Folgen
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It’s comeback season! What’s bringing lateral extra-articular tenodesis (LET) back to the landscape of ACL surgery? In this episode of BackTable Bone & Sports, Dr. Larry Balle joins sports orthopedic surgeon and knee specialist Dr. Kyle Borque to discuss the resurgence of lateral extra-articular tenodesis (LET) as an adjunct to ACL repair and reconstruction. They explore LET’s origins as a solution for rotation instability in the era of open ACL surgery, and examine how modern arthroscopic techniques, patient selection, and surgical evidence have driven LET’s renewed relevance in today's practice.
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Timestamps
00:00 - Introduction 02:36 - LET Origin Story14:16 - Modern LET Technique Updates23:13 - A Run-Down of the Procedure in the OR26:54 - Patient Selection for LET34:18 - Supporting LET with Published Evidence38:43 - Rehab After LET44:33 - Dismissing OA Concerns50:10 - Case Example: ACL Revision53:02 - Wrap Up
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More about this episode
The Drs. highlight the anatomy considerations, technical modifications, and the evidence that supports LET’s role in reducing graft failure, without changing rehab or increasing lateral OA risk. They compare LET with anterolateral ligament (ALL) reconstruction, emphasizing anatomy and technical approach. Dr. Borque details his modified technique using an iliotibial (IT) band strip fixed proximal and posterior to the lateral epicondyle of the femur. Furthermore, the doctors discuss selection factors for high-risk and revision patients, tactics to avoid overconstraint, and tips for patient counseling. They review the latest evidence, outline perioperative protocols, and address persistent myths about LET’s impact on recovery and osteoarthritis. The doctors highlight a real-world case example and the actionable insights for orthopedic surgeons to optimize ACL outcomes.
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Resources
Dr. Larry Ballehttps://www.linkedin.com/in/larry-balle-ii/
Dr. Kyle Borquehttps://www.drborque.com/
Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial https://pubmed.ncbi.nlm.nih.gov/31940222/
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BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists.
Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.
► https://www.backtable.com/app -
“The athlete’s job is to stay consistent with rehab and to be hungry to get back on the field. I think our job as a sports medicine team is to make sure that they’re safe and that they can perform.” In this episode of BackTable MSK, guest host and sports medicine physician Dr. Larry Balle joins physical therapist/athletic trainer Andy Glidewell to discuss how “return to play” is defined and why it is often misunderstood among athletes, coaches, physicians, and rehab teams.
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Get the BackTable apphttps://www.backtable.com/app
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Timestamps
00:00 - Introduction 04:25 - Return to Play from the Lens of Physical Therapy vs. Sports Medicine12:11 - Evidence-based vs. Anecdotal-based Practice for Return to Play21:18 - Is there an Appropriate Team Approach? 24:25 - Continuing Conservative Management vs. Surgical Intervention34:01 - Notes on a High-Profile Sports Medicine Case40:20 - The Influence of NIL on College Athletics42:51 - Obtaining Objective Metrics for Clearance52:38 - Influence of AI on Return to Play Algorithms 57:11 - Final Takeaways
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More about this episode
They emphasize that return to play is a milestone-based rehabilitation phase requiring clear communication, collaboration, and risk management, rather than rigid timelines or just “vibes.”
The conversation covers how evidence and objectivity have shaped protocols (notably ACL timelines), the role of prognostic indicators in operative vs. non-operative decisions, and practical use of functional strength and agility reassessment. They also address pressures of working with elite sport and NIL (Name, Image, Likeness) considerations. Furthermore, they expand on how AI may inform, but not replace, the humanistic and team-based components of decision making.
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Resources
Dr. Larry Ballehttps://www.linkedin.com/in/larry-balle-ii/
Dr. Andy Glidewellhttps://uamshealth.com/provider/michael-a-glidewell/
The Journal of Orthopedic and Sports Physical Therapyhttps://www.jospt.org/
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BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons.
Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.
► https://www.backtable.com/app -
Fehlende Folgen?
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Beyond the basics: anatomy, technique, and clinical pearls for the evolving world of hip embolization. In this episode of BackTable MSK, we dive into the fine details of hip embolization. In Part II of this two-part series, Brazilian interventionalists, Dr. Mateus Correa and Dr. Joaquim Filho, return with host Dr. Kavi Krishnasamy, to explore the nuances of hip embolization and reviewing real-world case studies.
