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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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 Hurdles
13:55 - Hip Etiologies Treated by Embolization
16:54 - Imaging Workup and the Role of MRI
24:23 - Offering Conservative Treatment Options Prior to Embolization
26:52 - Scoring Systems and Physical Exam
34:44 - Procedure Access Strategy
39:16 - When to Utilize Temporary vs. Permanent Embolics
46:34 - Post-Procedure and Follow-Up Guidelines
58:05 - 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.

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Resources

Dr. Mateus Correa
https://www.researchgate.net/profile/Mateus-Correa-4

Dr. Joaquim Filho
https://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

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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This podcast is supported by

Stryker
https://www.stryker.com/us/en/interventional-spine/products/mild-procedure.html

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Timestamps

00:00 - Introduction
04:22 - What is the MILD procedure?
09:55 - Comparing Discogenic Pain to Neurogenic Claudication
19:20 - MILD Procedure Technique
22:54 - Toolbox and Workflow
36:59 - MILD Makes a Difference in the Pain Management Field
41:53 - Objectifying Pain Measurements and Setting Patient Expectations
46:26 - Driving Mutual Understanding in Surgical Cohorts
01:00:53 - Collaboration Over Competition
01:05:32 - 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 Patterson
https://www.linkedin.com/in/denis-patterson-50ba0485/

MiDAS I (Mild Decompression Alternative to Open Surgery): a preliminary report of a prospective, multi-center clinical study
https://pubmed.ncbi.nlm.nih.gov/20648206/

The durability of Minimally Invasive Lumbar Decompression procedure in patients with symptomatic lumbar spinal stenosis: Long-term follow-up
https://pubmed.ncbi.nlm.nih.gov/33942964/

Pacific Spine and Pain Society
https://pacificspineandpainsociety.com/

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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

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

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Timestamps

00:00 - Introduction
01:18 - Ideal Patient for Plantar Fasciitis Embolization
02:14 - Workup, Imaging Needs, and the Reality of Insurance Coverage
03:53 - Benefits And Expectations
06:05 - Step By Step Procedure Walkthrough
11:29 - Pain Relief and Follow-Up Timeline
13:46 - GAE Case Setup
14:54 - Debating Access Strategy
15:54 - Crash Course in Genicular Artery Anatomy
19:08 - Minimalist GAE Toolkit Set-Up
22:32 - Time to Inject! The Wrap Up

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Resources

Dr. Mikin Patel
https://jointvascular.com/team/mikin-v-patel-md-mba/

Dr. Osman Ahmed
https://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 MSK
03:02 - Building Referral Networks
06:50 - Details on Clinic Workflow
10:08 - The Run Down on Shoulder Embolization Treatment Targets
22:09 - Current Insights on Shoulder OA Embolization
27:56 - Shoulder Embolization Setup and Access Choice
34:28 - Shoulder Embolization Strategy and Endpoints
36:38 - Post-Procedure Pain Control and Activity Limitations
42:26 - Shoulder Surgery Status-Post Embolization
44:17 - Discussing Existing Research Data on Shoulder Embolization
01:00:32 - Key Shoulder Arterial Anatomy and Variants
01:04:27 - Shoulder OA Case Discussion
01:09:08 - Final Thoughts

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RESOURCES

Dr. Yan Epelboym, MD, MPH
https://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-FX
https://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 - Introduction
02:02 - GAE in South America
03:57 - Patient Selection for GAE
13:18 - Procedure Techniques and Device Choices
23:54 - Challenges and Tips for TKA Patients Undergoing GAE
27:17 - Patient Follow-Up After Intervention
29:41 - Handling Treatment Failures
32:57 - Adjunctive Therapies for Post-TKA Patients with GAE
34:46 - Research Update: Dr. Viso’s Recent Publication on GAE in Post-TKA Patients
39:44 - Case Studies and Discussion
50:19 - Future Directions and Final Thoughts

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RESOURCES

Dr. Rene Viso
https://www.linkedin.com/in/rene-viso-11a245132/

Genicular Artery Embolization for Persistent Pain after Total Knee Arthroplasty: Initial Clinical Experience
https://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 - Introduction
05:54 - Patient Workup for GAE
10:42 - Setting Patient Expectations for GAE
16:24 - Procedure Approaches and Techniques
30:41 - Understanding Artery Targeting Strategies
34:56 - Approaches to Microcatheter Selection
38:18 - Choosing the Right Embolic Agents
47:43 - Managing Complications and Follow-Ups
51:23 - Challenges with Post-TKA Patients
54:16 - Future Directions