Afleveringen
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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.
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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.
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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.
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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
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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.
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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
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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/ -
Zijn er afleveringen die ontbreken?
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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.
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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.
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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
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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.
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This podcast is supported by:
Medtronic MVP
https://www.medtronic.com/mvp
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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.
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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.
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This podcast is supported by:
Medtronic Interventional
https://www.medtronic.com/interventional
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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.
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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
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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.
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This podcast is supported by:
Medtronic Interventional
https://www.medtronic.com/interventional
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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).
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TIMESTAMPS
00:00 - Introduction
01:17 - Overview of Lumbar Discogram Technique
04:56 - Contrast Injection and Pain Response
07:40 - Therapeutic Injections
10:00 - Discography Under CT Guidance
12:43 - Strategies for Challenging Cases
17:52 - Protocol for Infection Prevention
20:15 - Post-Discogram Treatment Options
21:30 - Emerging Therapies
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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.
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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
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This podcast is supported by:
Medtronic Interventional
https://www.medtronic.com/interventional
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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.
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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
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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.
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This podcast is supported by an educational grant from:
Medtronic
https://www.medtronic.com/
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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.
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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
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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.
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This podcast is supported by:
Quantum Surgical
https://www.quantumsurgical.com/
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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.
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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
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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 -
How can we ensure long-term spine health after tumor ablation? In this follow-up to our previous discussion, Dr. Glade Roper returns to the show to focus on early kyphoplasty treatment for ablation patients, aiming to prevent kyphosis and postural fatigue syndrome.
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This podcast is supported by an educational grant from Medtronic.
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SYNPOSIS
Dr. Roper provides detailed advice on performing kyphoplasty effectively, including methods to ensure optimal cement fill and the use of various tools. He also discusses the challenges of treating irradiated bones, the importance of restoring sagittal alignment for patients, and the need to accurately assess fracture morphologies on imaging.
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TIMESTAMPS
00:00 Kyphoplasty Tips and Tools
10:05 Impact of Radiation Therapy on the Spine
15:43 Cement Injection Techniques
25:00 Prevention of Postural Fatigue Syndrome
30:12 Fracture Morphology on Imaging
34:33 Balancing Work and Personal Life
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RESOURCES
BackTable MSK Ep. 63- Building a Bone Tumor Ablation Practice, Part 1:
https://www.backtable.com/shows/msk/podcasts/63/building-a-bone-tumor-ablation-practice-part-1
BackTable VI Ep. 211- Extra-Spinal Augmentation & The Future of Vertebral Augmentation:
https://www.backtable.com/shows/vi/podcasts/211/extraspinal-augmentation-the-future-of-vertebral-augmentation
Kyphon V System:
https://www.medtronic.com/en-us/healthcare-professionals/products/spinal-orthopedic/vertebral-augmentation/vertebroplasty/kyphon-v-premium-vertebroplasty-platform.html -
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.
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This podcast is supported by an educational grant from Medtronic.
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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.
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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
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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.
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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.
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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
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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.
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This podcast is supported by an educational grant from Medtronic.
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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.
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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
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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.
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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.
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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 - Laat meer zien
