BackTable Bone & Sports

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/

As our understanding of pain physiology evolves, neuromodulation continues to offer new treatment possibilities in MSK pain management. In this episode of the BackTable MSK, host Jacob Fleming discusses the evolving world of neuromodulation with Dr. Timothy Deer, a leading expert in the field. Dr. Deer shares insights from his extensive career and his innovative contributions in neuromodulation.
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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 conversation covers the development of spinal cord and dorsal root ganglion (DRG) stimulation, the significance of patient selection and challenges facing neuromodulation therapies, and exciting developments in the field, including AI. Dr. Deer and Dr. Fleming also discuss the importance of advanced training and the pioneering work by the American Society of Pain and Neuroscience (ASPN) to improve procedural education through its innovative MIS Certification Program.
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TIMESTAMPS
00:00 - Introduction
02:52 - What is Neuromodulation?
06:03 - Evolution of Neuromodulation
08:49 - Use of Closed Loop and AI
13:58 - DRG Stimulation Explained
19:58 - Progression of Peripheral Nerve Stimulation
26:26 - Handheld Navigation and Reducing Radiation Exposure
30:18 - The Umbrella of Specialties within ASPN
35:15 - Obtaining MIS Certification and Fellowship Program Outlook
44:07 - Future Directions of Neuromodulation
48:09 - Concluding Thoughts
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RESOURCES
Dr. Timothy Deer, MD
https://centerforpainrelief.com/doctor-timothy-deer/
American Society of Pain and Neuroscience (ASPN)
https://aspnpain.com/

“There is always constant review and constant learning”. In this BackTable MSK Brief, Dr. Mark Amsbaugh and Dr. Ran Lador discuss comprehensive treatment strategies for spinal tumors, highlighting the critical interplay between surgical and radiation oncology. 

The doctors explain the complex planning required based on tumor characteristics, including surgical options like en bloc resection and minimally invasive techniques, as well as the advancements in radiation therapy. The conversation emphasizes the importance of collaboration across disciplines to optimize patient outcomes, improve quality of life, and adapt to new medical advancements.

Episode Outline

00:00 - Introduction

00:21 - Collaboration Between Surgeons and Interventionalists

05:42 - Intertwined Approach of Radiation and Surgical Treatment

07:37 - Advancements in Radiation Techniques

14:15 - Advancements in Surgical Approach 

16:20 - Final Thoughts

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/

Check your ego at the door! In this BackTable MSK Brief, Dr. Mark Amsbaugh and Dr. Ran Lador share their multidisciplinary approach to the treatment of spinal tumors at the University of Texas and Memorial Hermann in Houston.

They highlight the distinctive aspects of their practice, including their extensive collaboration and support system for patients, the intricate process of managing spinal tumors, and the unique challenges and solutions they encounter. The doctors emphasize the importance of teamwork, minimally invasive techniques, and comprehensive patient-centered care to improve treatment outcomes for patients with spinal tumors.

Episode Outline

00:00 - Introduction 

03:18 - Addressing Potential Barriers in Receiving Spinal Tumor Treatment

04:32 - The Multidisciplinary Approach in Action

07:46 - Minimally Invasive Techniques and Their Impact

09:49 - Navigating Patient Care and Referrals

14:29 - Final Thoughts 

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/

Are you considering expanding your IR practice into pain management services? Get the download from someone who’s done it already. In this episode of BackTable MSK, Dr. Sean Maratto from Philadelphia's Jefferson Health Network is joined by guest Dr. Junjian Huang from Emory University School of Medicine to discuss the intricacies of building a pain management practice within the interventional radiology space.
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This podcast is supported by an educational grant from Medtronic.
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SYNPOSIS
Dr. Huang shares his career journey, highlighting his shift towards pain palliation. The conversation covers a range of topics including procedural insights, patient management strategies, navigating institutional politics, and future trends in orthopedic IR. Dr. Huang emphasizes the importance of balancing patient care with building robust referral networks, and shares valuable advice for budding interventional radiologists.
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TIMESTAMPS
00:00 - Introduction
02:20 - What’s Your Why? Why Pain Intervention?
12:52 - Building a Complex Pain Management Practice
24:47 - Marketing a Service Line
30:57 - Patient Impact from Pain Management Services
39:53 - Recommendations and Indications for Cryoneurolysis and BVNA
45:36 - Post-Procedure Follow-up and Psychosomatic Pain Guidance
52:35 - Insight to the Future of Interventional Pain and Final Thoughts
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RESOURCES
Dr. Junjian Huang, MD
https://med.emory.edu/directory/profile/?u=JHUAN22
Dr. Sean Maratto, MD
https://www.jeffersonhealth.org/find-a-doctor/m/maratto-sean-a

