbi.nlm.nih.gov/17828787/ The Catching Point https://www.catchingpoint.com David Prologo Website: https://www.drprologo.com/about We talk with interventional radiologist Dr. David Prologo about minimally invasive pain interventions, multidisciplinary pain management, and how he built a successful pain practice.


---


CHECK OUT OUR SPONSOR


RADPAD® Radiation Protection

https://www.radpad.com/


---


EARN CME


Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/GzA4Iu


---


SHOW NOTES


In this episode, host Dr. Michael Barraza interviews Dr. David Prologo, director of interventional radiology at Emory about minimally invasive pain interventions, multidisciplinary pain management, and how he created a booming practice that is well known by patients and providers nationally.


Dr. Prologo begins by discussing his training in obesity medicine and how his interests in pain management developed. He discusses his book, The Catching Point, which explores weight loss culture and the fault of society and medical providers in placing the blame on patients and the new options available in IR for weight loss. He says his interest in pain management was similar to his interest in obesity medicine. He was curious about how he could use his tools and skills as an IR to treat obesity and pain with minimally invasive procedures.


Next, they discuss how IR fits into the multidisciplinary team that plays a role in pain management. He explains that the combination of technology and an IRs position in the hospital makes them ideal for the job. He says a key is to maintain relationships with all other specialties by focusing initially on procedures that other specialties don't perform, in order to build rapport. He also notes that the procedures he performs result in rapid pain reduction and greatly decrease length of stay which is a huge incentive for hospitals and other specialties to seek out IR and make referrals.


Finally, the two discuss the types of patients Dr. Prologo treats, and the procedures he does. He divides patient population into neoplastic versus non neoplastic pain, and spine versus non spine pain. He sees 90% of patients in clinic for procedure planning. Dr. Prologo emphasizes the importance of advocating for patients and continuing to see them even if they do not need an IR procedure. He discusses his 8, 3, 3, 3 method for percutaneous cryoneurolysis and discusses the various outcomes he is able to achieve in pain reduction. Dr. Prologo minimizes non responders by doing test blocks, understanding central desensitization, and selecting patients for procedures appropriately.


---


RESOURCES


Interventional Cryoneurolysis: An Illustrative Approach: https://pubmed.ncbi.nlm.nih.gov/33308581/


Focused Cryo:

https://gra.org/company/213/Focused_Cryo.html


Nantes criteria for pudendal neuralgia:

https://pubmed.ncbi.nlm.nih.gov/17828787/


The Catching Point

https://www.catchingpoint.com


David Prologo Website:

https://www.drprologo.com/about

]]> 4185 Ep. 24 Unipedicular vs. Bipedicular Approach for Kyphoplasty with Dr. Thomas Andreshak Interventional radiologist Michael Barraza talks with orthopedic spine surgeon Thomas Andreshak about his approach to vertebral augmentation for compression fractures, including unipedicular vs. bipedicular approach, technique pearls, and post-procedure care. --- CHECK OUT OUR SPONSOR Medtronic Kyphon https://www.medtronic.com/kyphoplasty --- SHOW NOTES In this episode, orthopedic surgeon Dr.Thomas Andreshak and our host Dr. Michael Barraza discuss kyphoplasty technique, including different methods of imaging, approaches, sedation, and follow-up. Dr. Andreshak starts with obtaining a standing X-ray because it allows him to better observe cases of spondylolisthesis. He describes both unipedicular and bipedicular approaches, noting that the unipedicular approach can allow for greater cost savings, less cement used, and lower radiation exposure. The doctors also review the stages of bone healing: hematoma formation, fibrocartilage formation, bony callus formation, and bone remodeling. Dr. Andreshak warns against overfilling the vertebra, which creates stiffness and puts stress on the adjacent endplate. Finally, they discuss follow-up and considerations for future treatment if pain persists. --- RESOURCES Consulting Orthopedic Associates: https://consulting-ortho.com/ Kyphon Assist: https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/vertebral-augmentation/kyphon-assist.html Wed, 26 Jul 2023 05:05:00 -0000 full BackTable Interventional radiologist Michael Barraza talks with orthopedic spine surgeon Thomas Andreshak about his approach to vertebral augmentation for compression fractures, including unipedicular vs. bipedicular approach, technique pearls, and post-procedure care. Interventional radiologist Michael Barraza talks with orthopedic spine surgeon Thomas Andreshak about his approach to vertebral augmentation for compression fractures, including unipedicular vs. bipedicular approach, technique pearls, and post-procedure care. --- CHECK OUT OUR SPONSOR Medtronic Kyphon https://www.medtronic.com/kyphoplasty --- SHOW NOTES In this episode, orthopedic surgeon Dr.Thomas Andreshak and our host Dr. Michael Barraza discuss kyphoplasty technique, including different methods of imaging, approaches, sedation, and follow-up. Dr. Andreshak starts with obtaining a standing X-ray because it allows him to better observe cases of spondylolisthesis. He describes both unipedicular and bipedicular approaches, noting that the unipedicular approach can allow for greater cost savings, less cement used, and lower radiation exposure. The doctors also review the stages of bone healing: hematoma formation, fibrocartilage formation, bony callus formation, and bone remodeling. Dr. Andreshak warns against overfilling the vertebra, which creates stiffness and puts stress on the adjacent endplate. Finally, they discuss follow-up and considerations for future treatment if pain persists. --- RESOURCES Consulting Orthopedic Associates: https://consulting-ortho.com/ Kyphon Assist: https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/vertebral-augmentation/kyphon-assist.html Interventional radiologist Michael Barraza talks with orthopedic spine surgeon Thomas Andreshak about his approach to vertebral augmentation for compression fractures, including unipedicular vs. bipedicular approach, technique pearls, and post-procedure care.


---


CHECK OUT OUR SPONSOR


Medtronic Kyphon

https://www.medtronic.com/kyphoplasty


---


SHOW NOTES


In this episode, orthopedic surgeon Dr.Thomas Andreshak and our host Dr. Michael Barraza discuss kyphoplasty technique, including different methods of imaging, approaches, sedation, and follow-up.


Dr. Andreshak starts with obtaining a standing X-ray because it allows him to better observe cases of spondylolisthesis. He describes both unipedicular and bipedicular approaches, noting that the unipedicular approach can allow for greater cost savings, less cement used, and lower radiation exposure.


The doctors also review the stages of bone healing: hematoma formation, fibrocartilage formation, bony callus formation, and bone remodeling. Dr. Andreshak warns against overfilling the vertebra, which creates stiffness and puts stress on the adjacent endplate. Finally, they discuss follow-up and considerations for future treatment if pain persists.


---


RESOURCES


Consulting Orthopedic Associates:

https://consulting-ortho.com/


Kyphon Assist:

https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/vertebral-augmentation/kyphon-assist.html

]]> 1608 Ep. 23 RF Ablation for Painful Spinal Metastases with Dr. Nam Tran Neurosurgeon Dr. Nam Tran from Moffitt Cancer Center talks with us about RF ablation for painful spinal metastases, including patient selection and the importance of a multidisciplinary approach. --- CHECK OUT OUR SPONSOR Medtronic OsteoCool https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/tumor-management/osteocool-ablation-system-rf.html --- SHOW NOTES In this episode, neurosurgeon Dr. Nam Tran and our host Dr. Michael Barraza discuss minimally invasive procedures to treat both primary spine tumors and spine metastases. Dr. Tran describes the flexibility that kyphoplasty and spinal ablation can grant patients who are not suitable candidates for open surgical decompression. These minimally invasive procedures can reduce hospital stays from 4-5 days to just one night. Dr. Tran views ablation not only from a palliative pain reduction perspective, but also from an oncologic perspective that aims to reduce tumor burden. Dr. Tran says the ideal candidate for ablation is a patient who has isolated disease to the anterior column of the spine. With larger lesions, Dr. Tran relies on his neurosurgical background to take an aggressive approach in treating the entire vertebra. The doctors also discuss research studies that have made ablation more widely accepted and available (all articles are linked below). --- RESOURCES OPuS One Study: https://pubmed.ncbi.nlm.nih.gov/33129427/ CAFE Study: https://www.clinicaltrials.gov/ct2/show/study/NCT00211237 Sat, 22 Jul 2023 05:05:00 -0000 full BackTable Neurosurgeon Dr. Nam Tran from Moffitt Cancer Center talks with us about RF ablation for painful spinal metastases, including patient selection and the importance of a multidisciplinary approach. Neurosurgeon Dr. Nam Tran from Moffitt Cancer Center talks with us about RF ablation for painful spinal metastases, including patient selection and the importance of a multidisciplinary approach. --- CHECK OUT OUR SPONSOR Medtronic OsteoCool https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/tumor-management/osteocool-ablation-system-rf.html --- SHOW NOTES In this episode, neurosurgeon Dr. Nam Tran and our host Dr. Michael Barraza discuss minimally invasive procedures to treat both primary spine tumors and spine metastases. Dr. Tran describes the flexibility that kyphoplasty and spinal ablation can grant patients who are not suitable candidates for open surgical decompression. These minimally invasive procedures can reduce hospital stays from 4-5 days to just one night. Dr. Tran views ablation not only from a palliative pain reduction perspective, but also from an oncologic perspective that aims to reduce tumor burden. Dr. Tran says the ideal candidate for ablation is a patient who has isolated disease to the anterior column of the spine. With larger lesions, Dr. Tran relies on his neurosurgical background to take an aggressive approach in treating the entire vertebra. The doctors also discuss research studies that have made ablation more widely accepted and available (all articles are linked below). --- RESOURCES OPuS One Study: https://pubmed.ncbi.nlm.nih.gov/33129427/ CAFE Study: https://www.clinicaltrials.gov/ct2/show/study/NCT00211237 Neurosurgeon Dr. Nam Tran from Moffitt Cancer Center talks with us about RF ablation for painful spinal metastases, including patient selection and the importance of a multidisciplinary approach.


---


CHECK OUT OUR SPONSOR


Medtronic OsteoCool

https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/tumor-management/osteocool-ablation-system-rf.html


---


SHOW NOTES


In this episode, neurosurgeon Dr. Nam Tran and our host Dr. Michael Barraza discuss minimally invasive procedures to treat both primary spine tumors and spine metastases.


Dr. Tran describes the flexibility that kyphoplasty and spinal ablation can grant patients who are not suitable candidates for open surgical decompression. These minimally invasive procedures can reduce hospital stays from 4-5 days to just one night.


Dr. Tran views ablation not only from a palliative pain reduction perspective, but also from an oncologic perspective that aims to reduce tumor burden. Dr. Tran says the ideal candidate for ablation is a patient who has isolated disease to the anterior column of the spine. With larger lesions, Dr. Tran relies on his neurosurgical background to take an aggressive approach in treating the entire vertebra.


The doctors also discuss research studies that have made ablation more widely accepted and available (all articles are linked below).


---


RESOURCES


OPuS One Study: https://pubmed.ncbi.nlm.nih.gov/33129427/


CAFE Study: https://www.clinicaltrials.gov/ct2/show/study/NCT00211237

]]> 1181 Ep. 22 Genicular Nerve Ablation with Dr. John Smirniotopoulos In this episode, host Dr. Michael Barazza interviews Dr. John Smirniotopoulos about genicular nerve ablation, an innovative treatment option for the management of osteoarthritis. --- SHOW NOTES Dr. John Smirniotopoulos is an assistant professor of clinical radiology in the IR department at MedStar Georgetown University and MedStar Washington Hospital Center in DC. He developed the idea of genicular nerve ablation after consulting with his orthopedic colleagues at Georgetown about various pain interventions. He then formulated a treatment algorithm that begins with a conservative approach, using a nerve block for ablation. If the initial response is limited, a second ablation can be performed within six months. However, if the patient experiences only a short-term response, genicular artery embolization may be considered. Genicular nerve ablation proves to be a valuable therapy for patients who are not yet ready for knee replacements or need to postpone the procedure due to factors like high BMI or recent organ transplant. The therapy uses fluoroscopy or ultrasound to target four trunks of nerves, including the superomedial genicular, superolateral, inferomedial, and the suprapatellar nerves. The procedure is done under conscious sedation, and Dr. Smirniotopoulos aims for 50% pain reduction with his patients which is usually reached at six weeks. Dr. Smirniotopoulos and his team recently conducted a study to evaluate the outcomes of genicular nerve ablation. The results indicated a significant reduction in both the WOMAC score, which measures pain and functionality, and the Visual Analogue Scale (VAS) score, which is a subjective measure of pain. Surprisingly, they discovered that age over 50 was the biggest predictor of positive outcomes, contrary to their initial expectation that BMI would play a more significant role. They attribute this finding to a higher prevalence of advanced OA in the older age group. Additionally, patients under 50 may have more sports-related injuries such as meniscal tears, leading them to return to high-intensity activities sooner than older patients. Dr. Smirniotopoulos has also seen success in performing nerve ablation in the hip, shoulder, SI, and intervertebral joints. This wide application of the procedure makes it a valuable and versatile treatment option for patients. --- RESOURCES Genicular Nerve Radiofrequency Ablation: Is There a Predictor of Outcomes?: https://www.jvir.org/article/S1051-0443(22)01597-4/fulltext Wed, 19 Jul 2023 05:05:00 -0000 full BackTable In this episode, host Dr. Michael Barazza interviews Dr. John Smirniotopoulos about genicular nerve ablation, an innovative treatment option for the management of osteoarthritis. In this episode, host Dr. Michael Barazza interviews Dr. John Smirniotopoulos about genicular nerve ablation, an innovative treatment option for the management of osteoarthritis. --- SHOW NOTES Dr. John Smirniotopoulos is an assistant professor of clinical radiology in the IR department at MedStar Georgetown University and MedStar Washington Hospital Center in DC. He developed the idea of genicular nerve ablation after consulting with his orthopedic colleagues at Georgetown about various pain interventions. He then formulated a treatment algorithm that begins with a conservative approach, using a nerve block for ablation. If the initial response is limited, a second ablation can be performed within six months. However, if the patient experiences only a short-term response, genicular artery embolization may be considered. Genicular nerve ablation proves to be a valuable therapy for patients who are not yet ready for knee replacements or need to postpone the procedure due to factors like high BMI or recent organ transplant. The therapy uses fluoroscopy or ultrasound to target four trunks of nerves, including the superomedial genicular, superolateral, inferomedial, and the suprapatellar nerves. The procedure is done under conscious sedation, and Dr. Smirniotopoulos aims for 50% pain reduction with his patients which is usually reached at six weeks. Dr. Smirniotopoulos and his team recently conducted a study to evaluate the outcomes of genicular nerve ablation. The results indicated a significant reduction in both the WOMAC score, which measures pain and functionality, and the Visual Analogue Scale (VAS) score, which is a subjective measure of pain. Surprisingly, they discovered that age over 50 was the biggest predictor of positive outcomes, contrary to their initial expectation that BMI would play a more significant role. They attribute this finding to a higher prevalence of advanced OA in the older age group. Additionally, patients under 50 may have more sports-related injuries such as meniscal tears, leading them to return to high-intensity activities sooner than older patients. Dr. Smirniotopoulos has also seen success in performing nerve ablation in the hip, shoulder, SI, and intervertebral joints. This wide application of the procedure makes it a valuable and versatile treatment option for patients. --- RESOURCES Genicular Nerve Radiofrequency Ablation: Is There a Predictor of Outcomes?: https://www.jvir.org/article/S1051-0443(22)01597-4/fulltext In this episode, host Dr. Michael Barazza interviews Dr. John Smirniotopoulos about genicular nerve ablation, an innovative treatment option for the management of osteoarthritis.


---


SHOW NOTES


Dr. John Smirniotopoulos is an assistant professor of clinical radiology in the IR department at MedStar Georgetown University and MedStar Washington Hospital Center in DC. He developed the idea of genicular nerve ablation after consulting with his orthopedic colleagues at Georgetown about various pain interventions. He then formulated a treatment algorithm that begins with a conservative approach, using a nerve block for ablation. If the initial response is limited, a second ablation can be performed within six months. However, if the patient experiences only a short-term response, genicular artery embolization may be considered.


Genicular nerve ablation proves to be a valuable therapy for patients who are not yet ready for knee replacements or need to postpone the procedure due to factors like high BMI or recent organ transplant. The therapy uses fluoroscopy or ultrasound to target four trunks of nerves, including the superomedial genicular, superolateral, inferomedial, and the suprapatellar nerves. The procedure is done under conscious sedation, and Dr. Smirniotopoulos aims for 50% pain reduction with his patients which is usually reached at six weeks.


Dr. Smirniotopoulos and his team recently conducted a study to evaluate the outcomes of genicular nerve ablation. The results indicated a significant reduction in both the WOMAC score, which measures pain and functionality, and the Visual Analogue Scale (VAS) score, which is a subjective measure of pain. Surprisingly, they discovered that age over 50 was the biggest predictor of positive outcomes, contrary to their initial expectation that BMI would play a more significant role. They attribute this finding to a higher prevalence of advanced OA in the older age group. Additionally, patients under 50 may have more sports-related injuries such as meniscal tears, leading them to return to high-intensity activities sooner than older patients. Dr. Smirniotopoulos has also seen success in performing nerve ablation in the hip, shoulder, SI, and intervertebral joints. This wide application of the procedure makes it a valuable and versatile treatment option for patients.


---


RESOURCES


Genicular Nerve Radiofrequency Ablation: Is There a Predictor of Outcomes?:

https://www.jvir.org/article/S1051-0443(22)01597-4/fulltext

]]> 2990 Ep. 21 Novel Treatment of Unicameral & Aneurysmal Bone Cysts with Dr. Shankar Rajeswaran Dr. Sabeen Dhand chats with Interventional Radiologist Shankar Rajeswaran from Lurie Children's Hospital in Chicago about a novel minimally invasive treatment of unicameral and aneurysmal bone cysts. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/PzYQjW --- SHOW NOTES In this episode, pediatric interventional radiologist Dr. Shankar Rajeswaran joins host Dr. Sabeen Dhand to discuss a novel minimally-invasive treatment for unicameral and aneurysmal bone cysts. Pediatric interventional radiology is a rapidly growing field, and Dr. Rajeswaran describes how it has evolved in complexity and innovation over the course of his career. Dr. Rajeswaran says that there is a significant challenge that pediatric IRs must overcome-- treating children with IR devices that were originally designed to be used in adults. As a result, he emphasizes the need for creativity and flexibility in this field. Next, we define and differentiate between unicameral and aneurysmal bone cysts. Both can be benign; however, they carry the risk of causing pain, bone fracture, and growth deformities. Dr. Rajeswaran outlines the current standard of care, which includes monitoring and curettage and bone grafting. Then, he describes a new method of treatment, which involves needle injection of doxycycline to burn the walls of the cyst and bone paste to help generate new bone. This method can be applied to unicameral bone cysts and aneurysmal bone cysts, and it leaves no scarring. He also discusses the recurrence rate for various treatment methods. Overall, Dr. Rajeswaran encourages anyone interested in pediatric IR to reach out to doctors in the field for shadowing opportunities and guidance. --- RESOURCES Society for Pediatric Interventional Radiology: https://www.spir.org/ Lurie Children’s Hospital blog article over novel treatment of bone cysts: https://www.luriechildrens.org/en/blog/interventional-radiology-cutting-edge-procedure-puts-brooklyn-back-in-the-game/ Sat, 15 Jul 2023 05:05:00 -0000 full BackTable Dr. Sabeen Dhand chats with Interventional Radiologist Shankar Rajeswaran from Lurie Children's Hospital in Chicago about a novel minimally invasive treatment of unicameral and aneurysmal bone cysts. Dr. Sabeen Dhand chats with Interventional Radiologist Shankar Rajeswaran from Lurie Children's Hospital in Chicago about a novel minimally invasive treatment of unicameral and aneurysmal bone cysts. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/PzYQjW --- SHOW NOTES In this episode, pediatric interventional radiologist Dr. Shankar Rajeswaran joins host Dr. Sabeen Dhand to discuss a novel minimally-invasive treatment for unicameral and aneurysmal bone cysts. Pediatric interventional radiology is a rapidly growing field, and Dr. Rajeswaran describes how it has evolved in complexity and innovation over the course of his career. Dr. Rajeswaran says that there is a significant challenge that pediatric IRs must overcome-- treating children with IR devices that were originally designed to be used in adults. As a result, he emphasizes the need for creativity and flexibility in this field. Next, we define and differentiate between unicameral and aneurysmal bone cysts. Both can be benign; however, they carry the risk of causing pain, bone fracture, and growth deformities. Dr. Rajeswaran outlines the current standard of care, which includes monitoring and curettage and bone grafting. Then, he describes a new method of treatment, which involves needle injection of doxycycline to burn the walls of the cyst and bone paste to help generate new bone. This method can be applied to unicameral bone cysts and aneurysmal bone cysts, and it leaves no scarring. He also discusses the recurrence rate for various treatment methods. Overall, Dr. Rajeswaran encourages anyone interested in pediatric IR to reach out to doctors in the field for shadowing opportunities and guidance. --- RESOURCES Society for Pediatric Interventional Radiology: https://www.spir.org/ Lurie Children’s Hospital blog article over novel treatment of bone cysts: https://www.luriechildrens.org/en/blog/interventional-radiology-cutting-edge-procedure-puts-brooklyn-back-in-the-game/ Dr. Sabeen Dhand chats with Interventional Radiologist Shankar Rajeswaran from Lurie Children's Hospital in Chicago about a novel minimally invasive treatment of unicameral and aneurysmal bone cysts.


