Afleveringen
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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.
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CHECK OUT OUR SPONSOR
Stryker Interventional Spine
https://www.strykerivs.com
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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.
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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 -
Zijn er afleveringen die ontbreken?
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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.
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CHECK OUT OUR SPONSOR
Stryker Interventional Spine
https://www.strykerivs.com
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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.
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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
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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.
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CHECK OUT OUR SPONSOR
Stryker Interventional Spine
https://www.strykerivs.com
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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.
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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
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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.
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CHECK OUT OUR SPONSOR
Stryker Interventional Spine
https://www.strykerivs.com
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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.
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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
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RESOURCES
OGSIVEO (Nirogacestat):
https://www.ogsiveo.com/ -
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 -
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 -
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.
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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.
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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
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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.
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CHECK OUT OUR SPONSOR
Stryker Interventional Spine
https://www.strykerivs.com
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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.
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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
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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.
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CHECK OUT OUR SPONSOR
Stryker Interventional Spine
https://www.strykerivs.com
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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.
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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
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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 -
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 -
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 -
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.
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CHECK OUT OUR SPONSOR
Boston Scientific Visual ICE Cryoablation System
https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html
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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.
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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
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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.
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CHECK OUT OUR SPONSOR
Nevro HFX Spinal Cord Stimulator
https://www.hfxforpdn.com
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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
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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.
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CHECK OUT OUR SPONSOR
Merit Spine
https://www.merit.com/merit-spine/
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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/ - Laat meer zien