To ablate or not to ablate? That is the question. Learn how to tackle complex and unique cases of kyphoplasty and spinal ablation in part two of our discussion with Dr. Asad Baig and host Dr. Michael Barrazza.
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This podcast is supported by an educational grant from Medtronic.
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SYNPOSIS
This episode looks at the ins and outs of real-world kyphoplasty and spinal ablation cases, including detailed patient histories, diagnostic techniques like the Oswestry Disability Index and Roland-Morris Disability Questionnaire, and the challenges of treating patients with extensive spinal hardware, osteoporosis, and other complicating factors.
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TIMESTAMPS
00:00 - Introduction
01:38 - Hx of Osteoporosis and Previous Kyphoplasty
04:06 - Challenges in Identifying Fractures
05:29 - Tool Selection and Technique
10:35 - Post-Kyphoplasty Follow-Up and Patient Outcomes
13:29 - Importance of Timely Treatment
18:13 - Weight Loss and Cancer Concerns
28:26 - Final Thoughts and Takeaway
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RESOURCES
Dr. Asad Baig, MD
https://doctors.columbia.edu/us/ny/new-york/asad-baig-md-51-west-51st-street
OsteoCool RF Ablation System by Medtronic
https://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-radiofrequency-ablation-system.html

From patient selection to procedure technique–learn the key insights that shape a successful kyphoplasty and spine ablation practice. In this episode of the BackTable MSK Podcast, host Dr. Michael Barraza welcomes back Dr. Asad Baig, an Interventional Radiologist and director of the Interventional Spine Center at Columbia University. They discuss the latest developments at Columbia, focusing on exciting expansions in the interventional radiology and spine realms. The primary focus of their conversation is on advanced techniques in spine ablation and kyphoplasty, and the ideal patient profile for these treatments.
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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
Dr. Baig begins the episode by explaining the importance of collaborating with radiation oncologists and spine surgeons to optimize patient outcomes and emphasizes considerations, such as bone quality, prior to a spinal ablation. The episode also features Dr. Baig’s approach to treating sclerotic versus lytic lesions with his insights on navigating complex cases involving post-radiation fractures and internal fixation complications. This first episode of a two-part series emphasizes a multi-disciplinary approach and the need for precise imaging and patient communication when treating patients with spinal ablation.
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TIMESTAMPS
00:00 - Introduction
01:31 - Evaluating Patients Prior to Spine Ablation
09:02 - Who is the Ideal Candidate for Ablation Kyphoplasty?
14:24 - Approaching Lesions Within the Vertebral Body
21:26 - When is it Appropriate to Use Balloons After an OsteoCool Ablation?
27:58 - Approach to Patients with Significant Vertebral Height Loss
35:33 - Challenging Cases with Kyphoplasty
39:02 - Sclerotic versus Lytic Lesions
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RESOURCES
Dr. Asad Baig, MD
https://doctors.columbia.edu/us/ny/new-york/asad-baig-md-51-west-51st-street
OsteoCool RF Ablation System by Medtronic

https://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-radiofrequency-ablation-system.html

