In this BackTable MSK episode, host Dr. Jacob Fleming interviews Dr. Alan Sag about techniques and advancements in bone cryoablation. Dr. Sag is an interventional radiologist at Duke University Medical Center.

To start, Dr. Sag discusses his current practice and collaboration with orthopedic surgeons. He highlights IlluminOss, a new photodynamic bone stabilization system that uses similar concepts to endovascular balloons. Then, the doctors move onto discussing cryoablation, which was recently cleared by the FDA for use in pain palliation in bone metastases. Dr. Sag describes the procedural steps of cryoablation, pneumodissection with carbon dioxide, when to use polymethylmethacrylate (PMMA) augmentation, the value of same session biopsy, and education for referrers and patients.

Cryoneurolysis and intrathecal pain pumps are also discussed, as they can offer additional pain relief for patients and reduce opioid dependence.

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Stryker Interventional Spine

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SHOW NOTES

00:00 - Introduction

03:20 - Collaboration with Orthopedic Surgery

08:57 - FDA Clearance for Cryoablation

14:47 - Cement Augmentation after Cryoablation

19:22 - Approach to the Cryoablation Procedure

26:57 - The Value of Same Session Biopsy

29:11 - Coordinating Cross-Specialty Oncologic Care

33:30 - Side Effects of Cryoablation

38:03 - Cryoneurolysis for Pain Reduction

45:40 - Skin Safety During Cryoablation

50:58 - Preferred Imaging Modalities

57:28 - Neuromodulation with Intrathecal Pain Pumps

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RESOURCES

Symposium on Clinical Interventional Oncology (CIO):

https://www.hmpglobalevents.com/cio

BackTable VI Ep. 221- Building a Musculoskeletal Oncology Service Line with Dr. Alan Sag:

https://www.backtable.com/shows/vi/podcasts/221/building-a-musculoskeletal-interventional-oncology-service

IlluminOss Photodynamic Bone Stabilization System:

https://www.illuminoss.com/eu

BackTable VI Ep. 401- The MOTION Study: Cryoablation for Painful Bony Metastases with Dr. Jack Jennings:

https://www.backtable.com/shows/vi/podcasts/401/the-motion-study-cryoablation-for-painful-bone-metastases

BackTable VI Ep. 284- Ortho/IR Collaboration in Private Practice with Dr. Tony Brown & Dr. Daniel Lerman:

https://www.backtable.com/shows/vi/podcasts/284/ortho-ir-collaboration-in-private-practice

BackTable MSK Ep. 25- Advanced Minimally Invasive Pain Interventions with Dr. David Prologo:

https://www.backtable.com/shows/msk/podcasts/25/advanced-minimally-invasive-pain-interventions

Pneumodissection for Skin Protection in Image-Guided Cryoablation of Superficial Musculoskeletal Tumors:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5499669/

BackTable MSK 40- Innovating Pain Management: The Role of Spinal Cord Stimulators in Outpatient Care with Dr. Doug Beall

https://www.backtable.com/shows/msk/podcasts/40/innovating-pain-management-the-role-of-spinal-cord-stimulators-in-outpatient-care