Your bony fixation technique can make (or break) a complex fracture case. In this episode of the BackTable MSK Podcast, host Kavi Krishnasamy welcomes Dr. Brandon Key, interventional radiologist at Medical College of Wisconsin (MCW) in Milwaukee, to discuss bone stabilization techniques in treating pathologic and non-pathologic fractures.

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SYNPOSIS

Dr. Key shares insights into his practice, highlighting the importance of multidisciplinary collaboration with orthopedic surgery, the challenges of training in bony fixation, and the evolving technology that aids in these procedures, including the use of IlluminOss Photodynamic nails in complex bone interventions. Several detailed case studies illustrate the practical application and benefits of these advanced techniques, emphasizing their impact on patient outcomes and functionality.

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TIMESTAMPS

00:00 - Introduction
02:06 - A Run Down of Bone Stabilization in the IR Space
12:54 - What’s in the Toolbox?
17:51 - Patient Preparation and Procedure Setup
29:47 - Combining Fixation with Thermal Ablation
34:12 - Introducing the Photodynamic Nail by IlluminOss
40:22 - “The Learning Curve” of the Photodynamic Nail
47:48 - Dr. Key’s Guidance for Practice Building
52:01 - Literature Highlights on IlluminOss
55:01 - Case 1: Anterior Column Disease
01:01:27 - Case 2: Isolated Posterior Column Disease
01:05:37 - Case 3: Non-healing Pathologic Fracture of Pubic Ramus
01:09:37 - Case 4: Iliac Wing Fixation with Orthopedic Surgery
01:15:40 - Case 5: Sacral Defects
01:19:45 - Case 6: Reconstruction of Posterior Iliac Wing
01:23:50 - Post-Procedure Outcomes and Reflections
01:29:02 - Final Thoughts: Encouragement for Collaboration and Innovation

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RESOURCES

Dr. Brandon Key, MD
https://www.linkedin.com/in/brandon-key-md-367a01310/

A Prospective Study of the IlluminOss Photodynamic Nail System for Pelvic Stabilization: Treatment of Impending and Actual Fractures from Metastatic Bone Disease, Multiple Myeloma, and Primary Bone Lymphoma
https://pubmed.ncbi.nlm.nih.gov/39281295/

Minimally Invasive Stabilization Using Screws and Cement for Pelvic Metastases: Technical Considerations for the Pelvic "Screw and Glue" Technique
https://pubmed.ncbi.nlm.nih.gov/31435131/

IlluminOss
https://illuminoss.com/us

Flow-FX
https://flow-fx.net/products/

How to stay cool when a thermal ablation case gets complicated? Your toolbox can make all the difference. In this episode of the BackTable MSK Podcast, Dr. Alan Sag returns with host Dr. Jacob Fleming to continue the discussion on thermal protection in musculoskeletal ablation procedures. Part 2 focuses on real-world cases to provide practical insights and illustrate decision-making in complex thermal ablation cases.

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SYNPOSIS

Dr. Sag and Dr. Fleming discuss thermoprotection strategies in real-world cases, such as radiofrequency ablation (RFA) of inoperable rectal cancer and sacral metastases near nerve roots. They also discuss the importance of interdisciplinary collaboration, emerging technologies in the field, and the role of intraoperative neuromonitoring.

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TIMESTAMPS

00:00 - Introduction
00:55 - Ganglion Impar and Pelvic Pain Strategies
09:08 - The Active Thaw Phenomenon
18:20 - Nerve Protection During Ablations
23:16 - Motor and Sensory Neuromonitoring
34:06 - Temperature Management in Ablative Procedures
40:28 - Dosing Strategies for Gabapentin and Lyrica in Nerve Injuries
42:33 - Future Directions

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RESOURCES

Dr. Alan Alper Sag, M.D., FSIR
https://med.miami.edu/faculty/alan-alper-sag-md-fsir

Thermal Protection: Heightened Safety for Minimally Invasive Percutaneous Ablation of Musculoskeletal Tumors
https://pubs.rsna.org/doi/10.1148/rg.240238

Intraoperative Neuromonitoring for Peripheral Nerve Surgery
https://mayoclinic.elsevierpure.com/en/publications/intraoperative-neuromonitoring-for-peripheral-nerve-surgery/

Burns = big consequences. Let’s talk thermoprotection. In this episode of the BackTable MSK Podcast, host Jacob Fleming welcomes longtime friend and colleague Dr. Alan Sag to discuss thermoprotection in musculoskeletal ablation procedures over this two-part episode series. Part 1 focuses on established strategies and new techniques for protecting critical structures during ablation.

