Intradiscal ozone offers a minimally invasive approach to disc pain that can reduce inflammation and restore function. How well does it work and where does it fit in the lumbar radiculopathy treatment algorithm? In this episode of the Backtable MSK Podcast, host Jacob Fleming speaks with Dr. Alexis Kelekis about the contemporary role of intradiscal ozone and emerging innovations in interventional spine treatment.
---
SYNPOSIS
Dr. Kelekis, a prominent figure in radiology and interventional pain management, shares insights from the 2025 GRIBOI meeting held in Banff, AB, Canada. Topics discussed include the development and possibility of bone augmentation polymers, intradiscal ozone therapy, and various interventional treatments for degenerative disc disease and vertebral fractures. Dr. Kelekis also touches on the need for specialized training in interventional radiology and the future of personalized medicine in pain management.
---
TIMESTAMPS
00:00 - Introduction
06:40 - Ozone Treatment: Mechanism and Efficacy
13:23 - Challenges and Innovations in Spine Treatments
20:09 - Treatment Algorithm in Patients with Lower Extremity Radiculopathy
24:00 - Future Directions in Interventional Spine Treatments
30:28 - Closing Remarks
---
RESOURCES
SpinaFx:
https://spinafx.com/
GRIBOI:
https://www.griboi.org/

What sets apart those who are good from those who are great? This episode of Backtable MSK features a profound discussion on leadership and legacy with Dana Dunleavy, MD, Wayne Olan, MD, and David Tilton. Dr. Olan, Director of Minimally Invasive Neurosurgery at George Washington University Medical Center, and David Tilton, a former Navy SEAL and current business and racing professional, share their unique experiences and insights surrounding perseverance in success.
---
SYNPOSIS
The doctors discuss the importance of mentorship, collaboration, and cultivating a culture of growth and accountability. The conversation highlights how nurturing leaders can impact both professional and personal development, emphasizing that the best measure of success lies within the success of those you lead.
---
TIMESTAMPS
00:00 - Introduction
10:50 - Learning from Those Around You
16:56 - The Value of Continuous Learning and Avoiding Complacency
31:43 - The Importance of Teamwork and Mentorship
50:07 - The Role of Failure in Success
52:45 - Closing Remarks: Support and Courage

Who is the ultimate candidate for GAE, which technical approach is best, and how do you set your patients up for success? Tune into this week’s episode of BackTable to hear from interventional radiologists Dr. Osman Ahmed (University of Chicago Medicine) and Dr. Siddharth Padia (UCLA Health) as they discuss everything from patient selection to follow-up care, covering pre-procedure imaging, access, embolics, technical challenges, clinical data, and the future of genicular artery embolization.

---

This podcast is supported by:

Guerbet

---

SYNPOSIS

Dr. Ahmed and Dr. Padia debate their approaches to patient selection criteria, the use of MRI and cone beam CT, permanent vs. resorbable embolic materials, how many arteries to embolize, and the relevance of pain metrics post GAE. They also delve into follow-up considerations and the potential for GAE as a long term treatment.

---

TIMESTAMPS

00:00 Introduction

01:08 MRI for Patient Selection in GAE

08:53 Access Techniques: Femoral vs. Pedal

17:07 Cone Beam CT in GAE Procedures

27:20 Embolization Strategies

39:30 Challenges and Complications in Embolization

44:50 Follow-Up and Pain Metrics in Clinical Practice and Research

01:06:30 Repeat GAE Procedures: When and Why?

01:11:13 Post-Total Knee Replacement and GAE

01:21:01 Advice for IRs Looking to do GAE

01:24:32 Conclusion and Final Thoughts

---

RESOURCES

GENESIS Trial: https://pubmed.ncbi.nlm.nih.gov/33474601/

Landers et al Trial: https://pubmed.ncbi.nlm.nih.gov/37051829/

Attention radiologists: Were you trained to look for Tarlov cysts when reading spine MRI? In this episode of Backtable MSK, interventional neuroradiologist Dr. Kieran Murphy joins the studio to discuss the serious issue of chronic pain related to Tarlov cysts, a condition often overlooked in both diagnosis and treatment. Tarlov cysts, also known as perineural cysts, are fluid-filled sacs that form due to the dilation of the subarachnoid space around spinal nerve roots, most commonly at the base of the spine.

---

SYNPOSIS

Dr. Murphy highlights the high risk of depression and suicide among patients, who are often misdiagnosed and overprescribed ineffective pain medications. He explains how to identify and treat Tarlov cysts through aspiration and fibrin sealing, addresses the historical dismissal of their significance, and underscores the need for a better understanding of CSF leaks. Additionally, Dr. Murphy emphasizes the importance of institutional responsibility in occupational radiation safety for interventionalists, advocating for improved lead protection and antioxidant use to mitigate radiation damage. The episode concludes with a humbling reminder of the implicit biases present in medical practice and the ongoing need for more inclusive and attentive patient care.

---

TIMESTAMPS

00:00 - Introduction

01:24 - Challenges in Diagnosing and Treating Tarlov Cysts

04:05 - Patient Experiences and Misdiagnoses

06:06 - Cyst Aspiration Techniques

15:12 - Improved Diagnosis of CSF Abnormalities

22:10 - Allergic Reactions to Fibrin

25:30 - Implicit Bias in Medicine

34:50 - Radiation Safety in Radiology

43:47 - Final Thoughts and Reflections

You asked, and we delivered – here’s a comprehensive episode on Basivertebral Nerve Ablation (BVNA) for vertebrogenic lumbar pain! In this episode of Backtable MSK, our host Dr. Christopher Beck is joined by Dr. Asad Baig, Director of Interventional Spine at Columbia University, to discuss BVNA patient selection and procedural techniques.

---

SYNPOSIS

Dr. Baig begins by sharing his journey from residency to his current role, including his initial exposure to spine procedures and the mentors who guided him. He offers examples of his workup for back pain, covering detailed patient history and key MRI findings. Dr. Baig emphasizes the importance of understanding risks and alternatives, as well as how to effectively counsel patients on these topics. Additionally, he walks through the BVNA procedure and shares his technical pearls.

The episode concludes with Dr. Baig highlighting valuable resources for those interested in starting BVNA procedures and recognizing the supporting role of industry partners.

---

TIMESTAMPS

00:00 - Introduction

10:14 - Patient Selection for BVNA

14:45 - Imaging Findings

19:38 - Consent Process and Risks

22:18 - Procedural Technique

28:32 - Sedation and Pain Management

34:03 - Post-Procedure Care and Follow-Up

37:09 - Challenges and Troubleshooting

40:34 - Resources and Mentorship

We’ve had many discussions about the technical aspects of vertebroplasty and kyphoplasty on BackTable MSK. However, in this episode, we take a deeper look into the history of these procedures, exploring early research controversies and the challenges that threatened their existence. Our host, Dr. Jacob Fleming, is joined in the BackTable Studio by interventional neuroradiologist Dr. Joshua Hirsch, who was in San Diego for the ASSR 2025 meeting. Dr. Hirsch is the Chief of the Interventional Spine Service at Massachusetts General Hospital.

---

This podcast is supported by:

Medtronic MVP

https://www.medtronic.com/en-us/healthcare-professionals/products/spinal-orthopedic.html#aq=%40pagetype%3D%22product-model%22&cq=%40products_category%3D%22Spinal%20and%20orthopedic%22%20OR%20%40ontology_isa%3D%22Spinal%20and%20orthopedic%22

---

SYNPOSIS

Dr. Hirsch begins by outlining the historical origins of radiologists using cement injection and how this practice evolved into vertebroplasty. He then highlights early research on the procedure, focusing on key 2009 NEJM papers that sparked both scientific and public controversy, leading to setbacks in research and disparities in access to life-changing care. Since that time, newer studies have demonstrated the clear benefits of spinal augmentation for patients with vertebral insufficiency fractures, including Dr. Hirsch’s own research showing a mortality benefit compared to nonsurgical treatment. Overall, the doctors discuss how far this field has advanced and the exciting developments currently in progress.

---

TIMESTAMPS

00:00 - Introduction

03:09 - Historical Origins of Vertebroplasty

07:08 - Development and Evolution of Vertebroplasty

10:21 - Controversy Over 2009 Randomized Control Trials

16:35 - Disparities in Access to Vertebroplasty

21:01 - Dr. Hirsch’s Research on Mortality Benefit of Vertebroplasty

32:31 - Opportunities for Patient Education

35:29 - Vertebroplasty vs. Kyphoplasty

37:34 - Challenges in Research Interpretations and Insurance Coverage

42:26 - Future Directions in Vertebral Augmentation

---

RESOURCES

Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects (Jensen et al, 1997):