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Get the BackTable apphttps://www.backtable.com/app
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Timestamps
00:00 - Introduction 01:17 - Explanation of Hip Physical Exam Maneuvers 04:30 - Overview of Hip Embolization Technique with Anatomy10:10 - Case 1: Awake Superselective Angiography and Procedure Technique for GTPS Patient12:43 - Case 2: Patient Presents with Hip Pain, Increased Since L3 Compression Fracture18:15 - Mixing Imipenem20:40 - Overview of Hip Embolization Scientific Data32:52 - Closure Techniques and Final Thoughts
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More about this episode
Together, they apply the foundational skills of physical exam and procedure technique, including detailed anatomy, procedural technique, and hip physical exam maneuvers.The discussion also covers the latest research on the use of temporary embolization agents. Looking for a way to mix your Imipenem? Tune in for a “how to” and other intricate insights.
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Resources
Dr. Mateus Correahttps://www.researchgate.net/profile/Mateus-Correa-4
Dr. Joaquim Filhohttps://www.researchgate.net/profile/Joaquim-Da-Motta-Leal-Filho
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BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons.Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.
► https://www.backtable.com/app -
Ready to shake up hip pain management? In this episode of BackTable MSK, we unpack how embolization is opening a new frontier for patients caught between conservative care and surgery. Interventional radiologist Dr. Kavi Krishnasamy hosts Brazilian interventionalists, Dr. Mateus Correa and Dr. Joaquim Filho, to discuss hip embolization for Greater Trochanteric Pain Syndrome (GTPS) and early hip Osteoarthritis (OA). The doctors highlight building multidisciplinary referrals, reimbursement, and the availability of embolic agents. They also address pre-procedure workup, including imaging and physical exam findings.
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Get the BackTable apphttps://www.backtable.com/app
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Timestamps
00:00 - Introduction 02:37 - Guest Background in MSK Embolization 08:14 - Availability of Embolics and Preferences in Brazil 10:31 - Reimbursement and Access Hurdles13:55 - Hip Etiologies Treated by Embolization 16:54 - Imaging Workup and the Role of MRI24:23 - Offering Conservative Treatment Options Prior to Embolization 26:52 - Scoring Systems and Physical Exam34:44 - Procedure Access Strategy39:16 - When to Utilize Temporary vs. Permanent Embolics46:34 - Post-Procedure and Follow-Up Guidelines58:05 - Discussion of Current Evidence
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More about this episode
At the time of the procedure, Drs. Correa and Filho explain why they prefer certain vascular access points and specify arterial targets, favoring temporary embolic agents due to potential risk of Avascular Necrosis (AVN) of the femoral head. Furthermore, the doctors detail awake procedures with intraprocedural palpation and blush/pain-based endpoints, post-embolization pain flare management, follow-up schedules, and re-treatment criteria; all with consideration for current published evidence.
---Resources
Dr. Mateus Correahttps://www.researchgate.net/profile/Mateus-Correa-4
Dr. Joaquim Filhohttps://www.researchgate.net/profile/Joaquim-Da-Motta-Leal-Filho
---
BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons.Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.
► https://www.backtable.com/app -
Caught between conservative care and a large spine surgery, the MILD procedure offers potential as the in-between. On this episode of the BackTable MSK Podcast, Interventional Radiologist Dr. Dana Dunleavy welcomes pain specialist Dr. Denis Patterson to explore the evidence, technique, and evolving role of Minimally Invasive Lumbar Decompression (MILD) procedure for lumbar spinal stenosis with neurogenic claudication.
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Get the BackTable apphttps://www.backtable.com/app
---
This podcast is supported by
Strykerhttps://www.stryker.com/us/en/interventional-spine/products/mild-procedure.html
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Timestamps
00:00 - Introduction04:22 - What is the MILD procedure?09:55 - Comparing Discogenic Pain to Neurogenic Claudication 19:20 - MILD Procedure Technique 22:54 - Toolbox and Workflow36:59 - MILD Makes a Difference in the Pain Management Field41:53 - Objectifying Pain Measurements and Setting Patient Expectations46:26 - Driving Mutual Understanding in Surgical Cohorts 01:00:53 - Collaboration Over Competition01:05:32 - Final Takeaways
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More about this episode
Dr. Patterson explains the pathophysiology and diagnostic process, highlighting key insights from patient history and MRI findings. The physicians review technique evolution from multiple paramedian incisions and epidurograms to streamlined single midline incision access, and cross lateral oblique (CLO) fluoroscopic safety landmarks.