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SYNPOSIS

Dr. Sag shares how he approaches thermoprotection in complex MSK ablation cases. The discussion covers hydro-dissection techniques, hydro convection needle strategies, pump and tubing set up, troubleshooting, and visualization of the protective layer.

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TIMESTAMPS

00:00 - Introduction
02:49 - Thermoprotection 101
12:37 - Skin Injury and Mitigation Strategies
18:57 - Avoiding Bottlenecks with Hydrodissection
23:49 - Practical Recommendations for Cold Skin Protection
29:36 - Managing Complications and Wound Care
38:12 - Heating up with RFA and Microwave Ablations

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RESOURCES

Dr. Alan Alper Sag, M.D., FSIR
https://med.miami.edu/faculty/alan-alper-sag-md-fsir

Thermal Protection: Heightened Safety for Minimally Invasive Percutaneous Ablation of Musculoskeletal Tumors
https://pubs.rsna.org/doi/10.1148/rg.240238

Intraoperative Neuromonitoring for Peripheral Nerve Surgery
https://mayoclinic.elsevierpure.com/en/publications/intraoperative-neuromonitoring-for-peripheral-nerve-surgery/

Ablate before you radiate. Success with bone tumor ablation may have as much to do with your procedure technique as it does with your ability to collaborate. In this episode of BackTable MSK, interventional oncologist Dr. Damian Dupuy shares his approach to bone tumor ablation with host Dr. Kavi Krishnasamy, and offers practical advice on how to partner with your cancer care team to make ablation a viable treatment option.

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This podcast is supported by:

Medtronic Osteocool

https://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-2-0-bone-tumor-ablation-system.html

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SYNPOSIS

The doctors review the history of bone ablation techniques, including radiofrequency and cryoablation modalities. They discuss the significance of targeting the bone-tumor interface for pain palliation and highlight several case studies to illustrate various techniques and successful outcomes. The conversation also touches upon the synergistic benefits of combining ablation with radiation therapy and emphasizes the importance of multidisciplinary collaboration in treating cancer patients.

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TIMESTAMPS

00:00 - Introduction
02:07 - Dr. Dupuy’s Start in Bone Ablation
06:29 - Cryo vs. Microwave Therapies
08:25 - Dr. Dupuy’s Clinical Trial and Research Involvement
12:49 - Patient Selection and Treatment Strategies
25:54 - Sedation and Anesthesia Practices in Bone Ablation
28:46 - Treatment Approach: Oligometastases vs. Progressive Disease
36:22 - Microwave Ablation in Bone: Future Prospects
37:30 - Techniques for Treating Sclerotic and Lytic Lesions
40:01 - Skin Protection Methods in Superficial Lesion Treatments
41:49 - Reviewing Recent Clinical Trials: MOTION, OPuS One, and More
52:35 - Case Studies: Achieving Effective Ablation Techniques
01:08:08 - Final Thoughts and Recommendations

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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/

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/

A Multi-Center Observational Trial of Symptomatic, High-Risk Bone Metastases Treated with Percutaneous Ablation and Palliative Radiation Therapy (TRIBUTE)
https://clinicaltrials.gov/study/NCT06859801

“We learn traditionally that bone metastasis is terminal.” 一 Or is it? In this episode of the BackTable MSK podcast, host Dr. Jacob Fleming welcomes Dr. Francis Lee, a leading figure in orthopedic oncology, to discuss advancements in treating skeletal metastasis. Dr. Lee, the Wayne O. Southwick Professor from Yale and President-elect of the Musculoskeletal Tumor Society, shares his innovative AORIF (Ablation, Osteoplasty, Reinforcement and Internal Fixation) technique, which emphasizes collaboration between orthopedic oncologists and interventional radiologists.