---


EARN CME


Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/PzYQjW


---


SHOW NOTES


In this episode, pediatric interventional radiologist Dr. Shankar Rajeswaran joins host Dr. Sabeen Dhand to discuss a novel minimally-invasive treatment for unicameral and aneurysmal bone cysts.


Pediatric interventional radiology is a rapidly growing field, and Dr. Rajeswaran describes how it has evolved in complexity and innovation over the course of his career. Dr. Rajeswaran says that there is a significant challenge that pediatric IRs must overcome-- treating children with IR devices that were originally designed to be used in adults. As a result, he emphasizes the need for creativity and flexibility in this field.


Next, we define and differentiate between unicameral and aneurysmal bone cysts. Both can be benign; however, they carry the risk of causing pain, bone fracture, and growth deformities. Dr. Rajeswaran outlines the current standard of care, which includes monitoring and curettage and bone grafting. Then, he describes a new method of treatment, which involves needle injection of doxycycline to burn the walls of the cyst and bone paste to help generate new bone. This method can be applied to unicameral bone cysts and aneurysmal bone cysts, and it leaves no scarring. He also discusses the recurrence rate for various treatment methods.


Overall, Dr. Rajeswaran encourages anyone interested in pediatric IR to reach out to doctors in the field for shadowing opportunities and guidance.


---


RESOURCES


Society for Pediatric Interventional Radiology:

https://www.spir.org/


Lurie Children’s Hospital blog article over novel treatment of bone cysts:

https://www.luriechildrens.org/en/blog/interventional-radiology-cutting-edge-procedure-puts-brooklyn-back-in-the-game/

]]> 1961 Ep. 20 Microwave Ablation: A Powerful but Underused Modality for Treatment of Spine Tumors with Dr. Majid Khan In this episode, Dr. Jacob Fleming interviews Dr. Majid Khan, a spine interventionalist and expert in neuroimaging, about microwave ablation, a new treatment modality that has garnered significant attention. --- CHECK OUT OUR SPONSOR Boston Scientific Lab Agent https://www.bostonscientific.com/en-US/customer-service/ordering/lab-agent/contact.html?utm_source=oth_site&utm_medium=native&utm_campaign=pi-at-us-labagent-hci&utm_content=n-backtable-n-backtable_site_labagent_1_2023&cid=n10013205 --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/1YOW1H --- SHOW NOTES Dr. Khan completed his radiology residency in New York and his fellowship in neuroradiology at John Hopkins. As he progressed in the field, he observed a significant shift in spinal care towards interventional methods and began to study these techniques, which included radiofrequency ablation (RFA) and cryoablation for treating spinal tumors. However, when he treated cases of prostate cancer spine metastases, he realized that RFA was challenging, due to the high bone impedance of osteoblastic lesions. This obstacle piqued his interest in microwave ablation, an alternative technique that employs an electromagnetic wave to induce rapid oscillation of hydrogen atoms in water molecules. This oscillation generates frictional heat, leading to coagulative tumor necrosis. Unlike RFA, microwave ablation significantly reduces bone impedance, making it a promising solution for these cases. Dr. Khan cautions that special care must be taken when operating in areas near nerves due to the elevated temperatures. To ensure safety, he recommends the use of a probe within the frequency range of 900 MHz to 1.2 GHz and the incorporation of thermocouplers as a safeguard during the ablation process. Furthermore, Dr. Khan delves into the indications for ablation based on the extent of tumor metastasis. In cases of oligometastatic disease, he advises a more aggressive treatment approach by extending the ablation zone beyond the actual tumor size. On the other hand, when dealing with diffusely metastatic disease, the primary goal of treatment shifts towards pain reduction. The two conclude their discussion with Dr. Khan’s advice for physicians planning to utilize microwave ablation. He advises them to approach their initial 5-10 cases judiciously, in an effort to minimize the risk of complications that may adversely impact their self-confidence. Having adequate self confidence enhances the likelihood of achieving successful outcomes. For those looking for a valuable resource in the field, Dr. Khan has recently published a comprehensive textbook that features contributions from experts in the field. --- RESOURCES “Assessing long-term locoregional control of spinal osseous metastases after microwave ablation”: https://pubmed.ncbi.nlm.nih.gov/35963064/ Vertebral Augmentation: https://shop.thieme.com/Vertebral-Augmentation/9781684200153 Image Guided Interventions of the Spine https://link.springer.com/book/10.1007/978-3-030-80079-6 Wed, 12 Jul 2023 05:05:00 -0000 full BackTable In this episode, Dr. Jacob Fleming interviews Dr. Majid Khan, a spine interventionalist and expert in neuroimaging, about microwave ablation, a new treatment modality that has garnered significant attention. In this episode, Dr. Jacob Fleming interviews Dr. Majid Khan, a spine interventionalist and expert in neuroimaging, about microwave ablation, a new treatment modality that has garnered significant attention. --- CHECK OUT OUR SPONSOR Boston Scientific Lab Agent https://www.bostonscientific.com/en-US/customer-service/ordering/lab-agent/contact.html?utm_source=oth_site&utm_medium=native&utm_campaign=pi-at-us-labagent-hci&utm_content=n-backtable-n-backtable_site_labagent_1_2023&cid=n10013205 --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/1YOW1H --- SHOW NOTES Dr. Khan completed his radiology residency in New York and his fellowship in neuroradiology at John Hopkins. As he progressed in the field, he observed a significant shift in spinal care towards interventional methods and began to study these techniques, which included radiofrequency ablation (RFA) and cryoablation for treating spinal tumors. However, when he treated cases of prostate cancer spine metastases, he realized that RFA was challenging, due to the high bone impedance of osteoblastic lesions. This obstacle piqued his interest in microwave ablation, an alternative technique that employs an electromagnetic wave to induce rapid oscillation of hydrogen atoms in water molecules. This oscillation generates frictional heat, leading to coagulative tumor necrosis. Unlike RFA, microwave ablation significantly reduces bone impedance, making it a promising solution for these cases. Dr. Khan cautions that special care must be taken when operating in areas near nerves due to the elevated temperatures. To ensure safety, he recommends the use of a probe within the frequency range of 900 MHz to 1.2 GHz and the incorporation of thermocouplers as a safeguard during the ablation process. Furthermore, Dr. Khan delves into the indications for ablation based on the extent of tumor metastasis. In cases of oligometastatic disease, he advises a more aggressive treatment approach by extending the ablation zone beyond the actual tumor size. On the other hand, when dealing with diffusely metastatic disease, the primary goal of treatment shifts towards pain reduction. The two conclude their discussion with Dr. Khan’s advice for physicians planning to utilize microwave ablation. He advises them to approach their initial 5-10 cases judiciously, in an effort to minimize the risk of complications that may adversely impact their self-confidence. Having adequate self confidence enhances the likelihood of achieving successful outcomes. For those looking for a valuable resource in the field, Dr. Khan has recently published a comprehensive textbook that features contributions from experts in the field. --- RESOURCES “Assessing long-term locoregional control of spinal osseous metastases after microwave ablation”: https://pubmed.ncbi.nlm.nih.gov/35963064/ Vertebral Augmentation: https://shop.thieme.com/Vertebral-Augmentation/9781684200153 Image Guided Interventions of the Spine https://link.springer.com/book/10.1007/978-3-030-80079-6 In this episode, Dr. Jacob Fleming interviews Dr. Majid Khan, a spine interventionalist and expert in neuroimaging, about microwave ablation, a new treatment modality that has garnered significant attention.


---


CHECK OUT OUR SPONSOR


Boston Scientific Lab Agent

https://www.bostonscientific.com/en-US/customer-service/ordering/lab-agent/contact.html?utm_source=oth_site&utm_medium=native&utm_campaign=pi-at-us-labagent-hci&utm_content=n-backtable-n-backtable_site_labagent_1_2023&cid=n10013205


---


EARN CME


Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/1YOW1H


---


SHOW NOTES


Dr. Khan completed his radiology residency in New York and his fellowship in neuroradiology at John Hopkins. As he progressed in the field, he observed a significant shift in spinal care towards interventional methods and began to study these techniques, which included radiofrequency ablation (RFA) and cryoablation for treating spinal tumors. However, when he treated cases of prostate cancer spine metastases, he realized that RFA was challenging, due to the high bone impedance of osteoblastic lesions. This obstacle piqued his interest in microwave ablation, an alternative technique that employs an electromagnetic wave to induce rapid oscillation of hydrogen atoms in water molecules. This oscillation generates frictional heat, leading to coagulative tumor necrosis. Unlike RFA, microwave ablation significantly reduces bone impedance, making it a promising solution for these cases.


Dr. Khan cautions that special care must be taken when operating in areas near nerves due to the elevated temperatures. To ensure safety, he recommends the use of a probe within the frequency range of 900 MHz to 1.2 GHz and the incorporation of thermocouplers as a safeguard during the ablation process. Furthermore, Dr. Khan delves into the indications for ablation based on the extent of tumor metastasis. In cases of oligometastatic disease, he advises a more aggressive treatment approach by extending the ablation zone beyond the actual tumor size. On the other hand, when dealing with diffusely metastatic disease, the primary goal of treatment shifts towards pain reduction.


The two conclude their discussion with Dr. Khan’s advice for physicians planning to utilize microwave ablation. He advises them to approach their initial 5-10 cases judiciously, in an effort to minimize the risk of complications that may adversely impact their self-confidence. Having adequate self confidence enhances the likelihood of achieving successful outcomes. For those looking for a valuable resource in the field, Dr. Khan has recently published a comprehensive textbook that features contributions from experts in the field.


---


RESOURCES


“Assessing long-term locoregional control of spinal osseous metastases after microwave ablation”:

https://pubmed.ncbi.nlm.nih.gov/35963064/


Vertebral Augmentation:

https://shop.thieme.com/Vertebral-Augmentation/9781684200153


Image Guided Interventions of the Spine

https://link.springer.com/book/10.1007/978-3-030-80079-6

]]> 4186 Ep. 19 Treating Extraspinal Painful Bony Metastases with Dr. Steven Yevich Dr. Steven Yevich from MD Anderson Cancer Center talks with us about his approach to Treatment and Management of Painful Extra-spinal Bony Metastases. --- CHECK OUT OUR SPONSOR Medtronic OsteoCool https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/tumor-management/osteocool-ablation-system-rf.html --- SHOW NOTES In this episode, Dr. Steve Yevich joins Dr. Michael Barraza to discuss treatment of extraspinal painful bony metastases. Dr. Yevich tells us about his training in interventional oncology at Gustave Roussy Cancer Campus in Paris, and we discuss how he adjusted to identify the individual needs of the hospital when he came back to the US. We explain how to go into a case with either curative or palliative intent. Dr. Yevich shares when he would do soft tissue ablation around nerves and the location of the metastases he commonly treats. We emphasize the anatomic considerations to determine if ablation for the extraspinal bony metastases is feasible. We discuss some of the advanced techniques Dr. Yevich learned in Paris and the two types of cases that may need pre-ablation embolization. We discuss advancements in technologies and devices that have allowed for more creative solutions in IR. Sat, 08 Jul 2023 05:05:00 -0000 full BackTable Dr. Steven Yevich from MD Anderson Cancer Center talks with us about his approach to Treatment and Management of Painful Extra-spinal Bony Metastases. Dr. Steven Yevich from MD Anderson Cancer Center talks with us about his approach to Treatment and Management of Painful Extra-spinal Bony Metastases. --- CHECK OUT OUR SPONSOR Medtronic OsteoCool https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/tumor-management/osteocool-ablation-system-rf.html --- SHOW NOTES In this episode, Dr. Steve Yevich joins Dr. Michael Barraza to discuss treatment of extraspinal painful bony metastases. Dr. Yevich tells us about his training in interventional oncology at Gustave Roussy Cancer Campus in Paris, and we discuss how he adjusted to identify the individual needs of the hospital when he came back to the US. We explain how to go into a case with either curative or palliative intent. Dr. Yevich shares when he would do soft tissue ablation around nerves and the location of the metastases he commonly treats. We emphasize the anatomic considerations to determine if ablation for the extraspinal bony metastases is feasible. We discuss some of the advanced techniques Dr. Yevich learned in Paris and the two types of cases that may need pre-ablation embolization. We discuss advancements in technologies and devices that have allowed for more creative solutions in IR. Dr. Steven Yevich from MD Anderson Cancer Center talks with us about his approach to Treatment and Management of Painful Extra-spinal Bony Metastases.


---


CHECK OUT OUR SPONSOR


Medtronic OsteoCool

https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/tumor-management/osteocool-ablation-system-rf.html


---


SHOW NOTES


In this episode, Dr. Steve Yevich joins Dr. Michael Barraza to discuss treatment of extraspinal painful bony metastases. Dr. Yevich tells us about his training in interventional oncology at Gustave Roussy Cancer Campus in Paris, and we discuss how he adjusted to identify the individual needs of the hospital when he came back to the US.


We explain how to go into a case with either curative or palliative intent. Dr. Yevich shares when he would do soft tissue ablation around nerves and the location of the metastases he commonly treats. We emphasize the anatomic considerations to determine if ablation for the extraspinal bony metastases is feasible.


We discuss some of the advanced techniques Dr. Yevich learned in Paris and the two types of cases that may need pre-ablation embolization. We discuss advancements in technologies and devices that have allowed for more creative solutions in IR.

]]> 1608 Ep. 18 Awake Spine Surgery with Dr. Alok Sharan In this episode, Dr. Jacob Fleming interviews Dr. Alok Sharan about low back awake spinal surgery. This innovative approach offers patients a more pleasant surgical experience compared to traditional surgery under general anesthesia. Not only does it provide better patient outcomes, but it also reduces the need for opioid pain medication and allows for improved mobility after the procedure. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/3kWFrM --- SHOW NOTES Dr. Sharan began his career in academic medicine at Montefiore, where he gained valuable experience in caring for individuals with severe back problems requiring spine surgery. During his time at Montefiore, Dr. Sharan recognized the changing landscape of healthcare and decided to pursue a healthcare MBA. This unique combination of medical expertise and business knowledge led him to transition to private practice. Dr. Sharan explains that awake spinal surgery offers several benefits for patients undergoing spine procedures. It enables patients to mobilize and recover from surgery more quickly, leading to faster overall recovery times and decreased risk of delirium. Additionally, patients have the opportunity to return home on the same day as the surgery, promoting a more convenient and comfortable experience. Awake spinal surgery also helps reduce the reliance on narcotics for pain management, with patients typically only needing narcotics for around four days compared to the usual four to six weeks with surgeries performed under general anesthesia. Due to the improvement in patient outcomes and the tremendous cost-efficiency of the procedure, awake spinal surgery is an appealing option for individuals requiring spinal fusions and other procedures. Dr. Sharan's entrepreneurial drive has led him to create a comprehensive preoperative education program. His patients are provided with virtual reality headsets to simulate and experience the day of surgery and the actual surgical procedure. The aim is to alleviate any fears or anxieties the patients may have prior to undergoing surgery by immersing them in a realistic virtual environment. This approach helps to prepare patients mentally and emotionally, ensuring a smoother and more comfortable surgical experience. Dr. Sharan is now sharing his techniques with surgeons around the world and anticipates this technique being implemented in many fields in the future. --- RESOURCES Awake Spinal Fusion: https://awakespinalfusion.com Doc Social: https://doc.social Dr. Sharan’s LinkedIn: https://www.linkedin.com/in/alok-sharan-6a612610/ Wed, 05 Jul 2023 05:05:00 -0000 full BackTable In this episode, Dr. Jacob Fleming interviews Dr. Alok Sharan about low back awake spinal surgery. This innovative approach offers patients a more pleasant surgical experience compared to traditional surgery under general anesthesia. Not only does it provide better patient outcomes, but it also reduces the need for opioid pain medication and allows for improved mobility after the procedure. In this episode, Dr. Jacob Fleming interviews Dr. Alok Sharan about low back awake spinal surgery. This innovative approach offers patients a more pleasant surgical experience compared to traditional surgery under general anesthesia. Not only does it provide better patient outcomes, but it also reduces the need for opioid pain medication and allows for improved mobility after the procedure. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/3kWFrM --- SHOW NOTES Dr. Sharan began his career in academic medicine at Montefiore, where he gained valuable experience in caring for individuals with severe back problems requiring spine surgery. During his time at Montefiore, Dr. Sharan recognized the changing landscape of healthcare and decided to pursue a healthcare MBA. This unique combination of medical expertise and business knowledge led him to transition to private practice. Dr. Sharan explains that awake spinal surgery offers several benefits for patients undergoing spine procedures. It enables patients to mobilize and recover from surgery more quickly, leading to faster overall recovery times and decreased risk of delirium. Additionally, patients have the opportunity to return home on the same day as the surgery, promoting a more convenient and comfortable experience. Awake spinal surgery also helps reduce the reliance on narcotics for pain management, with patients typically only needing narcotics for around four days compared to the usual four to six weeks with surgeries performed under general anesthesia. Due to the improvement in patient outcomes and the tremendous cost-efficiency of the procedure, awake spinal surgery is an appealing option for individuals requiring spinal fusions and other procedures. Dr. Sharan's entrepreneurial drive has led him to create a comprehensive preoperative education program. His patients are provided with virtual reality headsets to simulate and experience the day of surgery and the actual surgical procedure. The aim is to alleviate any fears or anxieties the patients may have prior to undergoing surgery by immersing them in a realistic virtual environment. This approach helps to prepare patients mentally and emotionally, ensuring a smoother and more comfortable surgical experience. Dr. Sharan is now sharing his techniques with surgeons around the world and anticipates this technique being implemented in many fields in the future. --- RESOURCES Awake Spinal Fusion: https://awakespinalfusion.com Doc Social: https://doc.social Dr. Sharan’s LinkedIn: https://www.linkedin.com/in/alok-sharan-6a612610/ In this episode, Dr. Jacob Fleming interviews Dr. Alok Sharan about low back awake spinal surgery. This innovative approach offers patients a more pleasant surgical experience compared to traditional surgery under general anesthesia. Not only does it provide better patient outcomes, but it also reduces the need for opioid pain medication and allows for improved mobility after the procedure.