Resorbable embolics are gaining traction in musculoskeletal interventions, but what are the key technical considerations? Dr. Keerthi Prasad, interventional radiologist at the Centers for Pain Control and Vein Care joins host Dr. Ally Baheti to share practical insights when using resorbable embolics in MSK interventions.
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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
Dr. Prasad opens the conversation with an overview of embolic agents used in MSK interventions—including Imipenem, Lipiodol, and Nexsphere-F—and shares practical insights into technique selection. He explores the nuances of working with various resorbable embolics, highlighting clinical cases from his personal experience. The discussion also highlights Dr. Prasad’s innovative approach to establishing an outpatient-based lab (OBL) focused on musculoskeletal interventions. Additionally, Dr. Prasad also offers insight into the expanding role of resorbable embolics in treating conditions such as knee arthritis, plantar fasciitis, and adhesive capsulitis. The episode ends with a call to broaden access to this evolving treatment.
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TIMESTAMPS
00:00 - Introduction
01:55 - Outpatient Embolization and MSK Procedures
04:20 - Resorbable Embolics in Joint Embolization
04:52 - Available Resorbable Embolics in the US
07:57 - Technical Insights on Using Resorbable Embolics
15:18 - Patient Outcomes and Long-Term Durability
22:24 - Future of MSK Embolization Techniques
24:05 - Exploring New Applications for Resorbable Embolics
27:30 - Innovative Procedures and Techniques
37:00 - Final Thoughts and Advice for Practitioners

What is the optimal embolization technique in GAE? In this BackTable Brief, Dr. Osman Ahmed and Dr. Sid Padia, MD discuss the embolization of abnormal vessels, debating between targeting any abnormal vessel versus only the painful side. They reference studies and papers, including the Landers 2023 paper, to explore best practices. 

They consider the use of temporary resorbable embolics compared to permanent embolics, examining safety profiles, efficacy, and potential complications. The conversation then shifts towards the size of embolic particles and endpoints for different embolization materials. They discuss specific techniques and their impacts, highlighting the reproducibility of certain methods and preparing for the future of resorbable embolics in various medical applications.

Episode Outline

00:00 - Introduction

00:13 - Embolization of Abnormal Vessels

02:34 - Permanent vs. Resorbable Embolics

06:21 - Debating Particle Size 

11:06 - Technique When Using Permanent Spheres 

12:42 - Technique When Using Resorbable Spheres 

Resources

Dr. Venkatesh, “Kavi”, Krishnasamy, MD

https://www.uab.edu/medicine/radiology/faculty/intervent-radiology/profile/krishnasamy

Dr. Osman Ahmed, MD

https://bucksbauminstitute.uchicago.edu/bio/osman-ahmed-md/

Dr. Siddarth, “Sid”, Padia, MD

https://www.uclahealth.org/providers/siddharth-padia

Genicular artery embolization for early-stage knee osteoarthritis: results from a triple-blind single-centre randomized controlled trial

https://pmc.ncbi.nlm.nih.gov/articles/PMC10032233/

Multicenter Randomized Sham Controlled Study of Genicular Artery Embolization for Knee Pain Secondary to Osteoarthritis

https://pubmed.ncbi.nlm.nih.gov/34610422/

Which imaging and treatment techniques are optimal for GAE in the OBL? In this BackTable Brief, Dr. Osman Ahmed and Dr. Sid Padia explore instrument selection and CT techniques in the OBL for genicular artery embolization (GAE). 

Dr. Ahmed and Dr. Padia discuss the importance of not compromising on patient safety, and the careful selection of their approach to treatment. They further elaborate on the use of cone beam CT for more precise treatment planning, sharing insights on catheter selection, contrast solutions, and best practices for ensuring high-quality patient care, especially in the OBL (office-based lab) setting.

Episode Outline

00:00 - Introduction 

00:53 - Discussion on Catheter Selection and Preference 

03:37 - Use of Cone Beam CT in the OBL

10:42 - Cone Beam CT Protocols and Technique: Selective or Non-Selective?

12:38 - Contrast Solutions and Techniques

Resources

Dr. Venkatesh, “Kavi”, Krishnasamy, MD

https://www.uab.edu/medicine/radiology/faculty/intervent-radiology/profile/krishnasamy 

Dr. Osman Ahmed, MD

https://bucksbauminstitute.uchicago.edu/bio/osman-ahmed-md/ 

Dr. Siddarth, “Sid”, Padia, MD

https://www.uclahealth.org/providers/siddharth-padia