Episoder
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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
https://www.medtronic.com/
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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 -
Manglende episoder?
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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
https://www.medtronic.com/en-us/index.html
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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 -
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.
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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.
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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
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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.
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This podcast is supported by an educational grant from:
Guerbet
https://www.guerbet-us.com
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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.
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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
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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.
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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 -
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 - Vis mere