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This podcast is supported by an educational grant from Medtronic.

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SYNPOSIS

The conversation covers the complexities of bone metastasis, the biomechanics of skeletal ablation, and the importance of understanding bone-cancer interactions. Dr. Lee also shares insights from his translational research on cancer and bone dynamics, and emphasizes the need for continued interdisciplinary collaboration to drive forward minimally invasive treatments.

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TIMESTAMPS

00:00 - Introduction
01:39 - Crash Course: Orthopedic Oncology 101
13:24 - The Important Role of Biomechanics
20:10 - Dr Lee’s Training and Interdisciplinary Collaboration
28:13 - Intraoperative Imaging and Techniques in AORIF
40:15 - Cannulated Screws for Access and Fixation
42:24 - Case Study: Sacral Insufficiency Fracture and Cement Injection
44:17 - Understanding Cement Properties and Application
46:45 - Case Study Series: Approach to Reconstruction
57:58 - Decision Making in Complex Procedures
01:08:40 - The Power of Bone Regeneration
01:12:31 - Final Thoughts

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RESOURCES

Dr. Francis Lee, MD, PhD, FAAOS, MBA
https://medicine.yale.edu/profile/francis-lee/

Minimally Invasive Image-Guided Ablation, Osteoplasty, Reinforcement, and Internal Fixation (AORIF) for Osteolytic Lesions in the Pelvis and Periarticular Regions of Weight-Bearing Bones
https://pubmed.ncbi.nlm.nih.gov/32139256/

Living in the best of both worlds: balancing pain management and quality of life. In this BackTable MSK Brief, Dr. Mark Amsbaugh and Dr. Ran Lador discuss multidisciplinary approaches to treating spinal tumors with a particular focus on pain management. They explore the complexities of defining and treating pain related to spinal tumors, differentiating between mechanical instability, tumor burden, and neuropathic pain. 

The conversation delves into the roles of various treatments including opioids, radiation, nerve blocks, cryoablation, and surgical interventions. They highlight the evolving landscape of spine oncology, emphasizing the need for holistic approaches and the promising future of integrating advanced technologies for better patient outcomes.

Episode Outline

00:00 - Introduction 

00:53 - Approach to Pain Management in Spine Oncology

02:54 - Multimodal Analgesia

04:25 - What is a Safe Radiation Dose that Spares Spinal Nerves?

07:59 - The Balance Between Quality of Life and Pain Management 

09:58 - Final Remarks

Resources

Dr. Mark Amsbaugh, MD

https://med.uth.edu/neurosciences/dr-mark-j-amsbaugh-md/ 

Dr. Ran Lador, MD

https://med.uth.edu/ortho/2022/11/02/ran-lador-md/ 

Dr. Alexa Levey, MD

https://medicine.yale.edu/profile/alexa-levey/

As our understanding of pain physiology evolves, neuromodulation continues to offer new treatment possibilities in MSK pain management. In this episode of the BackTable MSK, host Jacob Fleming discusses the evolving world of neuromodulation with Dr. Timothy Deer, a leading expert in the field. Dr. Deer shares insights from his extensive career and his innovative contributions in neuromodulation.
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This podcast is supported by:
Medtronic Osteocool
https://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-2-0-bone-tumor-ablation-system.html
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SYNPOSIS
The conversation covers the development of spinal cord and dorsal root ganglion (DRG) stimulation, the significance of patient selection and challenges facing neuromodulation therapies, and exciting developments in the field, including AI. Dr. Deer and Dr. Fleming also discuss the importance of advanced training and the pioneering work by the American Society of Pain and Neuroscience (ASPN) to improve procedural education through its innovative MIS Certification Program.
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TIMESTAMPS
00:00 - Introduction
02:52 - What is Neuromodulation?
06:03 - Evolution of Neuromodulation
08:49 - Use of Closed Loop and AI
13:58 - DRG Stimulation Explained
19:58 - Progression of Peripheral Nerve Stimulation
26:26 - Handheld Navigation and Reducing Radiation Exposure
30:18 - The Umbrella of Specialties within ASPN
35:15 - Obtaining MIS Certification and Fellowship Program Outlook
44:07 - Future Directions of Neuromodulation
48:09 - Concluding Thoughts
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RESOURCES
Dr. Timothy Deer, MD
https://centerforpainrelief.com/doctor-timothy-deer/
American Society of Pain and Neuroscience (ASPN)
https://aspnpain.com/

“There is always constant review and constant learning”. In this BackTable MSK Brief, Dr. Mark Amsbaugh and Dr. Ran Lador discuss comprehensive treatment strategies for spinal tumors, highlighting the critical interplay between surgical and radiation oncology. 