The discussion also references the MiDAS and Cleveland Clinic studies showing pain and functional improvement with a complication rate similar to epidural steroid injections, along with promising long-term outcomes and reduced need for surgical re-intervention. This episode also tackles practical considerations, including the impact of Category I CPT codes on reimbursement, challenges in radiology reporting, privileging politics, and pathways for physician training and proctoring.
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Resources
Dr. Denis Pattersonhttps://www.linkedin.com/in/denis-patterson-50ba0485/
MiDAS I (Mild Decompression Alternative to Open Surgery): a preliminary report of a prospective, multi-center clinical studyhttps://pubmed.ncbi.nlm.nih.gov/20648206/
The durability of Minimally Invasive Lumbar Decompression procedure in patients with symptomatic lumbar spinal stenosis: Long-term follow-uphttps://pubmed.ncbi.nlm.nih.gov/33942964/
Pacific Spine and Pain Societyhttps://pacificspineandpainsociety.com/
---
BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons.
Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.
► https://www.backtable.com/app -
The embolization playbook is expanding. The question is: are you ready to use it? In this episode of the BackTable MSK Podcast, host Dr. Ally Bahehi joins Dr. Mikin Patel and Dr. Osmad Ahmed from Joint and Vascular Institute in the greater Chicago area to discuss plantar fasciitis embolization; a newer MSK embolization technique, building from concepts and clinical pearls for genicular artery embolization (GAE).
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Get the BackTable app
https://www.backtable.com/app
---
Timestamps
00:00 - Introduction01:18 - Ideal Patient for Plantar Fasciitis Embolization02:14 - Workup, Imaging Needs, and the Reality of Insurance Coverage 03:53 - Benefits And Expectations06:05 - Step By Step Procedure Walkthrough11:29 - Pain Relief and Follow-Up Timeline13:46 - GAE Case Setup14:54 - Debating Access Strategy 15:54 - Crash Course in Genicular Artery Anatomy19:08 - Minimalist GAE Toolkit Set-Up22:32 - Time to Inject! The Wrap Up
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Resources
Dr. Mikin Patelhttps://jointvascular.com/team/mikin-v-patel-md-mba/
Dr. Osman Ahmedhttps://jointvascular.com/team/osman-ahmed-m-d-fcirse/ -
Every new device and technique comes with a learning curve, and in this BackTable MSK Brief we’re navigating pelvic curves. Host Dr. Kavi Krishnasamy joins Dr. Brandon Key to dissect pelvic and sacral fixation techniques. They discuss patient positioning and prep to needle-guidance software, with procedural pearls scattered throughout the conversation.
Episode Outline
00:00 - Introduction
00:26 - Pelvic Positioning Strategy
04:00 - Need to Know: Needle Guidance
09:20 - Thermoablation in Pathologic Fracture Fixation
13:29 - The Photodynamic Nail by IlluminOss: An Overview
20:00 - Finding The Way with a Curved Trajectory
22:52 - Wrap Up
Resources
Dr. Brandon Key, MD
https://www.linkedin.com/in/brandon-key-md-367a01310/
IlluminOss
https://illuminoss.com/us -
For patients who have exhausted conservative management but aren’t ready for the knife, shoulder embolization offers a minimally invasive intermediary option. In this episode of BackTable MSK, host Kavi Krishnasamy welcomes Dr. Yan Epelboym, an interventional radiologist trailblazing the MSK IR space. The doctors discuss the rapid development of musculoskeletal embolization applications with an emphasis on shoulder embolization.
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SYNPOSIS
The episode begins with Dr. Epelboym outlining how his interest in musculoskeletal embolization developed after exposure to Okuno’s early work, along with practical considerations for establishing referral pathways for these procedures. He also provides updates on the ongoing ELECTRC clinical trial at Brigham and Women’s Hospital evaluating shoulder embolization. The discussion then turns to outcome measurement, including pain scoring systems and approaches to standardized clinical follow-up. The conversation concludes with a review of the existing literature on adhesive capsulitis, including a meta-analysis demonstrating improvements in pain and range of motion with predominantly minor adverse events, while emphasizing the ongoing need for randomized trials and greater procedural standardization.