https://pmc.ncbi.nlm.nih.gov/articles/PMC8337380/

Simplicity of randomized, controlled trials of percutaneous vertebroplasty (Hirsch et al, 2003):

https://pubmed.ncbi.nlm.nih.gov/16880881/

INvestigational Vertebroplasty Efficacy and Safety Trial (INVEST): a randomized controlled trial of percutaneous vertebroplasty (Gray et al, 2007):

https://pubmed.ncbi.nlm.nih.gov/18096050/

A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures (Buchbinder et al, 2009):

https://pubmed.ncbi.nlm.nih.gov/19657121/

A Randomized Trial of Balloon Kyphoplasty and Nonsurgical Management for Treating Acute Vertebral Compression Fractures (FREE) (Meirhaeghe et al, 2013):

https://pmc.ncbi.nlm.nih.gov/articles/PMC3678891/

A Randomized Trial of Vertebroplasty for Osteoporotic Spinal Fractures (Kallmes et al, 2009):

https://www.nejm.org/doi/full/10.1056/NEJMoa0900563

A Randomized Trial of Epidural Glucocorticoid Injections for Spinal Stenosis (Friedly et al, 2014):

https://www.nejm.org/doi/full/10.1056/NEJMoa1313265

Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial (Clark et al, 2016):

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31341-1/abstract

Number Needed to Treat with Vertebral Augmentation to Save a Life (Hirsch et al, 2020):

https://pmc.ncbi.nlm.nih.gov/articles/PMC6975314/

Major Medical Outcomes With Spinal Augmentation vs Conservative Therapy (McCullough et al, 2013):

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1710123

Harvey L. Neiman Policy Institute:

https://www.neimanhpi.org/

Dr. John Smirniotopoulos, an interventional radiologist at Georgetown/MedStar Washington Hospital Center, discusses the intricacies of genicular nerve ablation (GNA) for pain management in patients with osteoarthritis and post-surgical knee pain. He delves into the history and evolution of GNA, outlines the neurovascular anatomy, and explains his specific rationale for targeting various nerves for ablation.

---

SYNPOSIS

Dr. Smirniotopoulos also compares GNA with other procedures such as corticosteroid injections, hyaluronic acid injections, and genicular artery embolization (GAE). He emphasizes the importance of managing patient expectations, the role of physical therapy, and explores different modalities of GNA, including the use of cryoablation versus radiofrequency technology. The episode offers a comprehensive overview of expert insights for evaluating knee pain and performing effective GNA.

---

TIMESTAMPS

00:00 - Introduction

03:13 - Understanding Genicular Nerve Anatomy

12:06 - Tailoring GNA Treatment to Each Patient

22:39 - Comparing Ablation Devices and Methods

28:06 - GNA in Surgical and Post-Traumatic Patients

33:19 - Patient-Centered Decision Making

38:50 - Evaluating Functional Outcomes

43:39 - Comparing Treatment Modalities

49:34 - Post-Procedure Counseling and Expectations

58:40 - Future Directions in GNA Research

---

RESOURCES

Safety and efficacy comparison of three- vs four-needle technique in the management of moderate to severe osteoarthritis of the knee using cooled radiofrequency ablation (Wong, et al 2021):

https://pubmed.ncbi.nlm.nih.gov/32968824/

Musculoskeletal embolization is generating significant excitement in the field of chronic pain management. In this episode, Dr. Jacob Fleming hosts a discussion with Dr. Yuji Okuno from Japan, a pioneer in both basic science and clinical practice within the field of musculoskeletal embolization.

---

This podcast is supported by:

Medtronic MVP

https://www.medtronic.com/mvp

---

SYNPOSIS

The conversation delves into Dr. Okuno's groundbreaking work using embolization to treat chronic pain from conditions such as frozen shoulder, knee osteoarthritis, plantar fasciitis, and various sports injuries. Dr. Okuno discusses the development of new temporary embolic agents and compares different approaches to embolization treatments, including the innovative use of antibiotics as embolic material. The doctors also cover the intriguing concept of differential recanalization, where abnormal inflammatory vessels are less likely to recanalize than normal vessels after embolic treatment. Identifying hypervascularity through MRI, ultrasound, or angiogram is a crucial step before attempting embolization.

Overall, Dr. Okuno offers valuable insights into his clinical practice and the potential for groundbreaking advancements in musculoskeletal care worldwide.