---


EARN CME


Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/3kWFrM


---


SHOW NOTES


Dr. Sharan began his career in academic medicine at Montefiore, where he gained valuable experience in caring for individuals with severe back problems requiring spine surgery. During his time at Montefiore, Dr. Sharan recognized the changing landscape of healthcare and decided to pursue a healthcare MBA. This unique combination of medical expertise and business knowledge led him to transition to private practice.


Dr. Sharan explains that awake spinal surgery offers several benefits for patients undergoing spine procedures. It enables patients to mobilize and recover from surgery more quickly, leading to faster overall recovery times and decreased risk of delirium. Additionally, patients have the opportunity to return home on the same day as the surgery, promoting a more convenient and comfortable experience. Awake spinal surgery also helps reduce the reliance on narcotics for pain management, with patients typically only needing narcotics for around four days compared to the usual four to six weeks with surgeries performed under general anesthesia. Due to the improvement in patient outcomes and the tremendous cost-efficiency of the procedure, awake spinal surgery is an appealing option for individuals requiring spinal fusions and other procedures.


Dr. Sharan's entrepreneurial drive has led him to create a comprehensive preoperative education program. His patients are provided with virtual reality headsets to simulate and experience the day of surgery and the actual surgical procedure. The aim is to alleviate any fears or anxieties the patients may have prior to undergoing surgery by immersing them in a realistic virtual environment. This approach helps to prepare patients mentally and emotionally, ensuring a smoother and more comfortable surgical experience. Dr. Sharan is now sharing his techniques with surgeons around the world and anticipates this technique being implemented in many fields in the future.


---


RESOURCES


Awake Spinal Fusion:

https://awakespinalfusion.com


Doc Social:

https://doc.social


Dr. Sharan’s LinkedIn:

https://www.linkedin.com/in/alok-sharan-6a612610/

]]> 3033 Ep. 17 Multidisciplinary Approach to Treating Spinal Metastases with Dr. Jason Levy and Dr. Amir Lavaf Interventional Radiologist Jason Levy and Radiation Oncologist Amir Lavaf discuss the benefits of a Multidisciplinary Approach in the Treatment of Spinal and Bone Metastases. --- SHOW NOTES In this episode, Dr. Jason Levy and Dr. Amir Lavaf join Dr. Michael Barraza to discuss their multidisciplinary approach to treating spinal metastases. We examine the collaborative efforts between IR and radiation oncologists, and we break down the indications for treating spinal metastases. We discuss pain control and local control rates, and how doctors are working to improve them. Dr. Levy and Dr. Lavaf tell us why they are able to get better survival numbers when they approach the primary and metastatic disease at the same time. We explain how to work with tumor boards and different groups of doctors to make spinal metastases treatment easier. We discuss how to reduce risk of delayed skeletal events and radiation failure after spinal metastases treatment. We go over some of the challenges of working with the tumor board, and why it is important to develop relationships with medical oncologists and the importance of continuing systemic therapies. --- RESOURCES BackTable Podcast Episode 68: RF Ablation Therapy for Bone Metastases https://www.backtable.com/shows/vi/podcasts/68/rf-ablation-therapy-for-bone-metastases Sat, 24 Jun 2023 05:05:00 -0000 full BackTable Interventional Radiologist Jason Levy and Radiation Oncologist Amir Lavaf discuss the benefits of a Multidisciplinary Approach in the Treatment of Spinal and Bone Metastases. Interventional Radiologist Jason Levy and Radiation Oncologist Amir Lavaf discuss the benefits of a Multidisciplinary Approach in the Treatment of Spinal and Bone Metastases. --- SHOW NOTES In this episode, Dr. Jason Levy and Dr. Amir Lavaf join Dr. Michael Barraza to discuss their multidisciplinary approach to treating spinal metastases. We examine the collaborative efforts between IR and radiation oncologists, and we break down the indications for treating spinal metastases. We discuss pain control and local control rates, and how doctors are working to improve them. Dr. Levy and Dr. Lavaf tell us why they are able to get better survival numbers when they approach the primary and metastatic disease at the same time. We explain how to work with tumor boards and different groups of doctors to make spinal metastases treatment easier. We discuss how to reduce risk of delayed skeletal events and radiation failure after spinal metastases treatment. We go over some of the challenges of working with the tumor board, and why it is important to develop relationships with medical oncologists and the importance of continuing systemic therapies. --- RESOURCES BackTable Podcast Episode 68: RF Ablation Therapy for Bone Metastases https://www.backtable.com/shows/vi/podcasts/68/rf-ablation-therapy-for-bone-metastases Interventional Radiologist Jason Levy and Radiation Oncologist Amir Lavaf discuss the benefits of a Multidisciplinary Approach in the Treatment of Spinal and Bone Metastases.


---


SHOW NOTES


In this episode, Dr. Jason Levy and Dr. Amir Lavaf join Dr. Michael Barraza to discuss their multidisciplinary approach to treating spinal metastases. We examine the collaborative efforts between IR and radiation oncologists, and we break down the indications for treating spinal metastases.


We discuss pain control and local control rates, and how doctors are working to improve them. Dr. Levy and Dr. Lavaf tell us why they are able to get better survival numbers when they approach the primary and metastatic disease at the same time. We explain how to work with tumor boards and different groups of doctors to make spinal metastases treatment easier.


We discuss how to reduce risk of delayed skeletal events and radiation failure after spinal metastases treatment. We go over some of the challenges of working with the tumor board, and why it is important to develop relationships with medical oncologists and the importance of continuing systemic therapies.


---


RESOURCES


BackTable Podcast Episode 68: RF Ablation Therapy for Bone Metastases

https://www.backtable.com/shows/vi/podcasts/68/rf-ablation-therapy-for-bone-metastases

]]> 1939 Ep. 16 Transcranial Focused Ultrasound: Next Generation Imagine-Guided Therapy of the Brain with Dr. Bhavya Shah In this episode, host Dr. Jacob Fleming interviews one of his attendings Dr. Bhavya Shah about the remarkable features of focused ultrasound technology and its applications. They discuss its dynamic nature, allowing for a wide range of applications. --- SHOW NOTES Dr. Bhavya Shah is a neuroradiologist at UT Southwestern in Dallas, TX and the director of their transcranial-focused ultrasound lab. While in residency at Boston MIT, he studied the radiology applications for nerve regeneration and expanded his scope of practice during his fellowship at Stanford. Dr. Bhavya Shah explains the use of low intensity focused ultrasound (LIFU) and high intensity focused ultrasound (HIFU), particularly in the context of movement disorders including essential tremor and Parkinson’s disease. LIFU is used to identify the appropriate targets in the brain in relation to the disease and may be used to alter how neurons behave. In contrast, high intensity focused ultrasound (HIFU) is utilized to ablate and destroy tissues typically after the localization of the intended treatment area. Dr. Shah developed a way to identify targets in the brain for treatment with focused ultrasound with the use of four-tract tractography in cadavers. Using this technology, the brain can be thinly sliced into sections which could then be registered off an MRI back to the path using block face photography, allowing the identification of white matter tracts that enter and leave the thalamus. With these tracts identified, neuroradiologists can first stimulate the localized area with LIFU to confirm the location, then ablate using HIFU. The procedure lasts approximately 30-45 minutes as the patient remains awake. Remarkably, patients with essential tremor usually experience benefit immediately following the procedure as patients with Parkinson’s have symptom improvement within days to weeks. After two hours of observation, patients are discharged assuming no side effects. Side effects are uncommon but can include numbness and tingling around the mouth or fingertips as well as muscle weakness. Beyond its use for movement disorders, the adaptable nature of focused ultrasound technology shows promise for a broad range of applications, particularly for the use of neuropsychiatric conditions. Dr. Shah offers the potential for the use of HIFU as a wearable device that delivers constant stimulation modulated by biofeedback, potentially eliminating the need for MRI for the procedure. Dr. Shah and Dr. Fleming end the discussion with how radiology has evolved over the years and the importance of keeping an open mind working in a multidisciplinary team. They emphasize the gravity of patient engagement and the central goal of medicine and improving the standard of care should always be aimed at benefiting the patient. --- RESOURCES MRI–Guided Focused Ultrasound Thalamotomy for Essential Tremor: https://thejns.org/view/journals/j-neurosurg/138/4/article-p1028.xml Trial of Globus Pallidus Focused Ultrasound Ablation in Parkinson’s Disease: https://www.nejm.org/doi/10.1056/NEJMoa2202721 Long-term effects of bilateral subthalamic nucleus deep brain stimulation on gait disorders in Parkinson's disease: a clinical-instrumental study https://pubmed.ncbi.nlm.nih.gov/37208527/ Magnetic Resonance Image Guided Focused Ultrasound Thalamotomy. A Single Center Experience With 160 Procedures: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8894664/ Wed, 21 Jun 2023 05:05:00 -0000 full BackTable In this episode, host Dr. Jacob Fleming interviews one of his attendings Dr. Bhavya Shah about the remarkable features of focused ultrasound technology and its applications. They discuss its dynamic nature, allowing for a wide range of applications. In this episode, host Dr. Jacob Fleming interviews one of his attendings Dr. Bhavya Shah about the remarkable features of focused ultrasound technology and its applications. They discuss its dynamic nature, allowing for a wide range of applications. --- SHOW NOTES Dr. Bhavya Shah is a neuroradiologist at UT Southwestern in Dallas, TX and the director of their transcranial-focused ultrasound lab. While in residency at Boston MIT, he studied the radiology applications for nerve regeneration and expanded his scope of practice during his fellowship at Stanford. Dr. Bhavya Shah explains the use of low intensity focused ultrasound (LIFU) and high intensity focused ultrasound (HIFU), particularly in the context of movement disorders including essential tremor and Parkinson’s disease. LIFU is used to identify the appropriate targets in the brain in relation to the disease and may be used to alter how neurons behave. In contrast, high intensity focused ultrasound (HIFU) is utilized to ablate and destroy tissues typically after the localization of the intended treatment area. Dr. Shah developed a way to identify targets in the brain for treatment with focused ultrasound with the use of four-tract tractography in cadavers. Using this technology, the brain can be thinly sliced into sections which could then be registered off an MRI back to the path using block face photography, allowing the identification of white matter tracts that enter and leave the thalamus. With these tracts identified, neuroradiologists can first stimulate the localized area with LIFU to confirm the location, then ablate using HIFU. The procedure lasts approximately 30-45 minutes as the patient remains awake. Remarkably, patients with essential tremor usually experience benefit immediately following the procedure as patients with Parkinson’s have symptom improvement within days to weeks. After two hours of observation, patients are discharged assuming no side effects. Side effects are uncommon but can include numbness and tingling around the mouth or fingertips as well as muscle weakness. Beyond its use for movement disorders, the adaptable nature of focused ultrasound technology shows promise for a broad range of applications, particularly for the use of neuropsychiatric conditions. Dr. Shah offers the potential for the use of HIFU as a wearable device that delivers constant stimulation modulated by biofeedback, potentially eliminating the need for MRI for the procedure. Dr. Shah and Dr. Fleming end the discussion with how radiology has evolved over the years and the importance of keeping an open mind working in a multidisciplinary team. They emphasize the gravity of patient engagement and the central goal of medicine and improving the standard of care should always be aimed at benefiting the patient. --- RESOURCES MRI–Guided Focused Ultrasound Thalamotomy for Essential Tremor: https://thejns.org/view/journals/j-neurosurg/138/4/article-p1028.xml Trial of Globus Pallidus Focused Ultrasound Ablation in Parkinson’s Disease: https://www.nejm.org/doi/10.1056/NEJMoa2202721 Long-term effects of bilateral subthalamic nucleus deep brain stimulation on gait disorders in Parkinson's disease: a clinical-instrumental study https://pubmed.ncbi.nlm.nih.gov/37208527/ Magnetic Resonance Image Guided Focused Ultrasound Thalamotomy. A Single Center Experience With 160 Procedures: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8894664/ In this episode, host Dr. Jacob Fleming interviews one of his attendings Dr. Bhavya Shah about the remarkable features of focused ultrasound technology and its applications. They discuss its dynamic nature, allowing for a wide range of applications.


---


SHOW NOTES


Dr. Bhavya Shah is a neuroradiologist at UT Southwestern in Dallas, TX and the director of their transcranial-focused ultrasound lab. While in residency at Boston MIT, he studied the radiology applications for nerve regeneration and expanded his scope of practice during his fellowship at Stanford. Dr. Bhavya Shah explains the use of low intensity focused ultrasound (LIFU) and high intensity focused ultrasound (HIFU), particularly in the context of movement disorders including essential tremor and Parkinson’s disease. LIFU is used to identify the appropriate targets in the brain in relation to the disease and may be used to alter how neurons behave. In contrast, high intensity focused ultrasound (HIFU) is utilized to ablate and destroy tissues typically after the localization of the intended treatment area.


Dr. Shah developed a way to identify targets in the brain for treatment with focused ultrasound with the use of four-tract tractography in cadavers. Using this technology, the brain can be thinly sliced into sections which could then be registered off an MRI back to the path using block face photography, allowing the identification of white matter tracts that enter and leave the thalamus. With these tracts identified, neuroradiologists can first stimulate the localized area with LIFU to confirm the location, then ablate using HIFU. The procedure lasts approximately 30-45 minutes as the patient remains awake. Remarkably, patients with essential tremor usually experience benefit immediately following the procedure as patients with Parkinson’s have symptom improvement within days to weeks. After two hours of observation, patients are discharged assuming no side effects. Side effects are uncommon but can include numbness and tingling around the mouth or fingertips as well as muscle weakness.


Beyond its use for movement disorders, the adaptable nature of focused ultrasound technology shows promise for a broad range of applications, particularly for the use of neuropsychiatric conditions. Dr. Shah offers the potential for the use of HIFU as a wearable device that delivers constant stimulation modulated by biofeedback, potentially eliminating the need for MRI for the procedure. Dr. Shah and Dr. Fleming end the discussion with how radiology has evolved over the years and the importance of keeping an open mind working in a multidisciplinary team. They emphasize the gravity of patient engagement and the central goal of medicine and improving the standard of care should always be aimed at benefiting the patient.


---


RESOURCES


MRI–Guided Focused Ultrasound Thalamotomy for Essential Tremor:

https://thejns.org/view/journals/j-neurosurg/138/4/article-p1028.xml


Trial of Globus Pallidus Focused Ultrasound Ablation in Parkinson’s Disease:

https://www.nejm.org/doi/10.1056/NEJMoa2202721


Long-term effects of bilateral subthalamic nucleus deep brain stimulation on gait disorders in Parkinson's disease: a clinical-instrumental study

https://pubmed.ncbi.nlm.nih.gov/37208527/


Magnetic Resonance Image Guided Focused Ultrasound Thalamotomy. A Single Center Experience With 160 Procedures:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8894664/

]]> 2852 Ep. 15 El Futuro de MSK: Embolizaciones Musculoesqueletas con Dr. Ana Fernandez Martinez En este episodio de BackTable, las Dras. Gina Landinez y Ana María Fernández Martínez hablan sobre el intervencionismo musculoesquelético y las técnicas para la embolización del hombre rígido. --- SHOW NOTES La Dra. Fernández Martínez explica su trayectoria en el campo de intervencionismo musculoesquelético y la oportunidad de entrenarse en Japón. Luego entra en detalles técnicos, describiendo cómo obtiene acceso usando su microcatéter para entrar a las articulaciones que quiere tratar. Explica que estas arterias son de un calibre muy pequeño, así que necesita herramientas diferentes para los procedimientos esqueléticos. También, ella describe el efecto que tiene la embolización en las fibras nerviosas y la inflamación para restaurar la vascular normal. Adicionalmente, las doctoras explican quienes son los pacientes ideales para la embolización de un hombro rígido. Dra. Fernández Martínez distingue síntomas de un hombro rígido, como la limitación de la vida diaria y la movilidad, y hace la distinción entre esta patología y la artritis. Habla también del tiempo ideal para la embolización para optimizar los resultados y la importancia de la rehabilitación con la fisioterapia. Próximo, la doctora explica los beneficios inmediatos y a largo plazo que ve en sus pacientes. Usualmente, se pueden ver los efectos de la embolización tres meses después del procedimiento si el paciente participa en la fisioterapia, y el máximo beneficio ocurre a los seis meses. Repetición del procedimiento es posible también. Finalmente, las doctoras hablan sobre las complicaciones de la embolización, que incluyen un hematoma en la zona de punción. Dra. Fernandez Martinez termina el episodio alentando a sus colegas radiólogos intervencionistas a explorar la embolización musculoesquelética. Thu, 15 Jun 2023 15:35:00 -0000 full BackTable En este episodio de BackTable, las Dras. Gina Landinez y Ana María Fernández Martínez hablan sobre el intervencionismo musculoesquelético y las técnicas para la embolización del hombre rígido. En este episodio de BackTable, las Dras. Gina Landinez y Ana María Fernández Martínez hablan sobre el intervencionismo musculoesquelético y las técnicas para la embolización del hombre rígido. --- SHOW NOTES La Dra. Fernández Martínez explica su trayectoria en el campo de intervencionismo musculoesquelético y la oportunidad de entrenarse en Japón. Luego entra en detalles técnicos, describiendo cómo obtiene acceso usando su microcatéter para entrar a las articulaciones que quiere tratar. Explica que estas arterias son de un calibre muy pequeño, así que necesita herramientas diferentes para los procedimientos esqueléticos. También, ella describe el efecto que tiene la embolización en las fibras nerviosas y la inflamación para restaurar la vascular normal. Adicionalmente, las doctoras explican quienes son los pacientes ideales para la embolización de un hombro rígido. Dra. Fernández Martínez distingue síntomas de un hombro rígido, como la limitación de la vida diaria y la movilidad, y hace la distinción entre esta patología y la artritis. Habla también del tiempo ideal para la embolización para optimizar los resultados y la importancia de la rehabilitación con la fisioterapia. Próximo, la doctora explica los beneficios inmediatos y a largo plazo que ve en sus pacientes. Usualmente, se pueden ver los efectos de la embolización tres meses después del procedimiento si el paciente participa en la fisioterapia, y el máximo beneficio ocurre a los seis meses. Repetición del procedimiento es posible también. Finalmente, las doctoras hablan sobre las complicaciones de la embolización, que incluyen un hematoma en la zona de punción. Dra. Fernandez Martinez termina el episodio alentando a sus colegas radiólogos intervencionistas a explorar la embolización musculoesquelética. En este episodio de BackTable, las Dras. Gina Landinez y Ana María Fernández Martínez hablan sobre el intervencionismo musculoesquelético y las técnicas para la embolización del hombre rígido.


---


SHOW NOTES


La Dra. Fernández Martínez explica su trayectoria en el campo de intervencionismo musculoesquelético y la oportunidad de entrenarse en Japón. Luego entra en detalles técnicos, describiendo cómo obtiene acceso usando su microcatéter para entrar a las articulaciones que quiere tratar. Explica que estas arterias son de un calibre muy pequeño, así que necesita herramientas diferentes para los procedimientos esqueléticos. También, ella describe el efecto que tiene la embolización en las fibras nerviosas y la inflamación para restaurar la vascular normal.


Adicionalmente, las doctoras explican quienes son los pacientes ideales para la embolización de un hombro rígido. Dra. Fernández Martínez distingue síntomas de un hombro rígido, como la limitación de la vida diaria y la movilidad, y hace la distinción entre esta patología y la artritis. Habla también del tiempo ideal para la embolización para optimizar los resultados y la importancia de la rehabilitación con la fisioterapia. Próximo, la doctora explica los beneficios inmediatos y a largo plazo que ve en sus pacientes. Usualmente, se pueden ver los efectos de la embolización tres meses después del procedimiento si el paciente participa en la fisioterapia, y el máximo beneficio ocurre a los seis meses. Repetición del procedimiento es posible también.