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TIMESTAMPS
00:00 - Introduction 01:42 - Dr. Yan Epelboym’s Origin Story in MSK03:02 - Building Referral Networks06:50 - Details on Clinic Workflow 10:08 - The Run Down on Shoulder Embolization Treatment Targets22:09 - Current Insights on Shoulder OA Embolization27:56 - Shoulder Embolization Setup and Access Choice34:28 - Shoulder Embolization Strategy and Endpoints36:38 - Post-Procedure Pain Control and Activity Limitations42:26 - Shoulder Surgery Status-Post Embolization44:17 - Discussing Existing Research Data on Shoulder Embolization01:00:32 - Key Shoulder Arterial Anatomy and Variants01:04:27 - Shoulder OA Case Discussion01:09:08 - Final Thoughts
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RESOURCES
Dr. Yan Epelboym, MD, MPHhttps://www.linkedin.com/in/yan-epelboym-4a84991b/
Embolization Treatment of Chronic Refractory Shoulder Tendinopathy (ELECTRC)https://clinicaltrials.gov/study/NCT06095050 -
In orthopedic IR, confidence comes from exposure. It’s all about getting those reps in. In this BackTable MSK Brief, host Kavi Krishnasamy interviews Dr. Brandon Key from the Medical College of Wisconsin about implementing bone stabilization and fixation in interventional radiology for pathologic and non-pathologic fractures.
The doctors discuss key barriers which include limited training exposure and operational inefficiencies that discourage adoption. However, they highlight the evolving technology, vendor toolsets, and growing multidisciplinary collaboration that are mitigating these barriers. The discussion expands to cover trauma-related consults from orthopedic surgery, indications and evolving applications of the IlluminOss device, screw types and preferences, and the capabilities of the Flow-FX cement-delivery device.
Episode Outline
00:00 - Introduction
00:57 - The Delay in Take-Off of Bony Fixation and Stabilization at the Trainee Level
03:10 - Meaningful Multidisciplinary Momentum
05:35 - Treatment of Pathologic Fractures in the Orthopedic IR Space
09:17 - Considerations for Trauma and Fragility Cases
16:09 - Patient Prep and Approach
18:05 - Final Thoughts
Resources
Dr. Brandon Key, MD
https://www.linkedin.com/in/brandon-key-md-367a01310/
IlluminOss
https://illuminoss.com/us
Flow-FXhttps://flow-fx.net/products/ -
From anesthesia decisions to ablation strategy, what really separates a good outcome from a great one in bone tumor ablation? This BackTable MSK Brief features an enlightening conversation between host Kavi Krishnasamy and bone ablation pioneer Dr. Damian Dupuy. They cover anesthesia choices for different patient scenarios, optimal procedural techniques and agent selection for bone ablations, and the combination of local and systemic therapies for oligometastatic and oligo-progressive diseases. The doctors also tackle myths and realities around thermal and cryoablation, examining both clinical trial data and real-world experiences.
Episode Outline
00:00 - Introduction
00:40 - Selecting General Anesthesia vs. MAC
03:30 - Approach to Multiple Bony Lesions in Metastatic Disease
07:27 - Ablation Confirmation and Techniques Utilized in Bone Ablation
09:00 - Research Insights Surrounding RFA in Bone
12:16 - Sclerotic vs. Lytic Lesions: Techniques and Considerations
14:47 - Skin Protection During Superficial Lesion Treatments
16:38 - Analyzing Clinical Trials: Motion and OPuS One
20:51 - Conclusion
Resources
Dr. Damian E. Dupuy, MD, FACR
https://www.linkedin.com/in/damian-e-dupuy-md-facr-6b080b1b/
Radiofrequency Ablation Provides Rapid and Durable Pain Relief for the Palliative Treatment of Lytic Bone Metastases Independent of Radiation Therapy: Final Results from the OsteoCool Tumor Ablation Post-Market Study
https://pmc.ncbi.nlm.nih.gov/articles/PMC10156864/
Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Study
https://pmc.ncbi.nlm.nih.gov/articles/PMC8011449/ -
Bone tumor treatment: when do you burn it and when do you freeze it? In this BackTable MSK Brief, Dr. Damian Dupuy joins Host Dr. Kavi Krishnasamy to discuss the technical nuances of radiofrequency ablation (RFA) and cryoablation, patient selection criteria, procedural strategies, and the importance of setting appropriate patient expectations. Dr. Dupuy also shares insights on preventing complications like cryomyositis and myoglobinuria, underscoring the balance between aggressive treatment and patient safety.
