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

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