---

TIMESTAMPS

00:00 - Introduction

01:54 - Origins of Embolization for Pain

04:15 - Basic Science Research Discoveries and Clinical Trials

09:02 - Temporary Embolic Materials

15:28 - Techniques for Embolization

17:33 - Plantar Fasciitis Treatment

24:04 - Future of Embolization in Sports Injuries

28:11 - Diagnostic Imaging in Embolization

36:10 - Global Expansion and Collaborations

Vertebral augmentation for degenerative disc disease has traditionally been performed using cement injections. However, new biomaterials are emerging that may offer more precise targeting of the vertebral discs, potentially leading to higher patient satisfaction. In this episode of Backtable MSK, Dr. Olivier Clerk-Lamalice discusses significant advances in the treatment of degenerative disc disease, with a particular focus on disc augmentation using intradiscal hydrogel. This episode marks the third and final installment in our series on degenerative disc disease with Dr. Clerk-Lamalice.

---

This podcast is supported by:

Medtronic Interventional

https://www.medtronic.com/interventional

---

SYNPOSIS

Dr. Clerk-Lamalice begins by exploring the history of hydrogel use for degenerative disc disease, highlighting the different iterations of this biomaterial. As an experienced practitioner in this field, he shares valuable tips on injection volume and technique. His work is especially meaningful to him because the procedure provides significant pain relief for patients. The doctors also delve into patient selection criteria and ongoing clinical trials aimed at obtaining FDA approval in North America. Additionally, the episode offers a preview of the upcoming GRIBOI conference, which will focus on the use of injectable osteoarticular biomaterials in bone augmentation.

---

TIMESTAMPS

00:00 - Introduction

02:28 - History and Current Use of Intradiscal Hydrogel

07:19 - Technical Insights for Injection

12:51 - Clinical Outcomes and Patient Satisfaction

15:33 - Ongoing FDA Clinical Trials

16:38 - Future Research and GRIBOI Conference Details

---

RESOURCES

BackTable MSK Ep. 67- Introduction to the Treatment of Discogenic Back Pain:

https://www.backtable.com/shows/msk/podcasts/67/introduction-to-treatment-of-discogenic-back-pain

BackTable MSK Ep. 68- BackTable Basics: Lumbar Access and Discography

https://www.backtable.com/shows/msk/podcasts/68/backtable-basics-lumbar-disc-access-discography

GRIBOI Conference:

https://www.griboi.org/annualconference

Hydrogel Augmentation of the Lumbar Intervertebral Disc: An Early Feasibility Study of a Treatment for Discogenic Low Back Pain (Beal et al, 2024):

https://www.jvir.org/article/S1051-0443(23)00694-2/fulltext

The lumbar discogram is a cornerstone of musculoskeletal (MSK) radiology, as it enables interventionalists to pinpoint the exact level of discogenic back pain. In this episode of Backtable MSK, the Dr. Olivier Clerk-Lamalice and host Dr. Jacob Fleming explore the techniques and applications of the discogram, a procedure highly valued for its effectiveness in both diagnosis and pain management.

---

This podcast is supported by:

Medtronic Interventional

https://www.medtronic.com/interventional

---

SYNPOSIS

They discuss the fluoroscopically guided approach, focusing on techniques like Kambin’s triangle and the far-lateral approach. The doctors also cover their preferred contrast agents and injection methods, along with concurrent therapeutic injections.

The conversation delves into the varied disc anatomies that require different approaches, including adjustments in needle angulation. They also emphasize the importance of prophylactic antibiotics, potential challenges, and the evolving landscape of therapeutic options, including intradiscal platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC).

---

TIMESTAMPS

00:00 - Introduction

01:17 - Overview of Lumbar Discogram Technique

04:56 - Contrast Injection and Pain Response

07:40 - Therapeutic Injections

10:00 - Discography Under CT Guidance

12:43 - Strategies for Challenging Cases

17:52 - Protocol for Infection Prevention

20:15 - Post-Discogram Treatment Options

21:30 - Emerging Therapies

---

RESOURCES

BackTable MSK Ep. 68- Introduction to the Treatment of Discogenic Back Pain:

https://www.backtable.com/shows/msk/podcasts/67/introduction-to-treatment-of-discogenic-back-pain

BackTable MSK Ep. 62- Exploring Intradiscal PRP for Back Pain Relief with Dr. Guilherme Ferreira Dos Santos:

https://www.backtable.com/shows/msk/podcasts/62/exploring-intradiscal-prp-for-back-pain-relief