BackTable Bone & Sports

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.

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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