Episode Outline
00:00 - Introduction
00:40 - Bone Tumor Interface and Time Under Treatment
05:10 - Patient Selection and Treatment Considerations
07:57 - Approach to Large Bony Lesions
12:37 - Best Treatment Modality: Cryoablation vs. RFA
13:38 - Managing Collateral Damage
15:58 - Navigating Patient Expectations
Resources
Dr. Damian E. Dupuy, MD, FACR
https://www.linkedin.com/in/damian-e-dupuy-md-facr-6b080b1b/
Solitary painful osseous metastases: correlation of imaging features with pain palliation after radiofrequency ablation--a multicenter american college of radiology imaging network study
https://pubmed.ncbi.nlm.nih.gov/23657892/ -
Can genicular artery embolization (GAE) relieve chronic knee pain after total knee arthroplasty (TKA)? In this episode of BackTable MSK, Argentinian interventional radiologist Dr. Rene Viso joins host Dr. Kavi Krishnasamy to discuss the status of GAE in South America, patient selection criteria, procedural techniques, and the challenges of treating post-TKA patients with GAE.
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SYNPOSIS
Dr. Viso also highlights the importance of multidisciplinary collaboration and adjunctive therapies like genicular nerve blocks to improve patient outcomes. The episode concludes with a discussion on Dr. Viso's recent research and case studies, emphasizing the potential and complexities of GAE in managing chronic knee pain.
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TIMESTAMPS
00:00 - Introduction02:02 - GAE in South America03:57 - Patient Selection for GAE13:18 - Procedure Techniques and Device Choices23:54 - Challenges and Tips for TKA Patients Undergoing GAE27:17 - Patient Follow-Up After Intervention29:41 - Handling Treatment Failures32:57 - Adjunctive Therapies for Post-TKA Patients with GAE34:46 - Research Update: Dr. Viso’s Recent Publication on GAE in Post-TKA Patients 39:44 - Case Studies and Discussion50:19 - Future Directions and Final Thoughts
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RESOURCES
Dr. Rene Visohttps://www.linkedin.com/in/rene-viso-11a245132/
Genicular Artery Embolization for Persistent Pain after Total Knee Arthroplasty: Initial Clinical Experiencehttps://pubmed.ncbi.nlm.nih.gov/41320119/ -
How is genicular artery embolization reshaping our clinical approach to patients with chronic knee pain? Dr. Rachel Piechowiak and Dr. Faraz Khan, interventional radiologists at IR Centers join Dr. Don Garbett in a deep dive into the current state of Genicular Artery Embolization (GAE).
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SYNPOSIS
Dr. Piechowiak and Dr. Khan provide a deep dive on the technical nuances of GAE, covering patient selection, access strategies, and key procedural techniques. The conversation also details complex case scenarios and how to tailor catheters and embolics to navigate challenging anatomy. The doctors then share their structured approach to post-procedure follow-up, underscoring the importance of setting realistic treatment expectations with patients. The episode closes with their perspective on the future of genicular artery embolization, emphasizing the need for robust long-term outcomes data to better define the role of GAE in chronic knee pain management.
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TIMESTAMPS
00:00 - Introduction05:54 - Patient Workup for GAE10:42 - Setting Patient Expectations for GAE16:24 - Procedure Approaches and Techniques30:41 - Understanding Artery Targeting Strategies34:56 - Approaches to Microcatheter Selection38:18 - Choosing the Right Embolic Agents47:43 - Managing Complications and Follow-Ups51:23 - Challenges with Post-TKA Patients54:16 - Future Directions -
Frozen shoulder is characterized by progressive motion loss, distinct disease stages, and new treatment opportunities; raising important questions about timing, patient selection, and new interventional strategies. In this episode of the BackTable MSK Podcast, guest host Osman Ahmed welcomes orthopedic surgeon and upper extremity specialist Dr. Sameer Nagda to discuss the intricacies of adhesive capsulitis of the shoulder (“frozen shoulder”).
