BackTable MSK

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

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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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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

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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

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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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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

In this episode of The Back Table MSK Podcast, Dr. Alexa Levey discusses the importance of multidisciplinary treatment planning for sarcomas with Dr. Yvette Ho and Dr. Jessica Jones.

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CHECK OUT OUR SPONSOR

Stryker Interventional Spine

https://www.strykerivs.com

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SYNPOSIS

The conversation explores the necessity of a multidisciplinary approach and the challenges associated with managing both osseous and soft tissue sarcomas. Dr. Jones highlights recent advancements in precision medicine, including a novel drug, nirogacesta, for desmoid tumors. Dr. Ho addresses common misconceptions surrounding desmoid tumors, emphasizing their potential for significant tissue destruction, and shares insights from her experience in limb salvage surgery. Dr. Levey discusses the considerations involved in needle biopsy and presents case studies where cryoablation effectively reduced desmoid tumor sizes.

The doctors also discuss strategies for managing nociceptive and mechanical pain, such as intrathecal pain pumps, radiation therapy, and kyphoplasty.

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TIMESTAMPS

00:00 - Introduction

03:51 - Challenges in Sarcoma Management

13:06 - Precision Medicine in Treatment Planning

16:44 - The Role of Biopsy

20:51 - The Importance of Specialized Oncology Care

25:13 - Collaboration Throughout Treatment Course

31:03 - Cryoablation and Case Studies

35:13 - New Drug Development for Desmoid Tumors

39:06 - Limb Salvage Considerations

41:13 - Metastasis, Recurrence, and Pain Management

49:57 - Final Thoughts

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RESOURCES

OGSIVEO (Nirogacestat):

https://www.ogsiveo.com/

Basivertebral nerve ablation is a potential solution for anterior column spine pain. Dr. Olivier Clerk-Lamalice outlines a typical ablation procedure and discusses alternative approaches for challenging target locations.

The procedure generally uses a transpedicular approach with an 8-gauge introducer needle, visualized under fluoroscopy. The needle angle should ensure that the probe can later be placed in the center of the vertebral body. The basic technique is similar to that of vertebral augmentation, employing an aneural and avascular approach. A bipolar ablation probe is aimed 1-cm ventral to the posterior wall of the vertebral body to establish a safe ablation zone and avoid neural structures. The ablation is performed at 85°C for 15 minutes. It is important to ablate the nerve at the vertebral bodies both above and below the target level.

For challenging targets, such as at L5, S1, high-riding pelvis, or in cases with prior transpedicular screw placement, the goal is to take the straightest path possible, which can require the transiliac approach. 

TIMESTAMPS

00:00 - Standard Procedure Walkthrough 

05:54 - Alternate Approaches for Challenging Targets

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BackTable MSK Ep. 13- Basivertebral Nerve Ablation 

https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation