BackTable MSK

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/

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

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

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/

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/

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

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

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 to the Podcast 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

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/

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

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

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

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

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 https://www.medtronic.com/ --- 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

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

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

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

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/

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

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 https://www.medtronic.com/en-us/index.html --- 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

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

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

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

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. --- CHECK OUT OUR SPONSOR Guerbet https://www.guerbet-us.com --- 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/

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

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

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

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

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

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

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

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

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/

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. 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

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, 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. 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 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/

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

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, 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 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 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