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SYNPOSIS
Dr. Nagda shares his expertise on diagnosing and treating frozen shoulder, including the evaluation process, treatment options, and the role of early intervention. He emphasizes the importance of recognizing the stages of frozen shoulder and the potential benefits of embolization, particularly in the inflammatory stage. Dr. Nagda also shares his journey into shoulder specialization and his collaborative efforts with IR specialists to improve patient outcomes.
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TIMESTAMPS
00:00 - Introduction 04:29 - The Run Down: What is Frozen Shoulder?08:37 - Approaching the Diagnosis of Frozen Shoulder13:51 - Treatment Paradigms 22:48 - Comparing Traditional Treatments vs. Embolization26:39 - An Orthopedic Surgeon’s Perspective on Embolization for Frozen Shoulder35:36 - Surgical Options and When to Consider Them 37:55 - Final Thoughts
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RESOURCES
Dr. Sameer Nagda, MDhttps://www.sameernagdamd.com/sameer-nagda-md-sports-medicine-specialist-arlington-va.html
Adhesive Capsulitis of the Shoulderhttps://journals.lww.com/jaaos/abstract/2011/09000/adhesive_capsulitis_of_the_shoulder.4.aspx
Treatment of Adhesive Capsulitis of the Shoulderhttps://journals.lww.com/jaaos/abstract/2019/06150/treatment_of_adhesive_capsulitis_of_the_shoulder.3.aspx -
Your bony fixation technique can make (or break) a complex fracture case. In this episode of the BackTable MSK Podcast, host Kavi Krishnasamy welcomes Dr. Brandon Key, interventional radiologist at Medical College of Wisconsin (MCW) in Milwaukee, to discuss bone stabilization techniques in treating pathologic and non-pathologic fractures.
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SYNPOSIS
Dr. Key shares insights into his practice, highlighting the importance of multidisciplinary collaboration with orthopedic surgery, the challenges of training in bony fixation, and the evolving technology that aids in these procedures, including the use of IlluminOss Photodynamic nails in complex bone interventions. Several detailed case studies illustrate the practical application and benefits of these advanced techniques, emphasizing their impact on patient outcomes and functionality.
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TIMESTAMPS
00:00 - Introduction02:06 - A Run Down of Bone Stabilization in the IR Space12:54 - What’s in the Toolbox?17:51 - Patient Preparation and Procedure Setup29:47 - Combining Fixation with Thermal Ablation34:12 - Introducing the Photodynamic Nail by IlluminOss40:22 - “The Learning Curve” of the Photodynamic Nail47:48 - Dr. Key’s Guidance for Practice Building 52:01 - Literature Highlights on IlluminOss 55:01 - Case 1: Anterior Column Disease 01:01:27 - Case 2: Isolated Posterior Column Disease 01:05:37 - Case 3: Non-healing Pathologic Fracture of Pubic Ramus01:09:37 - Case 4: Iliac Wing Fixation with Orthopedic Surgery01:15:40 - Case 5: Sacral Defects01:19:45 - Case 6: Reconstruction of Posterior Iliac Wing 01:23:50 - Post-Procedure Outcomes and Reflections01:29:02 - Final Thoughts: Encouragement for Collaboration and Innovation
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RESOURCES
Dr. Brandon Key, MDhttps://www.linkedin.com/in/brandon-key-md-367a01310/
A Prospective Study of the IlluminOss Photodynamic Nail System for Pelvic Stabilization: Treatment of Impending and Actual Fractures from Metastatic Bone Disease, Multiple Myeloma, and Primary Bone Lymphomahttps://pubmed.ncbi.nlm.nih.gov/39281295/
Minimally Invasive Stabilization Using Screws and Cement for Pelvic Metastases: Technical Considerations for the Pelvic "Screw and Glue" Techniquehttps://pubmed.ncbi.nlm.nih.gov/31435131/
IlluminOsshttps://illuminoss.com/us
Flow-FXhttps://flow-fx.net/products/ -
How to stay cool when a thermal ablation case gets complicated? Your toolbox can make all the difference. In this episode of the BackTable MSK Podcast, Dr. Alan Sag returns with host Dr. Jacob Fleming to continue the discussion on thermal protection in musculoskeletal ablation procedures. Part 2 focuses on real-world cases to provide practical insights and illustrate decision-making in complex thermal ablation cases.