Finalmente, las doctoras hablan sobre las complicaciones de la embolización, que incluyen un hematoma en la zona de punción. Dra. Fernandez Martinez termina el episodio alentando a sus colegas radiólogos intervencionistas a explorar la embolización musculoesquelética.

]]> 2834 Ep. 14 Building a Pain Interventions Service Line with Dr. Stephen Hunt In this episode, host Dr. Michael Barraza interviews Dr. Stephen Hunt about building a pain practice, including his nerve ablation technique, how to obtain referrals, and why it is one of the most rewarding procedures that he does. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/z9cUt2 --- SHOW NOTES We begin by discussing what caused Dr. Hunt to start building a pain service. He was treating many patients with lung cancer, and he saw so many patients toward the end of their life. What they wanted was to reduce their suffering due to pain. He saw what was being offered for them, which was opioids, but this caused them to be disconnected from their families at such an important time in their life. He knew he could offer nerve blocks and ablation, so he began educating himself. As he learned about different blocks, he adapted them to create his own technique. Pretty soon, word got out that he was doing this, and he started getting referrals from oncologists. Soon after this, thoracic surgeons and breast surgeons began referring to him for post-thoracotomy and post-mastectomy pain. Next, radiation oncologists referred their patients with radiation necrosis of the ribs, and orthopedic surgeons referred patients to him for pain from musculoskeletal metastases. For his technique, he often starts with a test block using bupivacaine and triamcinolone, which prolongs the effect of the bupivacaine and provides relief for around two weeks. For the ablation, he does the block in the same way, waits 15 minutes, and then injects ethanol to ablate the nerve. Some tips he has learned for celiac ablation are to ablate the retrocrural splanchnic nerves, because they feed into the celiac, and you will get a better result. Other areas he commonly ablates are intercostal nerves. For these, to avoid devastating paralysis from damage to the spinal cord, he always orients his needle lateral and stays at least two inches away from the spine. He advises those new in pain interventions to remember your anatomy. In radiology, we learn it all, and if you remember these nerves, you will be able to help a lot of people with their pain and decrease their suffering, making an enormous impact on someone’s quality of life. --- RESOURCES PIGI Lab: https://www.med.upenn.edu/pigilab/ Twitter: @PigiLab @md_rogue Thu, 15 Jun 2023 15:34:00 -0000 full BackTable In this episode, host Dr. Michael Barraza interviews Dr. Stephen Hunt about building a pain practice, including his nerve ablation technique, how to obtain referrals, and why it is one of the most rewarding procedures that he does. In this episode, host Dr. Michael Barraza interviews Dr. Stephen Hunt about building a pain practice, including his nerve ablation technique, how to obtain referrals, and why it is one of the most rewarding procedures that he does. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/z9cUt2 --- SHOW NOTES We begin by discussing what caused Dr. Hunt to start building a pain service. He was treating many patients with lung cancer, and he saw so many patients toward the end of their life. What they wanted was to reduce their suffering due to pain. He saw what was being offered for them, which was opioids, but this caused them to be disconnected from their families at such an important time in their life. He knew he could offer nerve blocks and ablation, so he began educating himself. As he learned about different blocks, he adapted them to create his own technique. Pretty soon, word got out that he was doing this, and he started getting referrals from oncologists. Soon after this, thoracic surgeons and breast surgeons began referring to him for post-thoracotomy and post-mastectomy pain. Next, radiation oncologists referred their patients with radiation necrosis of the ribs, and orthopedic surgeons referred patients to him for pain from musculoskeletal metastases. For his technique, he often starts with a test block using bupivacaine and triamcinolone, which prolongs the effect of the bupivacaine and provides relief for around two weeks. For the ablation, he does the block in the same way, waits 15 minutes, and then injects ethanol to ablate the nerve. Some tips he has learned for celiac ablation are to ablate the retrocrural splanchnic nerves, because they feed into the celiac, and you will get a better result. Other areas he commonly ablates are intercostal nerves. For these, to avoid devastating paralysis from damage to the spinal cord, he always orients his needle lateral and stays at least two inches away from the spine. He advises those new in pain interventions to remember your anatomy. In radiology, we learn it all, and if you remember these nerves, you will be able to help a lot of people with their pain and decrease their suffering, making an enormous impact on someone’s quality of life. --- RESOURCES PIGI Lab: https://www.med.upenn.edu/pigilab/ Twitter: @PigiLab @md_rogue In this episode, host Dr. Michael Barraza interviews Dr. Stephen Hunt about building a pain practice, including his nerve ablation technique, how to obtain referrals, and why it is one of the most rewarding procedures that he does.


---


EARN CME


Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/z9cUt2


---


SHOW NOTES


We begin by discussing what caused Dr. Hunt to start building a pain service. He was treating many patients with lung cancer, and he saw so many patients toward the end of their life. What they wanted was to reduce their suffering due to pain. He saw what was being offered for them, which was opioids, but this caused them to be disconnected from their families at such an important time in their life. He knew he could offer nerve blocks and ablation, so he began educating himself. As he learned about different blocks, he adapted them to create his own technique.


Pretty soon, word got out that he was doing this, and he started getting referrals from oncologists. Soon after this, thoracic surgeons and breast surgeons began referring to him for post-thoracotomy and post-mastectomy pain. Next, radiation oncologists referred their patients with radiation necrosis of the ribs, and orthopedic surgeons referred patients to him for pain from musculoskeletal metastases.


For his technique, he often starts with a test block using bupivacaine and triamcinolone, which prolongs the effect of the bupivacaine and provides relief for around two weeks. For the ablation, he does the block in the same way, waits 15 minutes, and then injects ethanol to ablate the nerve. Some tips he has learned for celiac ablation are to ablate the retrocrural splanchnic nerves, because they feed into the celiac, and you will get a better result. Other areas he commonly ablates are intercostal nerves. For these, to avoid devastating paralysis from damage to the spinal cord, he always orients his needle lateral and stays at least two inches away from the spine. He advises those new in pain interventions to remember your anatomy. In radiology, we learn it all, and if you remember these nerves, you will be able to help a lot of people with their pain and decrease their suffering, making an enormous impact on someone’s quality of life.


---


RESOURCES


PIGI Lab:

https://www.med.upenn.edu/pigilab/


Twitter:

@PigiLab

@md_rogue

]]> 1979 Ep. 11 Interspinous Spacers for Spinal Stenosis Part II with Dr. Luigi Manfre In this episode, host Dr. Jacob Fleming interviews Dr. Luigi Manfrè, spine interventional neuroradiologist and chair of the European Society of Neuroradiology about treatment of spinal stenosis and spondylolisthesis using interspinous fusion spacers. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/Dr9Ojz --- SHOW NOTES Dr. Manfrè reviews his technique for interspinous spacer placement. He uses local anesthesia which he administers with a spinal needle. He adjusts the angulation and entry point using CT, then inserts the guide wire. When he has it positioned between two spinous processes, and when the wire abuts the facet, this is the end point of the guide wire. He then uses soft tissue dilators through a 5mm incision before placing a spacer over the spacer delivery system. He usually places 8-12mm spacers, occasionally using 14mm spacers. One of the main pitfalls that happens when placing spacers is oversizing. Dr. Manfrè believes that this is a more common phenomenon in open surgical decompression due to patient placement in the operating room. Patients are often placed prone with a pillow beneath their abdomen to flex the lumbar spine and aid in exposure and insertion of spacers. However, this causes measurements to be greater than they are in natural spine mechanics. Next, we discuss the historical idea that interspinous spacers induce an unnatural lumbar kyphosis. New research suggests this is not the case. In fact, spacers restore the natural alignment of the spine without inducing kyphosis. Additionally, in patients with stenosis at multiple levels, the addition of a spacer at the worst level improves the morphology of the entire spine. He usually only places one spacer for his patients, and rarely will place two. New unpublished research by Dr. Manfrè on upright MRI shows that spacers placed for patients with spinal stenosis cause expansion of the dural sac by up to 70% by the next day. What’s more, in patients with both stenosis and listhesis, placement of a fusion spacer to correct both the stenosis and the instability result in disappearance of listhesis on MR the day after the procedure. --- RESOURCES Dr. Manfrè Website: https://www.manfreluigi.com/index.html Manfrè Articles: https://jnis.bmj.com/content/12/7/673.abstract https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8511561/ https://journals.sagepub.com/doi/abs/10.15274/INR-2014-10052 ESNR Hands On Spine Course: https://www.esnr.org/en/spine-interventional-neuroradiology-full-hands-on-course/about-catania/ New Procedures in Spinal Interventional Neuroradiology: https://www.springer.com/series/13394 Thu, 15 Jun 2023 15:33:00 -0000 full BackTable In this episode, host Dr. Jacob Fleming interviews Dr. Luigi Manfrè, spine interventional neuroradiologist and chair of the European Society of Neuroradiology about treatment of spinal stenosis and spondylolisthesis using interspinous fusion spacers. In this episode, host Dr. Jacob Fleming interviews Dr. Luigi Manfrè, spine interventional neuroradiologist and chair of the European Society of Neuroradiology about treatment of spinal stenosis and spondylolisthesis using interspinous fusion spacers. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/Dr9Ojz --- SHOW NOTES Dr. Manfrè reviews his technique for interspinous spacer placement. He uses local anesthesia which he administers with a spinal needle. He adjusts the angulation and entry point using CT, then inserts the guide wire. When he has it positioned between two spinous processes, and when the wire abuts the facet, this is the end point of the guide wire. He then uses soft tissue dilators through a 5mm incision before placing a spacer over the spacer delivery system. He usually places 8-12mm spacers, occasionally using 14mm spacers. One of the main pitfalls that happens when placing spacers is oversizing. Dr. Manfrè believes that this is a more common phenomenon in open surgical decompression due to patient placement in the operating room. Patients are often placed prone with a pillow beneath their abdomen to flex the lumbar spine and aid in exposure and insertion of spacers. However, this causes measurements to be greater than they are in natural spine mechanics. Next, we discuss the historical idea that interspinous spacers induce an unnatural lumbar kyphosis. New research suggests this is not the case. In fact, spacers restore the natural alignment of the spine without inducing kyphosis. Additionally, in patients with stenosis at multiple levels, the addition of a spacer at the worst level improves the morphology of the entire spine. He usually only places one spacer for his patients, and rarely will place two. New unpublished research by Dr. Manfrè on upright MRI shows that spacers placed for patients with spinal stenosis cause expansion of the dural sac by up to 70% by the next day. What’s more, in patients with both stenosis and listhesis, placement of a fusion spacer to correct both the stenosis and the instability result in disappearance of listhesis on MR the day after the procedure. --- RESOURCES Dr. Manfrè Website: https://www.manfreluigi.com/index.html Manfrè Articles: https://jnis.bmj.com/content/12/7/673.abstract https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8511561/ https://journals.sagepub.com/doi/abs/10.15274/INR-2014-10052 ESNR Hands On Spine Course: https://www.esnr.org/en/spine-interventional-neuroradiology-full-hands-on-course/about-catania/ New Procedures in Spinal Interventional Neuroradiology: https://www.springer.com/series/13394 In this episode, host Dr. Jacob Fleming interviews Dr. Luigi Manfrè, spine interventional neuroradiologist and chair of the European Society of Neuroradiology about treatment of spinal stenosis and spondylolisthesis using interspinous fusion spacers.


---


CHECK OUT OUR SPONSOR


RADPAD® Radiation Protection

https://www.radpad.com/


---


EARN CME


Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/Dr9Ojz


---


SHOW NOTES


Dr. Manfrè reviews his technique for interspinous spacer placement. He uses local anesthesia which he administers with a spinal needle. He adjusts the angulation and entry point using CT, then inserts the guide wire. When he has it positioned between two spinous processes, and when the wire abuts the facet, this is the end point of the guide wire. He then uses soft tissue dilators through a 5mm incision before placing a spacer over the spacer delivery system. He usually places 8-12mm spacers, occasionally using 14mm spacers.


One of the main pitfalls that happens when placing spacers is oversizing. Dr. Manfrè believes that this is a more common phenomenon in open surgical decompression due to patient placement in the operating room. Patients are often placed prone with a pillow beneath their abdomen to flex the lumbar spine and aid in exposure and insertion of spacers. However, this causes measurements to be greater than they are in natural spine mechanics.


Next, we discuss the historical idea that interspinous spacers induce an unnatural lumbar kyphosis. New research suggests this is not the case. In fact, spacers restore the natural alignment of the spine without inducing kyphosis. Additionally, in patients with stenosis at multiple levels, the addition of a spacer at the worst level improves the morphology of the entire spine. He usually only places one spacer for his patients, and rarely will place two. New unpublished research by Dr. Manfrè on upright MRI shows that spacers placed for patients with spinal stenosis cause expansion of the dural sac by up to 70% by the next day. What’s more, in patients with both stenosis and listhesis, placement of a fusion spacer to correct both the stenosis and the instability result in disappearance of listhesis on MR the day after the procedure.


---


RESOURCES


Dr. Manfrè Website:

https://www.manfreluigi.com/index.html


Manfrè Articles:

https://jnis.bmj.com/content/12/7/673.abstract

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8511561/

https://journals.sagepub.com/doi/abs/10.15274/INR-2014-10052


ESNR Hands On Spine Course:

https://www.esnr.org/en/spine-interventional-neuroradiology-full-hands-on-course/about-catania/


New Procedures in Spinal Interventional Neuroradiology:

https://www.springer.com/series/13394

]]> 2965 Ep. 13 Basivertebral Nerve Ablation with Dr. Olivier Clerk-Lamalice In this episode, Dr. Jacob Fleming interviews Dr. Olivier Clerk-Lamalice about basivertebral nerve ablation for vertebrogenic back pain, including indications, procedure technique and exciting tech on the horizon in minimally invasive spine interventions. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/kN1FPR --- SHOW NOTES Dr. Clerk-Lamalice trained in Canada, first in engineering, and then medicine and diagnostic radiology at the Université de Sherbrooke in Calgary. He then completed a neuroradiology fellowship at Harvard, and a fellowship in interventional pain at The Spine Fracture Institute in Oklahoma City with Dr. Douglas Beall. Furthermore, he obtained his credentials as a fellow of interventional pain practice (FIPP), which is a widely recognized international designation. He now works at a comprehensive outpatient radiology center, where he practices both diagnostic and interventional radiology daily. They offer intrathecal drug administration, spinal cord stimulators, vertebral augmentation, Spine Jack, disc augmentation, nucleolysis, and various nerve blocks and ablations in and out of the spine. Their goal was to create a one stop shop for patients to come for consultation, imaging, expert advice and treatment. Next, we discuss vertebrogenic back pain and the basivertebral nerve (BVN). The BVN is a nonmyelinated, intraosseous nerve, while most other peripheral nerves are myelinated, meaning they can regenerate. The BVN cannot, so ablation of this nerve is a permanent treatment. It is located within the central portion of the vertebral body midway between the superior and inferior end plates, one third ventral to the posterior wall of the vertebral body. On a sagittal T2 sequence on MRI, there is a triangle at the posterior aspect at the midpoint of the vertebral body called the basivertebral canal, which contains the nerve, artery and vein. The BVN is responsible for vertebrogenic back pain, which is a form of anterior column pain characterized by low back pain worsened by flexion and sitting. It is diagnosed via MRI using the Modic classifications. Modic type 1 (edematous), and type 2 (fibrofatty end plate) changes can be seen in this disease. It can be difficult to distinguish vertebrogenic from discogenic pain due to the fact that the sinuvertebral nerve (SVN), responsible for discogenic pain, crosses paths with the BVN. However, with MRI and an anesthetic discogram, it is possible to determine the etiology and choose the right treatment. Finally, we discuss the steps of the procedure. Dr. Clerk-Lamalice uses an 8 gauge needle via a transpedicular approach, as is common for other spine procedures. He ensures the probe is positioned in the center of the vertebral body, parallel to the endplates. The nerve is ablated for 15 minutes at 85 C. The procedure takes 45 minutes, which includes an epidural steroid injection to bridge pain control during the periprocedural period. Patients usually go home within one hour after the procedure, and begin to experience the results within a couple days. There have been two trials for BVN ablation, which have made this intervention the most minimally invasive and evidence-based treatment for vertebrogenic pain. These studies indicated 25% of patients had a 50% reduction in pain, while 75% of patients had a 75% reduction of pain. Within that 75%, 30% reported being almost entirely pain free. To date, the study has followed participants to 8 years, and the results show the treatment is durable. --- RESOURCES Ep 210: Modern Vertebral Augmentation https://www.backtable.com/shows/vi/podcasts/210/modern-vertebral-augmentation Ep 94: Spine Interventions https://www.backtable.com/shows/vi/podcasts/94/innovation-in-spine-interventions Thu, 15 Jun 2023 15:33:00 -0000 full BackTable In this episode, Dr. Jacob Fleming interviews Dr. Olivier Clerk-Lamalice about basivertebral nerve ablation for vertebrogenic back pain, including indications, procedure technique and exciting tech on the horizon in minimally invasive spine interventions. In this episode, Dr. Jacob Fleming interviews Dr. Olivier Clerk-Lamalice about basivertebral nerve ablation for vertebrogenic back pain, including indications, procedure technique and exciting tech on the horizon in minimally invasive spine interventions. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/kN1FPR --- SHOW NOTES Dr. Clerk-Lamalice trained in Canada, first in engineering, and then medicine and diagnostic radiology at the Université de Sherbrooke in Calgary. He then completed a neuroradiology fellowship at Harvard, and a fellowship in interventional pain at The Spine Fracture Institute in Oklahoma City with Dr. Douglas Beall. Furthermore, he obtained his credentials as a fellow of interventional pain practice (FIPP), which is a widely recognized international designation. He now works at a comprehensive outpatient radiology center, where he practices both diagnostic and interventional radiology daily. They offer intrathecal drug administration, spinal cord stimulators, vertebral augmentation, Spine Jack, disc augmentation, nucleolysis, and various nerve blocks and ablations in and out of the spine. Their goal was to create a one stop shop for patients to come for consultation, imaging, expert advice and treatment. Next, we discuss vertebrogenic back pain and the basivertebral nerve (BVN). The BVN is a nonmyelinated, intraosseous nerve, while most other peripheral nerves are myelinated, meaning they can regenerate. The BVN cannot, so ablation of this nerve is a permanent treatment. It is located within the central portion of the vertebral body midway between the superior and inferior end plates, one third ventral to the posterior wall of the vertebral body. On a sagittal T2 sequence on MRI, there is a triangle at the posterior aspect at the midpoint of the vertebral body called the basivertebral canal, which contains the nerve, artery and vein. The BVN is responsible for vertebrogenic back pain, which is a form of anterior column pain characterized by low back pain worsened by flexion and sitting. It is diagnosed via MRI using the Modic classifications. Modic type 1 (edematous), and type 2 (fibrofatty end plate) changes can be seen in this disease. It can be difficult to distinguish vertebrogenic from discogenic pain due to the fact that the sinuvertebral nerve (SVN), responsible for discogenic pain, crosses paths with the BVN. However, with MRI and an anesthetic discogram, it is possible to determine the etiology and choose the right treatment. Finally, we discuss the steps of the procedure. Dr. Clerk-Lamalice uses an 8 gauge needle via a transpedicular approach, as is common for other spine procedures. He ensures the probe is positioned in the center of the vertebral body, parallel to the endplates. The nerve is ablated for 15 minutes at 85 C. The procedure takes 45 minutes, which includes an epidural steroid injection to bridge pain control during the periprocedural period. Patients usually go home within one hour after the procedure, and begin to experience the results within a couple days. There have been two trials for BVN ablation, which have made this intervention the most minimally invasive and evidence-based treatment for vertebrogenic pain. These studies indicated 25% of patients had a 50% reduction in pain, while 75% of patients had a 75% reduction of pain. Within that 75%, 30% reported being almost entirely pain free. To date, the study has followed participants to 8 years, and the results show the treatment is durable. --- RESOURCES Ep 210: Modern Vertebral Augmentation https://www.backtable.com/shows/vi/podcasts/210/modern-vertebral-augmentation Ep 94: Spine Interventions https://www.backtable.com/shows/vi/podcasts/94/innovation-in-spine-interventions In this episode, Dr. Jacob Fleming interviews Dr. Olivier Clerk-Lamalice about basivertebral nerve ablation for vertebrogenic back pain, including indications, procedure technique and exciting tech on the horizon in minimally invasive spine interventions.