The doctors explain the complex planning required based on tumor characteristics, including surgical options like en bloc resection and minimally invasive techniques, as well as the advancements in radiation therapy. The conversation emphasizes the importance of collaboration across disciplines to optimize patient outcomes, improve quality of life, and adapt to new medical advancements.

Episode Outline

00:00 - Introduction

00:21 - Collaboration Between Surgeons and Interventionalists

05:42 - Intertwined Approach of Radiation and Surgical Treatment

07:37 - Advancements in Radiation Techniques

14:15 - Advancements in Surgical Approach 

16:20 - Final Thoughts

Resources

Dr. Mark Amsbaugh, MD

https://med.uth.edu/neurosciences/dr-mark-j-amsbaugh-md/ 

Dr. Ran Lador, MD

https://med.uth.edu/ortho/2022/11/02/ran-lador-md/ 

Dr. Alexa Levey, MD

https://medicine.yale.edu/profile/alexa-levey/

Check your ego at the door! In this BackTable MSK Brief, Dr. Mark Amsbaugh and Dr. Ran Lador share their multidisciplinary approach to the treatment of spinal tumors at the University of Texas and Memorial Hermann in Houston.

They highlight the distinctive aspects of their practice, including their extensive collaboration and support system for patients, the intricate process of managing spinal tumors, and the unique challenges and solutions they encounter. The doctors emphasize the importance of teamwork, minimally invasive techniques, and comprehensive patient-centered care to improve treatment outcomes for patients with spinal tumors.

Episode Outline

00:00 - Introduction 

03:18 - Addressing Potential Barriers in Receiving Spinal Tumor Treatment

04:32 - The Multidisciplinary Approach in Action

07:46 - Minimally Invasive Techniques and Their Impact

09:49 - Navigating Patient Care and Referrals

14:29 - Final Thoughts 

Resources

Dr. Mark Amsbaugh, MD

https://med.uth.edu/neurosciences/dr-mark-j-amsbaugh-md/ 

Dr. Ran Lador, MD

https://med.uth.edu/ortho/2022/11/02/ran-lador-md/ 

Dr. Alexa Levey, MD

https://medicine.yale.edu/profile/alexa-levey/

Are you considering expanding your IR practice into pain management services? Get the download from someone who’s done it already. In this episode of BackTable MSK, Dr. Sean Maratto from Philadelphia's Jefferson Health Network is joined by guest Dr. Junjian Huang from Emory University School of Medicine to discuss the intricacies of building a pain management practice within the interventional radiology space.
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This podcast is supported by an educational grant from Medtronic.
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SYNPOSIS
Dr. Huang shares his career journey, highlighting his shift towards pain palliation. The conversation covers a range of topics including procedural insights, patient management strategies, navigating institutional politics, and future trends in orthopedic IR. Dr. Huang emphasizes the importance of balancing patient care with building robust referral networks, and shares valuable advice for budding interventional radiologists.
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TIMESTAMPS
00:00 - Introduction
02:20 - What’s Your Why? Why Pain Intervention?
12:52 - Building a Complex Pain Management Practice
24:47 - Marketing a Service Line
30:57 - Patient Impact from Pain Management Services
39:53 - Recommendations and Indications for Cryoneurolysis and BVNA
45:36 - Post-Procedure Follow-up and Psychosomatic Pain Guidance
52:35 - Insight to the Future of Interventional Pain and Final Thoughts
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RESOURCES
Dr. Junjian Huang, MD
https://med.emory.edu/directory/profile/?u=JHUAN22
Dr. Sean Maratto, MD
https://www.jeffersonhealth.org/find-a-doctor/m/maratto-sean-a