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SYNPOSIS
Dr. Sag and Dr. Fleming discuss thermoprotection strategies in real-world cases, such as radiofrequency ablation (RFA) of inoperable rectal cancer and sacral metastases near nerve roots. They also discuss the importance of interdisciplinary collaboration, emerging technologies in the field, and the role of intraoperative neuromonitoring.
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TIMESTAMPS
00:00 - Introduction00:55 - Ganglion Impar and Pelvic Pain Strategies09:08 - The Active Thaw Phenomenon18:20 - Nerve Protection During Ablations23:16 - Motor and Sensory Neuromonitoring34:06 - Temperature Management in Ablative Procedures40:28 - Dosing Strategies for Gabapentin and Lyrica in Nerve Injuries42:33 - Future Directions
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RESOURCES
Dr. Alan Alper Sag, M.D., FSIRhttps://med.miami.edu/faculty/alan-alper-sag-md-fsir
Thermal Protection: Heightened Safety for Minimally Invasive Percutaneous Ablation of Musculoskeletal Tumorshttps://pubs.rsna.org/doi/10.1148/rg.240238
Intraoperative Neuromonitoring for Peripheral Nerve Surgeryhttps://mayoclinic.elsevierpure.com/en/publications/intraoperative-neuromonitoring-for-peripheral-nerve-surgery/ -
Burns = big consequences. Let’s talk thermoprotection. In this episode of the BackTable MSK Podcast, host Jacob Fleming welcomes longtime friend and colleague Dr. Alan Sag to discuss thermoprotection in musculoskeletal ablation procedures over this two-part episode series. Part 1 focuses on established strategies and new techniques for protecting critical structures during ablation.
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SYNPOSIS
Dr. Sag shares how he approaches thermoprotection in complex MSK ablation cases. The discussion covers hydro-dissection techniques, hydro convection needle strategies, pump and tubing set up, troubleshooting, and visualization of the protective layer.
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TIMESTAMPS
00:00 - Introduction02:49 - Thermoprotection 10112:37 - Skin Injury and Mitigation Strategies18:57 - Avoiding Bottlenecks with Hydrodissection23:49 - Practical Recommendations for Cold Skin Protection 29:36 - Managing Complications and Wound Care38:12 - Heating up with RFA and Microwave Ablations
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RESOURCES
Dr. Alan Alper Sag, M.D., FSIRhttps://med.miami.edu/faculty/alan-alper-sag-md-fsir
Thermal Protection: Heightened Safety for Minimally Invasive Percutaneous Ablation of Musculoskeletal Tumorshttps://pubs.rsna.org/doi/10.1148/rg.240238
Intraoperative Neuromonitoring for Peripheral Nerve Surgeryhttps://mayoclinic.elsevierpure.com/en/publications/intraoperative-neuromonitoring-for-peripheral-nerve-surgery/ -
Ablate before you radiate. Success with bone tumor ablation may have as much to do with your procedure technique as it does with your ability to collaborate. In this episode of BackTable MSK, interventional oncologist Dr. Damian Dupuy shares his approach to bone tumor ablation with host Dr. Kavi Krishnasamy, and offers practical advice on how to partner with your cancer care team to make ablation a viable treatment option.
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This podcast is supported by:
Medtronic Osteocool
https://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-2-0-bone-tumor-ablation-system.html
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SYNPOSIS
The doctors review the history of bone ablation techniques, including radiofrequency and cryoablation modalities. They discuss the significance of targeting the bone-tumor interface for pain palliation and highlight several case studies to illustrate various techniques and successful outcomes. The conversation also touches upon the synergistic benefits of combining ablation with radiation therapy and emphasizes the importance of multidisciplinary collaboration in treating cancer patients.
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TIMESTAMPS
00:00 - Introduction02:07 - Dr. Dupuy’s Start in Bone Ablation06:29 - Cryo vs. Microwave Therapies08:25 - Dr. Dupuy’s Clinical Trial and Research Involvement 12:49 - Patient Selection and Treatment Strategies25:54 - Sedation and Anesthesia Practices in Bone Ablation28:46 - Treatment Approach: Oligometastases vs. Progressive Disease36:22 - Microwave Ablation in Bone: Future Prospects37:30 - Techniques for Treating Sclerotic and Lytic Lesions40:01 - Skin Protection Methods in Superficial Lesion Treatments41:49 - Reviewing Recent Clinical Trials: MOTION, OPuS One, and More52:35 - Case Studies: Achieving Effective Ablation Techniques01:08:08 - Final Thoughts and Recommendations
---
RESOURCES
Dr. Damian E. Dupuy, MD, FACRhttps://www.linkedin.com/in/damian-e-dupuy-md-facr-6b080b1b/
Solitary painful osseous metastases: correlation of imaging features with pain palliation after radiofrequency ablation--a multicenter american college of radiology imaging network studyhttps://pubmed.ncbi.nlm.nih.gov/23657892/
Radiofrequency Ablation Provides Rapid and Durable Pain Relief for the Palliative Treatment of Lytic Bone Metastases Independent of Radiation Therapy: Final Results from the OsteoCool Tumor Ablation Post-Market Studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC10156864/
Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC8011449/
A Multi-Center Observational Trial of Symptomatic, High-Risk Bone Metastases Treated with Percutaneous Ablation and Palliative Radiation Therapy (TRIBUTE)https://clinicaltrials.gov/study/NCT06859801 -
“We learn traditionally that bone metastasis is terminal.” 一 Or is it? In this episode of the BackTable MSK podcast, host Dr. Jacob Fleming welcomes Dr. Francis Lee, a leading figure in orthopedic oncology, to discuss advancements in treating skeletal metastasis. Dr. Lee, the Wayne O. Southwick Professor from Yale and President-elect of the Musculoskeletal Tumor Society, shares his innovative AORIF (Ablation, Osteoplasty, Reinforcement and Internal Fixation) technique, which emphasizes collaboration between orthopedic oncologists and interventional radiologists.
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This podcast is supported by an educational grant from Medtronic.
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SYNPOSIS
The conversation covers the complexities of bone metastasis, the biomechanics of skeletal ablation, and the importance of understanding bone-cancer interactions. Dr. Lee also shares insights from his translational research on cancer and bone dynamics, and emphasizes the need for continued interdisciplinary collaboration to drive forward minimally invasive treatments.
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TIMESTAMPS
00:00 - Introduction 01:39 - Crash Course: Orthopedic Oncology 10113:24 - The Important Role of Biomechanics20:10 - Dr Lee’s Training and Interdisciplinary Collaboration28:13 - Intraoperative Imaging and Techniques in AORIF40:15 - Cannulated Screws for Access and Fixation 42:24 - Case Study: Sacral Insufficiency Fracture and Cement Injection44:17 - Understanding Cement Properties and Application46:45 - Case Study Series: Approach to Reconstruction57:58 - Decision Making in Complex Procedures01:08:40 - The Power of Bone Regeneration01:12:31 - Final Thoughts
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RESOURCES
Dr. Francis Lee, MD, PhD, FAAOS, MBAhttps://medicine.yale.edu/profile/francis-lee/
Minimally Invasive Image-Guided Ablation, Osteoplasty, Reinforcement, and Internal Fixation (AORIF) for Osteolytic Lesions in the Pelvis and Periarticular Regions of Weight-Bearing Boneshttps://pubmed.ncbi.nlm.nih.gov/32139256/ -
Living in the best of both worlds: balancing pain management and quality of life. In this BackTable MSK Brief, Dr. Mark Amsbaugh and Dr. Ran Lador discuss multidisciplinary approaches to treating spinal tumors with a particular focus on pain management. They explore the complexities of defining and treating pain related to spinal tumors, differentiating between mechanical instability, tumor burden, and neuropathic pain.
The conversation delves into the roles of various treatments including opioids, radiation, nerve blocks, cryoablation, and surgical interventions. They highlight the evolving landscape of spine oncology, emphasizing the need for holistic approaches and the promising future of integrating advanced technologies for better patient outcomes.
Episode Outline
00:00 - Introduction
00:53 - Approach to Pain Management in Spine Oncology
02:54 - Multimodal Analgesia
04:25 - What is a Safe Radiation Dose that Spares Spinal Nerves?
07:59 - The Balance Between Quality of Life and Pain Management
09:58 - Final Remarks
Resources
Dr. Mark Amsbaugh, MD
https://med.uth.edu/neurosciences/dr-mark-j-amsbaugh-md/
Dr. Ran Lador, MD
https://med.uth.edu/ortho/2022/11/02/ran-lador-md/
Dr. Alexa Levey, MD
https://medicine.yale.edu/profile/alexa-levey/ - Mehr anzeigen