---


CHECK OUT OUR SPONSOR


RADPAD® Radiation Protection

https://www.radpad.com/


---


EARN CME


Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/kN1FPR


---


SHOW NOTES


Dr. Clerk-Lamalice trained in Canada, first in engineering, and then medicine and diagnostic radiology at the Université de Sherbrooke in Calgary. He then completed a neuroradiology fellowship at Harvard, and a fellowship in interventional pain at The Spine Fracture Institute in Oklahoma City with Dr. Douglas Beall. Furthermore, he obtained his credentials as a fellow of interventional pain practice (FIPP), which is a widely recognized international designation. He now works at a comprehensive outpatient radiology center, where he practices both diagnostic and interventional radiology daily. They offer intrathecal drug administration, spinal cord stimulators, vertebral augmentation, Spine Jack, disc augmentation, nucleolysis, and various nerve blocks and ablations in and out of the spine. Their goal was to create a one stop shop for patients to come for consultation, imaging, expert advice and treatment.


Next, we discuss vertebrogenic back pain and the basivertebral nerve (BVN). The BVN is a nonmyelinated, intraosseous nerve, while most other peripheral nerves are myelinated, meaning they can regenerate. The BVN cannot, so ablation of this nerve is a permanent treatment. It is located within the central portion of the vertebral body midway between the superior and inferior end plates, one third ventral to the posterior wall of the vertebral body. On a sagittal T2 sequence on MRI, there is a triangle at the posterior aspect at the midpoint of the vertebral body called the basivertebral canal, which contains the nerve, artery and vein. The BVN is responsible for vertebrogenic back pain, which is a form of anterior column pain characterized by low back pain worsened by flexion and sitting. It is diagnosed via MRI using the Modic classifications. Modic type 1 (edematous), and type 2 (fibrofatty end plate) changes can be seen in this disease. It can be difficult to distinguish vertebrogenic from discogenic pain due to the fact that the sinuvertebral nerve (SVN), responsible for discogenic pain, crosses paths with the BVN. However, with MRI and an anesthetic discogram, it is possible to determine the etiology and choose the right treatment.


Finally, we discuss the steps of the procedure. Dr. Clerk-Lamalice uses an 8 gauge needle via a transpedicular approach, as is common for other spine procedures. He ensures the probe is positioned in the center of the vertebral body, parallel to the endplates. The nerve is ablated for 15 minutes at 85 C. The procedure takes 45 minutes, which includes an epidural steroid injection to bridge pain control during the periprocedural period. Patients usually go home within one hour after the procedure, and begin to experience the results within a couple days. There have been two trials for BVN ablation, which have made this intervention the most minimally invasive and evidence-based treatment for vertebrogenic pain. These studies indicated 25% of patients had a 50% reduction in pain, while 75% of patients had a 75% reduction of pain. Within that 75%, 30% reported being almost entirely pain free. To date, the study has followed participants to 8 years, and the results show the treatment is durable.


---


RESOURCES


Ep 210: Modern Vertebral Augmentation

https://www.backtable.com/shows/vi/podcasts/210/modern-vertebral-augmentation


Ep 94: Spine Interventions

https://www.backtable.com/shows/vi/podcasts/94/innovation-in-spine-interventions

]]> 3560 Ep. 12 Ortho/IR Collaboration in Private Practice with Dr. Daniel Lerman and Dr. Anthony Brown In this episode, host Jacob Fleming interviews interventional radiologist Tony Brown and orthopedic oncologist Daniel Lerman about their multidisciplinary IR/orthopedics practice and innovative techniques for pelvic fixation in metastatic cancer patients. --- CHECK OUT OUR SPONSOR Viz.ai https://www.viz.ai/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/Bp4tmV --- SHOW NOTES The guests recount their first case together, a “no option” patient in which they collaborated on a tripod fixation of an acetabulum, using a combination of screw placement and cementoplasty. They realized that they were both invested in improving minimally invasive fixation and helping patients with pain management and daily functioning. Their collaboration blossomed into a joint practice of MSK interventional oncology that offers biomechanics knowledge of orthopedic surgery and the precise image guidance of interventional radiology. With the rise of systemic cancer therapies, more patients are living with metastatic bone disease, and this new treatment paradigm could offer them a true joint reconstruction and stable fixation. Overtime, they have streamlined the technique to make their cases more efficient and precise. Despite their advances, Dr. Brown notes that MSK interventional oncology still has a long way to go. In the community, pelvic fractures usually go untreated. He speaks about the importance of outreach to radiation oncologists and orthopedic surgeons and letting them know about new methods of pelvic fixation. Dr. Brown encourages IRs who are curious about MSK interventions to get in contact with colleagues who are already doing innovative techniques and device companies that offer classes. Additionally, there is a need for innovation in instrumentation. Most pelvic intervention tools have been adopted from spine tools; however pelvic anatomy and pelvic lesions are vastly different. Dr. Lerman highlights the uniqueness of each patient’s disease, tumor, and bone lysis. He believes that there is a need to elucidate why different patients respond to different types of constructs. --- RESOURCES Institute for Limb Preservation: https://www.limbpreservationcolorado.com/ Musculoskeletal Tumor Society (MSTS): http://msts.org/ Thu, 15 Jun 2023 15:33:00 -0000 full BackTable In this episode, host Jacob Fleming interviews interventional radiologist Tony Brown and orthopedic oncologist Daniel Lerman about their multidisciplinary IR/orthopedics practice and innovative techniques for pelvic fixation in metastatic cancer patients. In this episode, host Jacob Fleming interviews interventional radiologist Tony Brown and orthopedic oncologist Daniel Lerman about their multidisciplinary IR/orthopedics practice and innovative techniques for pelvic fixation in metastatic cancer patients. --- CHECK OUT OUR SPONSOR Viz.ai https://www.viz.ai/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/Bp4tmV --- SHOW NOTES The guests recount their first case together, a “no option” patient in which they collaborated on a tripod fixation of an acetabulum, using a combination of screw placement and cementoplasty. They realized that they were both invested in improving minimally invasive fixation and helping patients with pain management and daily functioning. Their collaboration blossomed into a joint practice of MSK interventional oncology that offers biomechanics knowledge of orthopedic surgery and the precise image guidance of interventional radiology. With the rise of systemic cancer therapies, more patients are living with metastatic bone disease, and this new treatment paradigm could offer them a true joint reconstruction and stable fixation. Overtime, they have streamlined the technique to make their cases more efficient and precise. Despite their advances, Dr. Brown notes that MSK interventional oncology still has a long way to go. In the community, pelvic fractures usually go untreated. He speaks about the importance of outreach to radiation oncologists and orthopedic surgeons and letting them know about new methods of pelvic fixation. Dr. Brown encourages IRs who are curious about MSK interventions to get in contact with colleagues who are already doing innovative techniques and device companies that offer classes. Additionally, there is a need for innovation in instrumentation. Most pelvic intervention tools have been adopted from spine tools; however pelvic anatomy and pelvic lesions are vastly different. Dr. Lerman highlights the uniqueness of each patient’s disease, tumor, and bone lysis. He believes that there is a need to elucidate why different patients respond to different types of constructs. --- RESOURCES Institute for Limb Preservation: https://www.limbpreservationcolorado.com/ Musculoskeletal Tumor Society (MSTS): http://msts.org/ In this episode, host Jacob Fleming interviews interventional radiologist Tony Brown and orthopedic oncologist Daniel Lerman about their multidisciplinary IR/orthopedics practice and innovative techniques for pelvic fixation in metastatic cancer patients.


---


CHECK OUT OUR SPONSOR


Viz.ai

https://www.viz.ai/


---


EARN CME


Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/Bp4tmV


---


SHOW NOTES


The guests recount their first case together, a “no option” patient in which they collaborated on a tripod fixation of an acetabulum, using a combination of screw placement and cementoplasty. They realized that they were both invested in improving minimally invasive fixation and helping patients with pain management and daily functioning. Their collaboration blossomed into a joint practice of MSK interventional oncology that offers biomechanics knowledge of orthopedic surgery and the precise image guidance of interventional radiology. With the rise of systemic cancer therapies, more patients are living with metastatic bone disease, and this new treatment paradigm could offer them a true joint reconstruction and stable fixation. Overtime, they have streamlined the technique to make their cases more efficient and precise.


Despite their advances, Dr. Brown notes that MSK interventional oncology still has a long way to go. In the community, pelvic fractures usually go untreated. He speaks about the importance of outreach to radiation oncologists and orthopedic surgeons and letting them know about new methods of pelvic fixation. Dr. Brown encourages IRs who are curious about MSK interventions to get in contact with colleagues who are already doing innovative techniques and device companies that offer classes. Additionally, there is a need for innovation in instrumentation. Most pelvic intervention tools have been adopted from spine tools; however pelvic anatomy and pelvic lesions are vastly different. Dr. Lerman highlights the uniqueness of each patient’s disease, tumor, and bone lysis. He believes that there is a need to elucidate why different patients respond to different types of constructs.


---


RESOURCES


Institute for Limb Preservation:

https://www.limbpreservationcolorado.com/


Musculoskeletal Tumor Society (MSTS):

http://msts.org/

]]> 3685 Ep. 9 Disc Disease and Intradiscal Therapies with Dr. Edward Yoon In this episode, host Dr. Jacob Fleming interviews Dr. Edward Yoon, interventional MSK radiologist and Chief of IR at the Hospital for Special Surgery. The doctors discuss novel intradiscal therapies to treat anterior column pain, as well as where the field of spine interventions is heading. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/teT47L --- SHOW NOTES Dr. Yoon outlines his path to his current specialty area. His interest in orthopedics and minimally invasive techniques led him to pursue fellowships in MSK radiology and spine intervention. He highlights how MSK IR is emerging as a cousin to orthopedic surgery, in the same way that VIR is related to vascular surgery. With nine different specialties practicing interventional pain and spine procedures, Dr. Yoon believes that IRs can differentiate themselves by taking ownership of follow up care and complications management. He emphasizes the importance of building a practice instead of waiting for patients to be referred to you. He also highlights the need to collaborate with colleagues in different specialties (orthopedics, PMR, pain management) to educate them about novel IR techniques and patient populations that could benefit from these. Next, the doctors discuss the leading cause of low axial chronic back pain: stable discogenic pain. Though there has not been a proven treatment to halt degenerative disc disease, there are a few therapies that could help patients with painful symptoms. Dr. Yoon describes his use of anesthetic discogram as a diagnostic and therapeutic tool for discogenic back pain. His injectant is a mix of lidocaine and dexamethasone, and he observes if the patient experiences pain relief. Due to literature that links discograms with accelerated disc degeneration, discograms are less commonly performed today. However, Dr. Yoon believes that many younger patients already have degenerated discs when they present for evaluation and every interventional procedure poses some risk that can reasonably be evaluated in collaboration with the patient. Alongside imaging, he evaluates patient symptoms, the most common being midline back pain that gets worse with flexion or axial loading. Dr. Yoon also offers tips for reading spine MRIs, which include adopting a systematic approach, noting important incidental findings, and correlating findings with patient symptoms. Finally, Dr. Yoon highlights some exciting therapies that are currently under investigation. The VIA Disc procedure involves an allographic injection of ground up nucleus pulposus into the disc. From the VAST Trial, there is data showing that treatment responders experience pain reduction and improved functioning. Autologous injection options include platelet rich plasma (PRP) and bone marrow aspirate concentrate (BMAC). Spinal modic changes could be treated with basivertebral nerve ablation (BVNA), which is a good option that is low-risk and does not preclude the possibility of future interventions. All of these therapies come with the caveat of unreliable insurance coverage, since many private payers are hesitant about approving them. The disconnect between evidence-based therapies, patient needs, and insurance coverage needs to be addressed if these therapies are to become mainstream. --- RESOURCES VAST Clinical Trial: https://pubmed.ncbi.nlm.nih.gov/34554689/ VIA Disc NP: https://gotviadisc.com/ Owestry Disability Index (ODI): https://www.aaos.org/quality/research-resources/patient-reported-outcome-measures/spine/ SMART Trial: https://pubmed.ncbi.nlm.nih.gov/32451777/ INTRACEPT Trial: https://www.nassopenaccess.org/article/S2666-5484(21)00041-X/fulltext Thu, 15 Jun 2023 15:32:00 -0000 full BackTable In this episode, host Dr. Jacob Fleming interviews Dr. Edward Yoon, interventional MSK radiologist and Chief of IR at the Hospital for Special Surgery. The doctors discuss novel intradiscal therapies to treat anterior column pain, as well as where the field of spine interventions is heading. In this episode, host Dr. Jacob Fleming interviews Dr. Edward Yoon, interventional MSK radiologist and Chief of IR at the Hospital for Special Surgery. The doctors discuss novel intradiscal therapies to treat anterior column pain, as well as where the field of spine interventions is heading. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/teT47L --- SHOW NOTES Dr. Yoon outlines his path to his current specialty area. His interest in orthopedics and minimally invasive techniques led him to pursue fellowships in MSK radiology and spine intervention. He highlights how MSK IR is emerging as a cousin to orthopedic surgery, in the same way that VIR is related to vascular surgery. With nine different specialties practicing interventional pain and spine procedures, Dr. Yoon believes that IRs can differentiate themselves by taking ownership of follow up care and complications management. He emphasizes the importance of building a practice instead of waiting for patients to be referred to you. He also highlights the need to collaborate with colleagues in different specialties (orthopedics, PMR, pain management) to educate them about novel IR techniques and patient populations that could benefit from these. Next, the doctors discuss the leading cause of low axial chronic back pain: stable discogenic pain. Though there has not been a proven treatment to halt degenerative disc disease, there are a few therapies that could help patients with painful symptoms. Dr. Yoon describes his use of anesthetic discogram as a diagnostic and therapeutic tool for discogenic back pain. His injectant is a mix of lidocaine and dexamethasone, and he observes if the patient experiences pain relief. Due to literature that links discograms with accelerated disc degeneration, discograms are less commonly performed today. However, Dr. Yoon believes that many younger patients already have degenerated discs when they present for evaluation and every interventional procedure poses some risk that can reasonably be evaluated in collaboration with the patient. Alongside imaging, he evaluates patient symptoms, the most common being midline back pain that gets worse with flexion or axial loading. Dr. Yoon also offers tips for reading spine MRIs, which include adopting a systematic approach, noting important incidental findings, and correlating findings with patient symptoms. Finally, Dr. Yoon highlights some exciting therapies that are currently under investigation. The VIA Disc procedure involves an allographic injection of ground up nucleus pulposus into the disc. From the VAST Trial, there is data showing that treatment responders experience pain reduction and improved functioning. Autologous injection options include platelet rich plasma (PRP) and bone marrow aspirate concentrate (BMAC). Spinal modic changes could be treated with basivertebral nerve ablation (BVNA), which is a good option that is low-risk and does not preclude the possibility of future interventions. All of these therapies come with the caveat of unreliable insurance coverage, since many private payers are hesitant about approving them. The disconnect between evidence-based therapies, patient needs, and insurance coverage needs to be addressed if these therapies are to become mainstream. --- RESOURCES VAST Clinical Trial: https://pubmed.ncbi.nlm.nih.gov/34554689/ VIA Disc NP: https://gotviadisc.com/ Owestry Disability Index (ODI): https://www.aaos.org/quality/research-resources/patient-reported-outcome-measures/spine/ SMART Trial: https://pubmed.ncbi.nlm.nih.gov/32451777/ INTRACEPT Trial: https://www.nassopenaccess.org/article/S2666-5484(21)00041-X/fulltext In this episode, host Dr. Jacob Fleming interviews Dr. Edward Yoon, interventional MSK radiologist and Chief of IR at the Hospital for Special Surgery. The doctors discuss novel intradiscal therapies to treat anterior column pain, as well as where the field of spine interventions is heading.


---


CHECK OUT OUR SPONSOR


RADPAD® Radiation Protection

https://www.radpad.com/


---


EARN CME


Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/teT47L


---


SHOW NOTES


Dr. Yoon outlines his path to his current specialty area. His interest in orthopedics and minimally invasive techniques led him to pursue fellowships in MSK radiology and spine intervention. He highlights how MSK IR is emerging as a cousin to orthopedic surgery, in the same way that VIR is related to vascular surgery. With nine different specialties practicing interventional pain and spine procedures, Dr. Yoon believes that IRs can differentiate themselves by taking ownership of follow up care and complications management. He emphasizes the importance of building a practice instead of waiting for patients to be referred to you. He also highlights the need to collaborate with colleagues in different specialties (orthopedics, PMR, pain management) to educate them about novel IR techniques and patient populations that could benefit from these.


Next, the doctors discuss the leading cause of low axial chronic back pain: stable discogenic pain. Though there has not been a proven treatment to halt degenerative disc disease, there are a few therapies that could help patients with painful symptoms. Dr. Yoon describes his use of anesthetic discogram as a diagnostic and therapeutic tool for discogenic back pain. His injectant is a mix of lidocaine and dexamethasone, and he observes if the patient experiences pain relief. Due to literature that links discograms with accelerated disc degeneration, discograms are less commonly performed today. However, Dr. Yoon believes that many younger patients already have degenerated discs when they present for evaluation and every interventional procedure poses some risk that can reasonably be evaluated in collaboration with the patient. Alongside imaging, he evaluates patient symptoms, the most common being midline back pain that gets worse with flexion or axial loading. Dr. Yoon also offers tips for reading spine MRIs, which include adopting a systematic approach, noting important incidental findings, and correlating findings with patient symptoms.


Finally, Dr. Yoon highlights some exciting therapies that are currently under investigation. The VIA Disc procedure involves an allographic injection of ground up nucleus pulposus into the disc. From the VAST Trial, there is data showing that treatment responders experience pain reduction and improved functioning. Autologous injection options include platelet rich plasma (PRP) and bone marrow aspirate concentrate (BMAC). Spinal modic changes could be treated with basivertebral nerve ablation (BVNA), which is a good option that is low-risk and does not preclude the possibility of future interventions. All of these therapies come with the caveat of unreliable insurance coverage, since many private payers are hesitant about approving them. The disconnect between evidence-based therapies, patient needs, and insurance coverage needs to be addressed if these therapies are to become mainstream.


---


RESOURCES


VAST Clinical Trial:

https://pubmed.ncbi.nlm.nih.gov/34554689/


VIA Disc NP:

https://gotviadisc.com/


Owestry Disability Index (ODI):

https://www.aaos.org/quality/research-resources/patient-reported-outcome-measures/spine/


SMART Trial:

https://pubmed.ncbi.nlm.nih.gov/32451777/


INTRACEPT Trial:

https://www.nassopenaccess.org/article/S2666-5484(21)00041-X/fulltext

]]> 4266 Ep. 10 Interspinous Spacers for Spinal Stenosis Part I with Dr. Luigi Manfre Thu, 15 Jun 2023 15:32:00 -0000 full BackTable 3837 Ep. 8 Ultrasound Guided MSK Interventions with Dr. Jason Cox In this episode, guest host Dr. Jacob Fleming interviews Dr. Jason Cox about musculoskeletal interventions and how he uses ultrasound for diagnosis and intervention in his full spectrum musculoskeletal practice. --- CHECK OUT OUR SPONSOR Laurel Road for Doctors https://www.laurelroad.com/healthcare-banking/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/ZHCWxF --- SHOW NOTES We begin by discussing Dr. Cox’s path to MSK intervention. During his interventional training at University of Missouri, the musculoskeletal radiology program was rebuilt, and ultrasound was incorporated heavily. He used his ultrasound skills from vascular intervention in IR to learn musculoskeletal anatomy on ultrasound. He was drawn to MSK radiology due to the mechanical aspect of MSK work and the integration of visual spatial awareness and hand eye coordination involved in MSK ultrasound. He started out by learning steroid injections for sports injuries, commonly rotator cuff injuries. He now does around 20 diagnostic or interventional ultrasound procedures each day in his clinic. He opened his clinic with a partner, and did it slowly while still working at his prior job. He started working at his new clinic on his vacation days until he could build up the clientele to leave his prior job. One of the biggest challenges in opening his MSK radiology clinic was finding a sonographer able to do the complex MSK cases he was doing. The most common procedure Dr. Cox does at his clinic is ultrasound guided carpal tunnel release. He also does tendon barbotage for hydroxyapatite deposition disease for the rotator cuff tendons. His practice has grown largely due to the number of patients that are referred because they cannot get an MRI. He reads his ultrasound exams like an MRI report, with a high level of detail, differential diagnosis and recommendations. --- RESOURCES Institute for Advanced Medical Education: https://www.iame.com Linked In: https://www.linkedin.com/in/jasoncoxmd Ultrasound First Clinic: https://ultrasound-first.com European Society of Musculoskeletal Radiology: https://www.essr.org Thu, 15 Jun 2023 15:31:00 -0000 full BackTable In this episode, guest host Dr. Jacob Fleming interviews Dr. Jason Cox about musculoskeletal interventions and how he uses ultrasound for diagnosis and intervention in his full spectrum musculoskeletal practice. In this episode, guest host Dr. Jacob Fleming interviews Dr. Jason Cox about musculoskeletal interventions and how he uses ultrasound for diagnosis and intervention in his full spectrum musculoskeletal practice. --- CHECK OUT OUR SPONSOR Laurel Road for Doctors https://www.laurelroad.com/healthcare-banking/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/ZHCWxF --- SHOW NOTES We begin by discussing Dr. Cox’s path to MSK intervention. During his interventional training at University of Missouri, the musculoskeletal radiology program was rebuilt, and ultrasound was incorporated heavily. He used his ultrasound skills from vascular intervention in IR to learn musculoskeletal anatomy on ultrasound. He was drawn to MSK radiology due to the mechanical aspect of MSK work and the integration of visual spatial awareness and hand eye coordination involved in MSK ultrasound. He started out by learning steroid injections for sports injuries, commonly rotator cuff injuries. He now does around 20 diagnostic or interventional ultrasound procedures each day in his clinic. He opened his clinic with a partner, and did it slowly while still working at his prior job. He started working at his new clinic on his vacation days until he could build up the clientele to leave his prior job. One of the biggest challenges in opening his MSK radiology clinic was finding a sonographer able to do the complex MSK cases he was doing. The most common procedure Dr. Cox does at his clinic is ultrasound guided carpal tunnel release. He also does tendon barbotage for hydroxyapatite deposition disease for the rotator cuff tendons. His practice has grown largely due to the number of patients that are referred because they cannot get an MRI. He reads his ultrasound exams like an MRI report, with a high level of detail, differential diagnosis and recommendations. --- RESOURCES Institute for Advanced Medical Education: https://www.iame.com Linked In: https://www.linkedin.com/in/jasoncoxmd Ultrasound First Clinic: https://ultrasound-first.com European Society of Musculoskeletal Radiology: https://www.essr.org In this episode, guest host Dr. Jacob Fleming interviews Dr. Jason Cox about musculoskeletal interventions and how he uses ultrasound for diagnosis and intervention in his full spectrum musculoskeletal practice.


---


CHECK OUT OUR SPONSOR


Laurel Road for Doctors

https://www.laurelroad.com/healthcare-banking/


---


EARN CME


Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/ZHCWxF


---


SHOW NOTES


We begin by discussing Dr. Cox’s path to MSK intervention. During his interventional training at University of Missouri, the musculoskeletal radiology program was rebuilt, and ultrasound was incorporated heavily. He used his ultrasound skills from vascular intervention in IR to learn musculoskeletal anatomy on ultrasound. He was drawn to MSK radiology due to the mechanical aspect of MSK work and the integration of visual spatial awareness and hand eye coordination involved in MSK ultrasound.


He started out by learning steroid injections for sports injuries, commonly rotator cuff injuries. He now does around 20 diagnostic or interventional ultrasound procedures each day in his clinic. He opened his clinic with a partner, and did it slowly while still working at his prior job. He started working at his new clinic on his vacation days until he could build up the clientele to leave his prior job. One of the biggest challenges in opening his MSK radiology clinic was finding a sonographer able to do the complex MSK cases he was doing.


The most common procedure Dr. Cox does at his clinic is ultrasound guided carpal tunnel release. He also does tendon barbotage for hydroxyapatite deposition disease for the rotator cuff tendons. His practice has grown largely due to the number of patients that are referred because they cannot get an MRI. He reads his ultrasound exams like an MRI report, with a high level of detail, differential diagnosis and recommendations.


---


RESOURCES


Institute for Advanced Medical Education:

https://www.iame.com


Linked In:

https://www.linkedin.com/in/jasoncoxmd


Ultrasound First Clinic:

https://ultrasound-first.com


European Society of Musculoskeletal Radiology:

https://www.essr.org

]]> 3690 Ep. 7 Desmoid Tumors: IR's Role in Diagnosis and Management with Dr. Jack Jennings In this episode, host Dr. Jacob Fleming interviews Dr. Jack Jennings about cryoablation, multidisciplinary care, and practice building for the treatment of desmoid tumors. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/aNJOCP --- SHOW NOTES First, Dr. Jennings describes the typical presentation of desmoid tumors, also known as “aggressive fibromatosis.” These are neoplasms of fibrous connective tissue, but unlike sarcomas, they do not metastasize to other parts of the body. We quickly review characteristic imaging findings such as hypointense T1 and T2 signals. In the last decade, sorafenib (tyrosine kinase inhibitor) was established as a therapy for desmoid tumors. However, since sorafenib has failed to show significant efficacy, there has been exploration into other treatments such as surgical resection and cryoablation. Dr. Jennings encourages IRs to attend sarcoma tumor boards to learn about desmoid cases and opportunities to perform cryoablations when desmoids cannot be surgically resected. In extra-abdominal desmoids, cryoablation is ideal, since the interventionist can see the low attenuation ice ball forming and sculpt ablation zones to match irregular desmoid shapes. Dr. Jennings recommends forming a 10mm ablation margin around the tumor. Additionally, he discusses both active and passive thermal protection techniques for surrounding tissues. He utilizes carbon dioxide, hydropneumodissection, and motor/somatosensory evoked potentials to keep non-target tissues out of the ablation zone. The bowel and nerves (especially in the extremities) are critically important to avoid. For post-procedural care, Dr. Jennings emphasizes that pain is very common, due to large inflammatory responses. He usually admits patients overnight to monitor pain levels and give IV Decadron. Patients are then sent home with Medrol Dosepak. We also talk about the importance of informed consent about pain and potential nerve injuries. Finally, we discuss how IRs can be advocates for patients with desmoids. Dr. Jennings believes that preemptive measures can go a long way when talking to third party payers. He will usually include current National Comprehensive Cancer Network (NCCN) guidelines and current cryoablation papers in his clinic notes to support his recommendations. He also encourages IRs to collaborate with oncologists, surgeons, and radiation oncologists to craft the best treatment plan for their patients. --- RESOURCES Washington University MSK Interventions: https://www.mir.wustl.edu/education/subspecialty-programs/musculoskeletal-imaging-and-interventions/ Neuroanatomic Considerations in Percutaneous Tumor Ablation: https://pubs.rsna.org/doi/10.1148/rg.334125141 Anatomically Based Guidelines for Core Needle Biopsy of Bone Tumors: Implications for Limb-sparing Surgery: https://pubs.rsna.org/doi/10.1148/rg.271065092 National Comprehensive Cancer Network (NCCN) Guidelines for Soft Tissue Sarcomas (including Desmoid Tumors): https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1464 Society for Interventional Oncology (SIO): http://www.sio-central.org/ Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011449/ Thu, 15 Jun 2023 15:31:00 -0000 full BackTable In this episode, host Dr. Jacob Fleming interviews Dr. Jack Jennings about cryoablation, multidisciplinary care, and practice building for the treatment of desmoid tumors. In this episode, host Dr. Jacob Fleming interviews Dr. Jack Jennings about cryoablation, multidisciplinary care, and practice building for the treatment of desmoid tumors. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/aNJOCP --- SHOW NOTES First, Dr. Jennings describes the typical presentation of desmoid tumors, also known as “aggressive fibromatosis.” These are neoplasms of fibrous connective tissue, but unlike sarcomas, they do not metastasize to other parts of the body. We quickly review characteristic imaging findings such as hypointense T1 and T2 signals. In the last decade, sorafenib (tyrosine kinase inhibitor) was established as a therapy for desmoid tumors. However, since sorafenib has failed to show significant efficacy, there has been exploration into other treatments such as surgical resection and cryoablation. Dr. Jennings encourages IRs to attend sarcoma tumor boards to learn about desmoid cases and opportunities to perform cryoablations when desmoids cannot be surgically resected. In extra-abdominal desmoids, cryoablation is ideal, since the interventionist can see the low attenuation ice ball forming and sculpt ablation zones to match irregular desmoid shapes. Dr. Jennings recommends forming a 10mm ablation margin around the tumor. Additionally, he discusses both active and passive thermal protection techniques for surrounding tissues. He utilizes carbon dioxide, hydropneumodissection, and motor/somatosensory evoked potentials to keep non-target tissues out of the ablation zone. The bowel and nerves (especially in the extremities) are critically important to avoid. For post-procedural care, Dr. Jennings emphasizes that pain is very common, due to large inflammatory responses. He usually admits patients overnight to monitor pain levels and give IV Decadron. Patients are then sent home with Medrol Dosepak. We also talk about the importance of informed consent about pain and potential nerve injuries. Finally, we discuss how IRs can be advocates for patients with desmoids. Dr. Jennings believes that preemptive measures can go a long way when talking to third party payers. He will usually include current National Comprehensive Cancer Network (NCCN) guidelines and current cryoablation papers in his clinic notes to support his recommendations. He also encourages IRs to collaborate with oncologists, surgeons, and radiation oncologists to craft the best treatment plan for their patients. --- RESOURCES Washington University MSK Interventions: https://www.mir.wustl.edu/education/subspecialty-programs/musculoskeletal-imaging-and-interventions/ Neuroanatomic Considerations in Percutaneous Tumor Ablation: https://pubs.rsna.org/doi/10.1148/rg.334125141 Anatomically Based Guidelines for Core Needle Biopsy of Bone Tumors: Implications for Limb-sparing Surgery: https://pubs.rsna.org/doi/10.1148/rg.271065092 National Comprehensive Cancer Network (NCCN) Guidelines for Soft Tissue Sarcomas (including Desmoid Tumors): https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1464 Society for Interventional Oncology (SIO): http://www.sio-central.org/ Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011449/ In this episode, host Dr. Jacob Fleming interviews Dr. Jack Jennings about cryoablation, multidisciplinary care, and practice building for the treatment of desmoid tumors.


---


CHECK OUT OUR SPONSOR


RADPAD® Radiation Protection

https://www.radpad.com/


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First, Dr. Jennings describes the typical presentation of desmoid tumors, also known as “aggressive fibromatosis.” These are neoplasms of fibrous connective tissue, but unlike sarcomas, they do not metastasize to other parts of the body. We quickly review characteristic imaging findings such as hypointense T1 and T2 signals. In the last decade, sorafenib (tyrosine kinase inhibitor) was established as a therapy for desmoid tumors. However, since sorafenib has failed to show significant efficacy, there has been exploration into other treatments such as surgical resection and cryoablation.


Dr. Jennings encourages IRs to attend sarcoma tumor boards to learn about desmoid cases and opportunities to perform cryoablations when desmoids cannot be surgically resected. In extra-abdominal desmoids, cryoablation is ideal, since the interventionist can see the low attenuation ice ball forming and sculpt ablation zones to match irregular desmoid shapes. Dr. Jennings recommends forming a 10mm ablation margin around the tumor. Additionally, he discusses both active and passive thermal protection techniques for surrounding tissues. He utilizes carbon dioxide, hydropneumodissection, and motor/somatosensory evoked potentials to keep non-target tissues out of the ablation zone. The bowel and nerves (especially in the extremities) are critically important to avoid.


For post-procedural care, Dr. Jennings emphasizes that pain is very common, due to large inflammatory responses. He usually admits patients overnight to monitor pain levels and give IV Decadron. Patients are then sent home with Medrol Dosepak. We also talk about the importance of informed consent about pain and potential nerve injuries.


Finally, we discuss how IRs can be advocates for patients with desmoids. Dr. Jennings believes that preemptive measures can go a long way when talking to third party payers. He will usually include current National Comprehensive Cancer Network (NCCN) guidelines and current cryoablation papers in his clinic notes to support his recommendations. He also encourages IRs to collaborate with oncologists, surgeons, and radiation oncologists to craft the best treatment plan for their patients.


---


RESOURCES


Washington University MSK Interventions:

https://www.mir.wustl.edu/education/subspecialty-programs/musculoskeletal-imaging-and-interventions/


Neuroanatomic Considerations in Percutaneous Tumor Ablation:

https://pubs.rsna.org/doi/10.1148/rg.334125141


Anatomically Based Guidelines for Core Needle Biopsy of Bone Tumors: Implications for Limb-sparing Surgery:

https://pubs.rsna.org/doi/10.1148/rg.271065092


National Comprehensive Cancer Network (NCCN) Guidelines for Soft Tissue Sarcomas (including Desmoid Tumors):

https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1464


Society for Interventional Oncology (SIO):

http://www.sio-central.org/


Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Study:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011449/

]]> 4048 Ep. 6 Building a Musculoskeletal Interventional Oncology Service with Dr. Alan Sag Dr. Jacob Fleming talks with Dr. Alan Alper Sag about building a musculoskeletal (MSK) interventions practice at Duke University Medical Center, collaborating with other specialists, and future predictions for MSK IR. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/o00BlF --- SHOW NOTES In this episode, our host Dr. Jacob Fleming interviews Dr. Alan Sag about building a musculoskeletal (MSK) interventions practice at Duke University Medical Center, collaborating with other specialists, and future predictions for MSK IR. Dr. Sag starts the episode by sharing his unique experience abroad. His first job was centered around helping to build an IR practice at a teaching hospital in Istanbul. This process helped him discover that the key to practice building was forming foundational cross-specialty relationships. These eventually led to more patient referrals and a higher level of care coordination. When he transitioned to an academic position, Dr. Sag first saw an unmet need in bone cryoablation. He recognized that IR procedures could be powerful alternatives to opioid escalation. A key turning point for his department came when a local TV station covered one of his patient’s stories, and he saw a large increase in referrals. Dr. Sag emphasizes that it was important to ensure that the practice was set up with enough resources to accomodate a large volume of patients. Additionally, it was crucial to recognize when to say “no” to patients when a procedure was contraindicated for them. This patient-first approach also showed referring doctors that he was independently and objectively assessing patients, which helps with trust-building. As we move onto discussing multidisciplinary care, Dr. Sag says that learning another specialty’s vocabulary can greatly enhance your communication and show your desire to collaborate. He encourages IRs to be flexible and learn which conditions are important to the referring doctors. When working with anesthesiology and PM&R, IRs can offer their services to enhance their pain palliation efforts. When working with oncologists, this pain palliation can allow cancer patients to continue participating in clinical trials. Finally, we discuss the next frontiers of MSK interventions. Dr Sag is excited by the prospect of standardization of MSK training, internally cemented screws, and vertebral body stents. --- RESOURCES Dr. Alan Sag Twitter: https://twitter.com/AlanAlperMD?s=20&t=8RGQsroHPZ9Vyc-0lpkiVQ Bone Cryoablation Media Coverage: https://www.wral.com/komen-s-kohl-tries-tumor-freezing-therapy-in-ongoing-cancer-fight/18974441/ Duke Center for Brain & Spine Metastasis: http://dukecancerinstitute.org/DCBSM SpineJack System: https://strykerivs.com/products/families/spinejack-system Society of Interventional Oncology (SIO): http://www.sio-central.org/ SIO’s “Language of Oncology” Course: http://www.sio-central.org/p/cm/ld/fid=385 Visible Body Anatomy Atlas: https://www.visiblebody.com/anatomy-and-physiology-apps/human-anatomy-atlas e-Anatomy Atlas: https://www.imaios.com/en/e-Anatomy Ep. 199- Advanced Minimally Invasive Pain Interventions: https://www.backtable.com/shows/vi/podcasts/199/advanced-minimally-invasive-pain-interventions Thu, 15 Jun 2023 15:30:00 -0000 full BackTable Dr. Jacob Fleming talks with Dr. Alan Alper Sag about building a musculoskeletal (MSK) interventions practice at Duke University Medical Center, collaborating with other specialists, and future predictions for MSK IR. Dr. Jacob Fleming talks with Dr. Alan Alper Sag about building a musculoskeletal (MSK) interventions practice at Duke University Medical Center, collaborating with other specialists, and future predictions for MSK IR. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/o00BlF --- SHOW NOTES In this episode, our host Dr. Jacob Fleming interviews Dr. Alan Sag about building a musculoskeletal (MSK) interventions practice at Duke University Medical Center, collaborating with other specialists, and future predictions for MSK IR. Dr. Sag starts the episode by sharing his unique experience abroad. His first job was centered around helping to build an IR practice at a teaching hospital in Istanbul. This process helped him discover that the key to practice building was forming foundational cross-specialty relationships. These eventually led to more patient referrals and a higher level of care coordination. When he transitioned to an academic position, Dr. Sag first saw an unmet need in bone cryoablation. He recognized that IR procedures could be powerful alternatives to opioid escalation. A key turning point for his department came when a local TV station covered one of his patient’s stories, and he saw a large increase in referrals. Dr. Sag emphasizes that it was important to ensure that the practice was set up with enough resources to accomodate a large volume of patients. Additionally, it was crucial to recognize when to say “no” to patients when a procedure was contraindicated for them. This patient-first approach also showed referring doctors that he was independently and objectively assessing patients, which helps with trust-building. As we move onto discussing multidisciplinary care, Dr. Sag says that learning another specialty’s vocabulary can greatly enhance your communication and show your desire to collaborate. He encourages IRs to be flexible and learn which conditions are important to the referring doctors. When working with anesthesiology and PM&R, IRs can offer their services to enhance their pain palliation efforts. When working with oncologists, this pain palliation can allow cancer patients to continue participating in clinical trials. Finally, we discuss the next frontiers of MSK interventions. Dr Sag is excited by the prospect of standardization of MSK training, internally cemented screws, and vertebral body stents. --- RESOURCES Dr. Alan Sag Twitter: https://twitter.com/AlanAlperMD?s=20&t=8RGQsroHPZ9Vyc-0lpkiVQ Bone Cryoablation Media Coverage: https://www.wral.com/komen-s-kohl-tries-tumor-freezing-therapy-in-ongoing-cancer-fight/18974441/ Duke Center for Brain & Spine Metastasis: http://dukecancerinstitute.org/DCBSM SpineJack System: https://strykerivs.com/products/families/spinejack-system Society of Interventional Oncology (SIO): http://www.sio-central.org/ SIO’s “Language of Oncology” Course: http://www.sio-central.org/p/cm/ld/fid=385 Visible Body Anatomy Atlas: https://www.visiblebody.com/anatomy-and-physiology-apps/human-anatomy-atlas e-Anatomy Atlas: https://www.imaios.com/en/e-Anatomy Ep. 199- Advanced Minimally Invasive Pain Interventions: https://www.backtable.com/shows/vi/podcasts/199/advanced-minimally-invasive-pain-interventions Dr. Jacob Fleming talks with Dr. Alan Alper Sag about building a musculoskeletal (MSK) interventions practice at Duke University Medical Center, collaborating with other specialists, and future predictions for MSK IR.


---


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Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/o00BlF


---


SHOW NOTES


In this episode, our host Dr. Jacob Fleming interviews Dr. Alan Sag about building a musculoskeletal (MSK) interventions practice at Duke University Medical Center, collaborating with other specialists, and future predictions for MSK IR.


Dr. Sag starts the episode by sharing his unique experience abroad. His first job was centered around helping to build an IR practice at a teaching hospital in Istanbul. This process helped him discover that the key to practice building was forming foundational cross-specialty relationships. These eventually led to more patient referrals and a higher level of care coordination.


When he transitioned to an academic position, Dr. Sag first saw an unmet need in bone cryoablation. He recognized that IR procedures could be powerful alternatives to opioid escalation. A key turning point for his department came when a local TV station covered one of his patient’s stories, and he saw a large increase in referrals. Dr. Sag emphasizes that it was important to ensure that the practice was set up with enough resources to accomodate a large volume of patients. Additionally, it was crucial to recognize when to say “no” to patients when a procedure was contraindicated for them. This patient-first approach also showed referring doctors that he was independently and objectively assessing patients, which helps with trust-building.


As we move onto discussing multidisciplinary care, Dr. Sag says that learning another specialty’s vocabulary can greatly enhance your communication and show your desire to collaborate. He encourages IRs to be flexible and learn which conditions are important to the referring doctors. When working with anesthesiology and PM&R, IRs can offer their services to enhance their pain palliation efforts. When working with oncologists, this pain palliation can allow cancer patients to continue participating in clinical trials.


Finally, we discuss the next frontiers of MSK interventions. Dr Sag is excited by the prospect of standardization of MSK training, internally cemented screws, and vertebral body stents.


---


RESOURCES


Dr. Alan Sag Twitter:

https://twitter.com/AlanAlperMD?s=20&t=8RGQsroHPZ9Vyc-0lpkiVQ


Bone Cryoablation Media Coverage:

https://www.wral.com/komen-s-kohl-tries-tumor-freezing-therapy-in-ongoing-cancer-fight/18974441/


Duke Center for Brain & Spine Metastasis:

http://dukecancerinstitute.org/DCBSM


SpineJack System:

https://strykerivs.com/products/families/spinejack-system


Society of Interventional Oncology (SIO):

http://www.sio-central.org/


SIO’s “Language of Oncology” Course:

http://www.sio-central.org/p/cm/ld/fid=385


Visible Body Anatomy Atlas:

https://www.visiblebody.com/anatomy-and-physiology-apps/human-anatomy-atlas


e-Anatomy Atlas:

https://www.imaios.com/en/e-Anatomy


Ep. 199- Advanced Minimally Invasive Pain Interventions:

https://www.backtable.com/shows/vi/podcasts/199/advanced-minimally-invasive-pain-interventions

]]> 3368 Ep. 4 Extraspinal Augmentation and the Future of Vertebral Augmentation with Dr. Doug Beall In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall, interventional radiologist, about extravertebral augmentation, new technology in interventional spine, and intrathecal drug pumps. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/XssSys --- SHOW NOTES In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall, interventional radiologist, about extravertebral augmentation, new technology in interventional spine, and intrathecal drug pumps. This is the final installment of our 4-part BackTable VI series on osteoporosis treatment. We begin by discussing insufficiency fractures outside of the vertebral body. Dr. Beall discusses how he has treated insufficiency fractures of the pelvis, sacrum, acetabulum, tibia, and calcaneus. He prefers to use a combination of rebar screws and cement, and he enjoys finding innovative solutions for patients without good options for pain relief. He discusses how he recently used this technique for an SI joint fusion. Next, we discuss two exciting innovations that will propel the field of interventional spine forward in the coming years. First, they discuss disc augmentation with hydrogels such as PVA (polyvinyl alcohol), PEG (polyethylene glycol), and PVP (polyvinyl povidone) which can be used to augment the annulus and nucleus without any requirement for ablation or regeneration. Secondly, Dr. Beall discusses the possibilities of interspinous process devices such as the Minuteman® fusion device. He hopes that technology is moving from spacers (the current method) to anterior column support. He believes that this is possible via Kambin’s Triangle (the space between the exiting nerve root, superior articular process, and transverse process). Finally, we discuss Dr. Beall’s newest book, ‘Intrathecal Pump Drug Delivery’. He attributes the small number of IRs doing this procedure to a lack of familiarity and a “how-to guide”. For this reason, he published his book, which includes types of medications used in intrathecal pumps, medication concentrations, trialing doses, and how the pump is used. He welcomes all IRs interested in learning how to incorporate intrathecal pumps into their practice to reach out to him and follow him on social media to keep up to date on training courses and webinars about this topic. --- RESOURCES Dr. Douglas Beall LinkedIn: https://www.linkedin.com/in/douglas-beall-604ba68 Dr. Douglas Beall Twitter: @DougBeall Minuteman® interspinous-interlaminar fusion device: https://spinalsimplicity.com/minuteman/ Douglas Beall Books: Intrathecal Pump Drug Delivery Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation Thu, 15 Jun 2023 15:28:00 -0000 full BackTable In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall, interventional radiologist, about extravertebral augmentation, new technology in interventional spine, and intrathecal drug pumps. In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall, interventional radiologist, about extravertebral augmentation, new technology in interventional spine, and intrathecal drug pumps. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/XssSys --- SHOW NOTES In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall, interventional radiologist, about extravertebral augmentation, new technology in interventional spine, and intrathecal drug pumps. This is the final installment of our 4-part BackTable VI series on osteoporosis treatment. We begin by discussing insufficiency fractures outside of the vertebral body. Dr. Beall discusses how he has treated insufficiency fractures of the pelvis, sacrum, acetabulum, tibia, and calcaneus. He prefers to use a combination of rebar screws and cement, and he enjoys finding innovative solutions for patients without good options for pain relief. He discusses how he recently used this technique for an SI joint fusion. Next, we discuss two exciting innovations that will propel the field of interventional spine forward in the coming years. First, they discuss disc augmentation with hydrogels such as PVA (polyvinyl alcohol), PEG (polyethylene glycol), and PVP (polyvinyl povidone) which can be used to augment the annulus and nucleus without any requirement for ablation or regeneration. Secondly, Dr. Beall discusses the possibilities of interspinous process devices such as the Minuteman® fusion device. He hopes that technology is moving from spacers (the current method) to anterior column support. He believes that this is possible via Kambin’s Triangle (the space between the exiting nerve root, superior articular process, and transverse process). Finally, we discuss Dr. Beall’s newest book, ‘Intrathecal Pump Drug Delivery’. He attributes the small number of IRs doing this procedure to a lack of familiarity and a “how-to guide”. For this reason, he published his book, which includes types of medications used in intrathecal pumps, medication concentrations, trialing doses, and how the pump is used. He welcomes all IRs interested in learning how to incorporate intrathecal pumps into their practice to reach out to him and follow him on social media to keep up to date on training courses and webinars about this topic. --- RESOURCES Dr. Douglas Beall LinkedIn: https://www.linkedin.com/in/douglas-beall-604ba68 Dr. Douglas Beall Twitter: @DougBeall Minuteman® interspinous-interlaminar fusion device: https://spinalsimplicity.com/minuteman/ Douglas Beall Books: Intrathecal Pump Drug Delivery Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall, interventional radiologist, about extravertebral augmentation, new technology in interventional spine, and intrathecal drug pumps.


---


CHECK OUT OUR SPONSOR


RADPAD® Radiation Protection

https://www.radpad.com/


---


EARN CME


Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/XssSys


---


SHOW NOTES


In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall, interventional radiologist, about extravertebral augmentation, new technology in interventional spine, and intrathecal drug pumps. This is the final installment of our 4-part BackTable VI series on osteoporosis treatment.


We begin by discussing insufficiency fractures outside of the vertebral body. Dr. Beall discusses how he has treated insufficiency fractures of the pelvis, sacrum, acetabulum, tibia, and calcaneus. He prefers to use a combination of rebar screws and cement, and he enjoys finding innovative solutions for patients without good options for pain relief. He discusses how he recently used this technique for an SI joint fusion.


Next, we discuss two exciting innovations that will propel the field of interventional spine forward in the coming years. First, they discuss disc augmentation with hydrogels such as PVA (polyvinyl alcohol), PEG (polyethylene glycol), and PVP (polyvinyl povidone) which can be used to augment the annulus and nucleus without any requirement for ablation or regeneration. Secondly, Dr. Beall discusses the possibilities of interspinous process devices such as the Minuteman® fusion device. He hopes that technology is moving from spacers (the current method) to anterior column support. He believes that this is possible via Kambin’s Triangle (the space between the exiting nerve root, superior articular process, and transverse process).


Finally, we discuss Dr. Beall’s newest book, ‘Intrathecal Pump Drug Delivery’. He attributes the small number of IRs doing this procedure to a lack of familiarity and a “how-to guide”. For this reason, he published his book, which includes types of medications used in intrathecal pumps, medication concentrations, trialing doses, and how the pump is used. He welcomes all IRs interested in learning how to incorporate intrathecal pumps into their practice to reach out to him and follow him on social media to keep up to date on training courses and webinars about this topic.


---


RESOURCES


Dr. Douglas Beall LinkedIn:

https://www.linkedin.com/in/douglas-beall-604ba68


Dr. Douglas Beall Twitter: @DougBeall


Minuteman® interspinous-interlaminar fusion device:

https://spinalsimplicity.com/minuteman/


Douglas Beall Books:

Intrathecal Pump Drug Delivery

Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation

]]> 3154 Ep. 5 Radiologist as Spine and Pain Specialist with Dr. John Michels Jacob Fleming interviews interventional pain specialist and former Super Bowl champion John S. Michels about his journey into the subspecialty, pathways for getting involved in interventional pain management, and his philosophy on comprehensive patient care. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/1DSmJG --- SHOW NOTES In this episode, host Dr. Jacob Fleming interviews interventional pain specialist and former Super Bowl champion Dr. John Michels about his journey into the subspecialty, pathways for getting involved in interventional pain management, and his philosophy on comprehensive patient care. Dr. Michels describes his first career as an NFL player with the Green Bay Packers and how it taught him to be comfortable with external pressures and delayed gratification. He recounts the knee injury that led to an early retirement from the field, as well as interactions with radiologists, surgeons, and rehabilitation specialists that got him thinking about entering the field of medicine. He ended up pursuing a diagnostic residency at Baylor University, and then an additional interventional pain fellowship at the University of California at Irvine. Throughout his training, he recognizes that there is great synergistic benefit when specialists team up to provide multidisciplinary care and teach each other different skills. For example, he refined his physical exam skills by working with a PM&R physician, and he also taught other physicians how to read imaging. Dr. Michels believes that the most gratifying part of his career is the opportunity to diagnose, treat, and follow up with patients. In his Dallas-based independent OBL, he splits his time between clinic and procedural days. He enjoys seeing the impact that his interventions have on patients, and he is committed to providing alternatives to opioid use. Dr. Michels encourages more radiologists to explore the field of interventional pain, which is now recognized as a radiology subspecialty by the American Board of Radiology. Overall, when imaging is combined with physical examination and history-taking, the patient will enjoy the benefits of better diagnosis and care. --- RESOURCES Dr. John Michel’s Website: https://www.johnmichelsmd.com/ Interventional Spine & Pain: http://www.spinedallas.com/ ABR Pain Medicine Subspecialty: https://www.theabr.org/radiation-oncology/subspecialties/pain-medicine UC Irvine Pain Fellowship: https://anesthesiology.uci.edu/education-fellowships-pain-medicine.shtml Thu, 15 Jun 2023 15:28:00 -0000 full BackTable Jacob Fleming interviews interventional pain specialist and former Super Bowl champion John S. Michels about his journey into the subspecialty, pathways for getting involved in interventional pain management, and his philosophy on comprehensive patient care. Jacob Fleming interviews interventional pain specialist and former Super Bowl champion John S. Michels about his journey into the subspecialty, pathways for getting involved in interventional pain management, and his philosophy on comprehensive patient care. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/1DSmJG --- SHOW NOTES In this episode, host Dr. Jacob Fleming interviews interventional pain specialist and former Super Bowl champion Dr. John Michels about his journey into the subspecialty, pathways for getting involved in interventional pain management, and his philosophy on comprehensive patient care. Dr. Michels describes his first career as an NFL player with the Green Bay Packers and how it taught him to be comfortable with external pressures and delayed gratification. He recounts the knee injury that led to an early retirement from the field, as well as interactions with radiologists, surgeons, and rehabilitation specialists that got him thinking about entering the field of medicine. He ended up pursuing a diagnostic residency at Baylor University, and then an additional interventional pain fellowship at the University of California at Irvine. Throughout his training, he recognizes that there is great synergistic benefit when specialists team up to provide multidisciplinary care and teach each other different skills. For example, he refined his physical exam skills by working with a PM&R physician, and he also taught other physicians how to read imaging. Dr. Michels believes that the most gratifying part of his career is the opportunity to diagnose, treat, and follow up with patients. In his Dallas-based independent OBL, he splits his time between clinic and procedural days. He enjoys seeing the impact that his interventions have on patients, and he is committed to providing alternatives to opioid use. Dr. Michels encourages more radiologists to explore the field of interventional pain, which is now recognized as a radiology subspecialty by the American Board of Radiology. Overall, when imaging is combined with physical examination and history-taking, the patient will enjoy the benefits of better diagnosis and care. --- RESOURCES Dr. John Michel’s Website: https://www.johnmichelsmd.com/ Interventional Spine & Pain: http://www.spinedallas.com/ ABR Pain Medicine Subspecialty: https://www.theabr.org/radiation-oncology/subspecialties/pain-medicine UC Irvine Pain Fellowship: https://anesthesiology.uci.edu/education-fellowships-pain-medicine.shtml Jacob Fleming interviews interventional pain specialist and former Super Bowl champion John S. Michels about his journey into the subspecialty, pathways for getting involved in interventional pain management, and his philosophy on comprehensive patient care.


---


CHECK OUT OUR SPONSOR


RADPAD® Radiation Protection

https://www.radpad.com/


---


EARN CME


Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/1DSmJG


---


SHOW NOTES


In this episode, host Dr. Jacob Fleming interviews interventional pain specialist and former Super Bowl champion Dr. John Michels about his journey into the subspecialty, pathways for getting involved in interventional pain management, and his philosophy on comprehensive patient care.


Dr. Michels describes his first career as an NFL player with the Green Bay Packers and how it taught him to be comfortable with external pressures and delayed gratification. He recounts the knee injury that led to an early retirement from the field, as well as interactions with radiologists, surgeons, and rehabilitation specialists that got him thinking about entering the field of medicine. He ended up pursuing a diagnostic residency at Baylor University, and then an additional interventional pain fellowship at the University of California at Irvine.


Throughout his training, he recognizes that there is great synergistic benefit when specialists team up to provide multidisciplinary care and teach each other different skills. For example, he refined his physical exam skills by working with a PM&R physician, and he also taught other physicians how to read imaging.


Dr. Michels believes that the most gratifying part of his career is the opportunity to diagnose, treat, and follow up with patients. In his Dallas-based independent OBL, he splits his time between clinic and procedural days. He enjoys seeing the impact that his interventions have on patients, and he is committed to providing alternatives to opioid use. Dr. Michels encourages more radiologists to explore the field of interventional pain, which is now recognized as a radiology subspecialty by the American Board of Radiology. Overall, when imaging is combined with physical examination and history-taking, the patient will enjoy the benefits of better diagnosis and care.


---


RESOURCES


Dr. John Michel’s Website:

https://www.johnmichelsmd.com/


Interventional Spine & Pain:

http://www.spinedallas.com/


ABR Pain Medicine Subspecialty:

https://www.theabr.org/radiation-oncology/subspecialties/pain-medicine


UC Irvine Pain Fellowship:

https://anesthesiology.uci.edu/education-fellowships-pain-medicine.shtml

]]> 3614 Ep. 2 Primer on Medical Treatment of Osteoporosis and Non-surgical Management with Dr. Doug Beall In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall about current osteoporosis diagnosis criteria, his treatment algorithm, and recent data showing efficacy of osteoanabolic agents and vertebroplasty. --- CHECK OUT OUR SPONSOR DI4MDs https://www.di4mds.com --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/oQMiwe --- SHOW NOTES In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall about current osteoporosis diagnosis criteria, his treatment algorithm, and recent data showing efficacy of osteoanabolic agents and vertebroplasty. This is the second installment of our 4-part BackTable VI series on osteoporosis treatment. As we continue our conversation from Ep. 208, Dr. Beall outlines his typical follow up protocol for his patients. This includes DEXA scans in the first and second years, prescriptions for antiresorptive and/or osteoanabolic agents, and possible Romosozumab injections. Dr. Beall emphasizes that thoroughness is key to treating the disease process, and each encounter is a reimbursable event that can benefit both the patient and the practice. Next, we shift to talking about the American Association of Clinical Endocrinologists (AACE) diagnostic criteria for osteoporosis. Dr. Beall highlights the fact that there are 4 categories that encompass information about DEXA (T-scores), FRAX scores, and fragility fractures. Sole reliance on DEXA score cutoffs can lead to under-diagnosis and increased mortality risk for patients. Notably, any past fragility fracture in a postmenopausal woman is sufficient for an osteoporosis diagnosis. Dr. Beall shares that 82% of patients with fragility fractures do not have T-scores in the osteoporotic range. On the other hand, there are confounding factors that can give a falsely elevated T-score. As we shift to discussing medications for osteoporosis, Dr. Beall emphasizes the need to consider the order in which they are prescribed. He advocates for initially using osteo anabolics (specifically a PTH analog) for 2 years to build up bone mineral density, and then maintaining that density with antiresorptives afterwards. He notes that with the risk of bisphosphonate side effects like osteonecrosis of the jaw and atypical femur fracture, it is unwise to prescribe these antiresorptives as an initial treatment. Finally, we begin the conversation about vertebroplasty and recent trials proving its efficacy in reducing pain and improving function for patients. Tune in to our next 2 installments to learn about Dr. Beall’s clinical pearls for vertebral augmentation! --- RESOURCES Dr. Douglas Beall Twitter: @DougBeall BackTable VI Episode 94, Innovation in Spine Interventions with Dr. Douglas Beall: https://www.backtable.com/shows/vi/podcasts/94/innovation-in-spine-interventions Comparison of thoracolumbosacral orthosis and no orthosis for the treatment of thoracolumbar burst fractures: interim analysis of a multicenter randomized clinical equivalence trial (2009): https://pubmed.ncbi.nlm.nih.gov/19769510/ Comparative study of the treatment outcomes of osteoporotic compression fractures without neurologic injury using a rigid brace, a soft brace, and no brace: a prospective randomized controlled non-inferiority trial (2014): https://pubmed.ncbi.nlm.nih.gov/25471910/ The efficacy of conservative treatment of osteoporotic compression fractures on acute pain relief: a systematic review with meta-analysis (2015): https://pubmed.ncbi.nlm.nih.gov/25725810/ Clinical effect of balloon kyphoplasty in elderly patients with multiple osteoporotic vertebral fracture (2019): https://pubmed.ncbi.nlm.nih.gov/30837413/ Thu, 15 Jun 2023 15:24:00 -0000 full BackTable In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall about current osteoporosis diagnosis criteria, his treatment algorithm, and recent data showing efficacy of osteoanabolic agents and vertebroplasty. In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall about current osteoporosis diagnosis criteria, his treatment algorithm, and recent data showing efficacy of osteoanabolic agents and vertebroplasty. --- CHECK OUT OUR SPONSOR DI4MDs https://www.di4mds.com --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/oQMiwe --- SHOW NOTES In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall about current osteoporosis diagnosis criteria, his treatment algorithm, and recent data showing efficacy of osteoanabolic agents and vertebroplasty. This is the second installment of our 4-part BackTable VI series on osteoporosis treatment. As we continue our conversation from Ep. 208, Dr. Beall outlines his typical follow up protocol for his patients. This includes DEXA scans in the first and second years, prescriptions for antiresorptive and/or osteoanabolic agents, and possible Romosozumab injections. Dr. Beall emphasizes that thoroughness is key to treating the disease process, and each encounter is a reimbursable event that can benefit both the patient and the practice. Next, we shift to talking about the American Association of Clinical Endocrinologists (AACE) diagnostic criteria for osteoporosis. Dr. Beall highlights the fact that there are 4 categories that encompass information about DEXA (T-scores), FRAX scores, and fragility fractures. Sole reliance on DEXA score cutoffs can lead to under-diagnosis and increased mortality risk for patients. Notably, any past fragility fracture in a postmenopausal woman is sufficient for an osteoporosis diagnosis. Dr. Beall shares that 82% of patients with fragility fractures do not have T-scores in the osteoporotic range. On the other hand, there are confounding factors that can give a falsely elevated T-score. As we shift to discussing medications for osteoporosis, Dr. Beall emphasizes the need to consider the order in which they are prescribed. He advocates for initially using osteo anabolics (specifically a PTH analog) for 2 years to build up bone mineral density, and then maintaining that density with antiresorptives afterwards. He notes that with the risk of bisphosphonate side effects like osteonecrosis of the jaw and atypical femur fracture, it is unwise to prescribe these antiresorptives as an initial treatment. Finally, we begin the conversation about vertebroplasty and recent trials proving its efficacy in reducing pain and improving function for patients. Tune in to our next 2 installments to learn about Dr. Beall’s clinical pearls for vertebral augmentation! --- RESOURCES Dr. Douglas Beall Twitter: @DougBeall BackTable VI Episode 94, Innovation in Spine Interventions with Dr. Douglas Beall: https://www.backtable.com/shows/vi/podcasts/94/innovation-in-spine-interventions Comparison of thoracolumbosacral orthosis and no orthosis for the treatment of thoracolumbar burst fractures: interim analysis of a multicenter randomized clinical equivalence trial (2009): https://pubmed.ncbi.nlm.nih.gov/19769510/ Comparative study of the treatment outcomes of osteoporotic compression fractures without neurologic injury using a rigid brace, a soft brace, and no brace: a prospective randomized controlled non-inferiority trial (2014): https://pubmed.ncbi.nlm.nih.gov/25471910/ The efficacy of conservative treatment of osteoporotic compression fractures on acute pain relief: a systematic review with meta-analysis (2015): https://pubmed.ncbi.nlm.nih.gov/25725810/ Clinical effect of balloon kyphoplasty in elderly patients with multiple osteoporotic vertebral fracture (2019): https://pubmed.ncbi.nlm.nih.gov/30837413/ In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall about current osteoporosis diagnosis criteria, his treatment algorithm, and recent data showing efficacy of osteoanabolic agents and vertebroplasty.


---


CHECK OUT OUR SPONSOR


DI4MDs

https://www.di4mds.com


---


EARN CME


Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/oQMiwe


---


SHOW NOTES


In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall about current osteoporosis diagnosis criteria, his treatment algorithm, and recent data showing efficacy of osteoanabolic agents and vertebroplasty. This is the second installment of our 4-part BackTable VI series on osteoporosis treatment.

As we continue our conversation from Ep. 208, Dr. Beall outlines his typical follow up protocol for his patients. This includes DEXA scans in the first and second years, prescriptions for antiresorptive and/or osteoanabolic agents, and possible Romosozumab injections. Dr. Beall emphasizes that thoroughness is key to treating the disease process, and each encounter is a reimbursable event that can benefit both the patient and the practice.


Next, we shift to talking about the American Association of Clinical Endocrinologists (AACE) diagnostic criteria for osteoporosis. Dr. Beall highlights the fact that there are 4 categories that encompass information about DEXA (T-scores), FRAX scores, and fragility fractures. Sole reliance on DEXA score cutoffs can lead to under-diagnosis and increased mortality risk for patients. Notably, any past fragility fracture in a postmenopausal woman is sufficient for an osteoporosis diagnosis. Dr. Beall shares that 82% of patients with fragility fractures do not have T-scores in the osteoporotic range. On the other hand, there are confounding factors that can give a falsely elevated T-score.


As we shift to discussing medications for osteoporosis, Dr. Beall emphasizes the need to consider the order in which they are prescribed. He advocates for initially using osteo anabolics (specifically a PTH analog) for 2 years to build up bone mineral density, and then maintaining that density with antiresorptives afterwards. He notes that with the risk of bisphosphonate side effects like osteonecrosis of the jaw and atypical femur fracture, it is unwise to prescribe these antiresorptives as an initial treatment.


Finally, we begin the conversation about vertebroplasty and recent trials proving its efficacy in reducing pain and improving function for patients. Tune in to our next 2 installments to learn about Dr. Beall’s clinical pearls for vertebral augmentation!


---


RESOURCES


Dr. Douglas Beall Twitter:

@DougBeall


BackTable VI Episode 94, Innovation in Spine Interventions with Dr. Douglas Beall:

https://www.backtable.com/shows/vi/podcasts/94/innovation-in-spine-interventions


Comparison of thoracolumbosacral orthosis and no orthosis for the treatment of thoracolumbar burst fractures: interim analysis of a multicenter randomized clinical equivalence trial (2009):

https://pubmed.ncbi.nlm.nih.gov/19769510/


Comparative study of the treatment outcomes of osteoporotic compression fractures without neurologic injury using a rigid brace, a soft brace, and no brace: a prospective randomized controlled non-inferiority trial (2014):

https://pubmed.ncbi.nlm.nih.gov/25471910/


The efficacy of conservative treatment of osteoporotic compression fractures on acute pain relief: a systematic review with meta-analysis (2015):

https://pubmed.ncbi.nlm.nih.gov/25725810/


Clinical effect of balloon kyphoplasty in elderly patients with multiple osteoporotic vertebral fracture (2019):

https://pubmed.ncbi.nlm.nih.gov/30837413/

]]> 2772 Ep. 3 Modern Vertebral Augmentation with Dr. Doug Beall In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall, interventional radiologist, about the latest advances in vertebral augmentation, how to reduce complications, and tips for producing successful and sustainable outcomes. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/PdIxV5 --- SHOW NOTES In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall, interventional radiologist, about the latest advances in vertebral augmentation, how to reduce complications, and tips for producing successful and sustainable outcomes. This is the third installment of our 4-part BackTable VI series on osteoporosis treatment. Dr. Beall begins by discussing the newest technique in the treatment of vertebral compression fractures, screw-assisted vertebral augmentation, with emphasis on how it can decrease the excessive vertebral motion induced by a fracture. He uses the three-column approach (anterior, middle, and posterior column) using SpineJack in the front and pedicle screws in the back. They also discuss vertebral body stents and shaped balloons, two emerging technologies that will be available soon. Next, they discuss complications in kyphoplasty and vertebral body augmentation. Dr. Beall shares how to recognize various types of cement extravasation. Importantly, if the cement starts to form a lenticular shape, stop injecting because continued injection will cause the cement to enter the spinal canal. The lenticular, biconvex shape that occurs with this pattern is due to the anterior epidural ligaments and midline anterior epidural ligament. He says to let the cement harden in the anterior epidural space once you reach the basivertebral plexus, and then continue injecting. Extravasation, to some degree, is normal, and recognizing where it is going is the key to avoiding complications. We end by discussing how to improve outcomes. Dr. Beall says that injecting more cement is the best way to produce better outcomes. Lastly, he adds that filling the cleft is the best way to achieve the greatest degree of pain reduction, which ultimately is what indicates a successful outcome. --- RESOURCES Dr. Douglas Beall Twitter: @DougBeall BackTable VI Episode 94, Innovation in Spine Interventions with Dr. Douglas Beall: https://www.backtable.com/shows/vi/podcasts/94/innovation-in-spine-interventions Cianfoni publication on Stent-Screw-Assisted Internal Fixation (SAIF): https://jnis.bmj.com/content/11/6/603 Venmans publication on Pulmonary Emboli during Vertebroplasty: www.ajnr.org/content/29/10/1983 Thu, 15 Jun 2023 15:24:00 -0000 full BackTable In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall, interventional radiologist, about the latest advances in vertebral augmentation, how to reduce complications, and tips for producing successful and sustainable outcomes. In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall, interventional radiologist, about the latest advances in vertebral augmentation, how to reduce complications, and tips for producing successful and sustainable outcomes. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/PdIxV5 --- SHOW NOTES In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall, interventional radiologist, about the latest advances in vertebral augmentation, how to reduce complications, and tips for producing successful and sustainable outcomes. This is the third installment of our 4-part BackTable VI series on osteoporosis treatment. Dr. Beall begins by discussing the newest technique in the treatment of vertebral compression fractures, screw-assisted vertebral augmentation, with emphasis on how it can decrease the excessive vertebral motion induced by a fracture. He uses the three-column approach (anterior, middle, and posterior column) using SpineJack in the front and pedicle screws in the back. They also discuss vertebral body stents and shaped balloons, two emerging technologies that will be available soon. Next, they discuss complications in kyphoplasty and vertebral body augmentation. Dr. Beall shares how to recognize various types of cement extravasation. Importantly, if the cement starts to form a lenticular shape, stop injecting because continued injection will cause the cement to enter the spinal canal. The lenticular, biconvex shape that occurs with this pattern is due to the anterior epidural ligaments and midline anterior epidural ligament. He says to let the cement harden in the anterior epidural space once you reach the basivertebral plexus, and then continue injecting. Extravasation, to some degree, is normal, and recognizing where it is going is the key to avoiding complications. We end by discussing how to improve outcomes. Dr. Beall says that injecting more cement is the best way to produce better outcomes. Lastly, he adds that filling the cleft is the best way to achieve the greatest degree of pain reduction, which ultimately is what indicates a successful outcome. --- RESOURCES Dr. Douglas Beall Twitter: @DougBeall BackTable VI Episode 94, Innovation in Spine Interventions with Dr. Douglas Beall: https://www.backtable.com/shows/vi/podcasts/94/innovation-in-spine-interventions Cianfoni publication on Stent-Screw-Assisted Internal Fixation (SAIF): https://jnis.bmj.com/content/11/6/603 Venmans publication on Pulmonary Emboli during Vertebroplasty: www.ajnr.org/content/29/10/1983 In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall, interventional radiologist, about the latest advances in vertebral augmentation, how to reduce complications, and tips for producing successful and sustainable outcomes.


---


CHECK OUT OUR SPONSOR


RADPAD® Radiation Protection

https://www.radpad.com/


---


EARN CME


Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/PdIxV5


---


SHOW NOTES


In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall, interventional radiologist, about the latest advances in vertebral augmentation, how to reduce complications, and tips for producing successful and sustainable outcomes. This is the third installment of our 4-part BackTable VI series on osteoporosis treatment.


Dr. Beall begins by discussing the newest technique in the treatment of vertebral compression fractures, screw-assisted vertebral augmentation, with emphasis on how it can decrease the excessive vertebral motion induced by a fracture. He uses the three-column approach (anterior, middle, and posterior column) using SpineJack in the front and pedicle screws in the back. They also discuss vertebral body stents and shaped balloons, two emerging technologies that will be available soon.


Next, they discuss complications in kyphoplasty and vertebral body augmentation. Dr. Beall shares how to recognize various types of cement extravasation. Importantly, if the cement starts to form a lenticular shape, stop injecting because continued injection will cause the cement to enter the spinal canal. The lenticular, biconvex shape that occurs with this pattern is due to the anterior epidural ligaments and midline anterior epidural ligament. He says to let the cement harden in the anterior epidural space once you reach the basivertebral plexus, and then continue injecting. Extravasation, to some degree, is normal, and recognizing where it is going is the key to avoiding complications.


We end by discussing how to improve outcomes. Dr. Beall says that injecting more cement is the best way to produce better outcomes. Lastly, he adds that filling the cleft is the best way to achieve the greatest degree of pain reduction, which ultimately is what indicates a successful outcome.


---


RESOURCES


Dr. Douglas Beall Twitter:

@DougBeall


BackTable VI Episode 94, Innovation in Spine Interventions with Dr. Douglas Beall:

https://www.backtable.com/shows/vi/podcasts/94/innovation-in-spine-interventions


Cianfoni publication on Stent-Screw-Assisted Internal Fixation (SAIF):

https://jnis.bmj.com/content/11/6/603


Venmans publication on Pulmonary Emboli during Vertebroplasty:

www.ajnr.org/content/29/10/1983

]]> 2140 Ep. 1 Why We Need to Be Treating Osteoporosis for Our Compression Fracture Patients with Dr. Doug Beall In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall about the importance of interventional radiologists stepping up to address the entire picture of osteoporosis and taking the initiative to treat the underlying cause of the disease. --- CHECK OUT OUR SPONSOR Laurel Road for Doctors https://www.laurelroad.com/healthcare-banking/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/xVGPFx --- SHOW NOTES In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall about the importance of interventional radiologists stepping up to address the entire picture of osteoporosis and taking the initiative to treat the underlying cause of the disease. This is the first installment of our 4-part BackTable VI series on osteoporosis treatment. Dr. Beall starts by stating his mission: he not only performs vertebral augmentation; he also offers DXA scans and T-score analysis, prescribes osteoanabolic agents, and follows up with patients over time. Dr. Beall cites data showing that both vertebral augmentation and osteoporosis medications can improve patients’ quality of life and significantly reduce mortality. Even with newer osteoanabolic agents like Teriparatide, Abaloparatide, and Romosozumab being approved for treatment, osteoporosis screening rates have dropped in recent years. This is a pressing concern, since osteoporosis is a growing societal burden, given the increasing population of elderly patients. Furthermore, treatment of osteoporosis allows patients to regain mobility, which reduces comorbidities. We finish this episode by discussing how IRs have the potential to learn about osteoanabolic medications, counsel patients, and take ownership of this disease process. --- RESOURCES Dr. Douglas Beall Twitter: @DougBeall BackTable VI Episode 94, Innovation in Spine Interventions with Dr. Douglas Beall: https://www.backtable.com/shows/vi/podcasts/94/innovation-in-spine-interventions Number Needed to Treat with Vertebral Augmentation to Save a Life: http://www.ajnr.org/content/early/2019/12/19/ajnr.A6367 Risk of Mortality Following Clinical Fractures: https://pubmed.ncbi.nlm.nih.gov/11069188/ Prospective and Multicenter Evaluation of Outcomes for Quality of Life and Activities of Daily Living for Balloon Kyphoplasty in the Treatment of Vertebral Compression Fractures: The EVOLVE Trial: https://journals.lww.com/neurosurgery/Fulltext/2019/01000/Prospective_and_Multicenter_Evaluation_of_Outcomes.20.aspx Thu, 15 Jun 2023 15:21:00 -0000 full BackTable In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall about the importance of interventional radiologists stepping up to address the entire picture of osteoporosis and taking the initiative to treat the underlying cause of the disease. In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall about the importance of interventional radiologists stepping up to address the entire picture of osteoporosis and taking the initiative to treat the underlying cause of the disease. --- CHECK OUT OUR SPONSOR Laurel Road for Doctors https://www.laurelroad.com/healthcare-banking/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/xVGPFx --- SHOW NOTES In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall about the importance of interventional radiologists stepping up to address the entire picture of osteoporosis and taking the initiative to treat the underlying cause of the disease. This is the first installment of our 4-part BackTable VI series on osteoporosis treatment. Dr. Beall starts by stating his mission: he not only performs vertebral augmentation; he also offers DXA scans and T-score analysis, prescribes osteoanabolic agents, and follows up with patients over time. Dr. Beall cites data showing that both vertebral augmentation and osteoporosis medications can improve patients’ quality of life and significantly reduce mortality. Even with newer osteoanabolic agents like Teriparatide, Abaloparatide, and Romosozumab being approved for treatment, osteoporosis screening rates have dropped in recent years. This is a pressing concern, since osteoporosis is a growing societal burden, given the increasing population of elderly patients. Furthermore, treatment of osteoporosis allows patients to regain mobility, which reduces comorbidities. We finish this episode by discussing how IRs have the potential to learn about osteoanabolic medications, counsel patients, and take ownership of this disease process. --- RESOURCES Dr. Douglas Beall Twitter: @DougBeall BackTable VI Episode 94, Innovation in Spine Interventions with Dr. Douglas Beall: https://www.backtable.com/shows/vi/podcasts/94/innovation-in-spine-interventions Number Needed to Treat with Vertebral Augmentation to Save a Life: http://www.ajnr.org/content/early/2019/12/19/ajnr.A6367 Risk of Mortality Following Clinical Fractures: https://pubmed.ncbi.nlm.nih.gov/11069188/ Prospective and Multicenter Evaluation of Outcomes for Quality of Life and Activities of Daily Living for Balloon Kyphoplasty in the Treatment of Vertebral Compression Fractures: The EVOLVE Trial: https://journals.lww.com/neurosurgery/Fulltext/2019/01000/Prospective_and_Multicenter_Evaluation_of_Outcomes.20.aspx In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall about the importance of interventional radiologists stepping up to address the entire picture of osteoporosis and taking the initiative to treat the underlying cause of the disease.


---


CHECK OUT OUR SPONSOR


Laurel Road for Doctors

https://www.laurelroad.com/healthcare-banking/


---


EARN CME


Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/xVGPFx


---


SHOW NOTES


In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall about the importance of interventional radiologists stepping up to address the entire picture of osteoporosis and taking the initiative to treat the underlying cause of the disease. This is the first installment of our 4-part BackTable VI series on osteoporosis treatment.


Dr. Beall starts by stating his mission: he not only performs vertebral augmentation; he also offers DXA scans and T-score analysis, prescribes osteoanabolic agents, and follows up with patients over time. Dr. Beall cites data showing that both vertebral augmentation and osteoporosis medications can improve patients’ quality of life and significantly reduce mortality.


Even with newer osteoanabolic agents like Teriparatide, Abaloparatide, and Romosozumab being approved for treatment, osteoporosis screening rates have dropped in recent years. This is a pressing concern, since osteoporosis is a growing societal burden, given the increasing population of elderly patients. Furthermore, treatment of osteoporosis allows patients to regain mobility, which reduces comorbidities. We finish this episode by discussing how IRs have the potential to learn about osteoanabolic medications, counsel patients, and take ownership of this disease process.


---


RESOURCES


Dr. Douglas Beall Twitter:

@DougBeall


BackTable VI Episode 94, Innovation in Spine Interventions with Dr. Douglas Beall:

https://www.backtable.com/shows/vi/podcasts/94/innovation-in-spine-interventions


Number Needed to Treat with Vertebral Augmentation to Save a Life:

http://www.ajnr.org/content/early/2019/12/19/ajnr.A6367

Risk of Mortality Following Clinical Fractures:

https://pubmed.ncbi.nlm.nih.gov/11069188/


Prospective and Multicenter Evaluation of Outcomes for Quality of Life and Activities of Daily Living for Balloon Kyphoplasty in the Treatment of Vertebral Compression Fractures: The EVOLVE Trial:

https://journals.lww.com/neurosurgery/Fulltext/2019/01000/Prospective_and_Multicenter_Evaluation_of_Outcomes.20.aspx

]]> 1918