BackTable MSK

What evidence is currently available regarding the use of genicular artery embolization (GAE) for treating knee osteoarthritis? Principal investigator Dr. Mark Little discusses the GENESIS 2 trial, a large randomized controlled study aimed at assessing the outcomes of embolizing abnormal genicular arteries to reduce pain in patients with mild to moderate knee osteoarthritis. Dr. Little explains the trial’s design, methodology, and the significance of key data points such as the Knee Injury and Osteoarthritis Outcome Score (KOOS), cost-effectiveness, and quality of life measures. He also covers the materials and techniques used in both the GENESIS 1 and 2 trials, the neuropsychological tests integrated into the study, and potential geographic and anatomical challenges encountered during GAE. Dr. Little highlights the importance of high-quality research and data to support the procedure's efficacy and safety. TIMESTAMPS 00:00 - Overview of GENESIS 2 Trial 04:42 - Embolic Materials and Techniques 09:10 - Challenges in Patient Anatomy & Comorbidities 12:40 - Final Thoughts CHECK OUT THE FULL EPISODE Exploring GAE: Clinical Insights & Outcomes with Dr. Mark Little https://www.backtable.com/shows/msk/podcasts/50/exploring-gae-clinical-insights-outcomes

For patients suffering from intractable pain due to knee osteoarthritis, genicular artery embolization (GAE) offers a minimally invasive treatment with potential long-term benefits. Dr. Mark Little, an interventional radiologist at Royal Berkshire NHS Foundation Trust, joins us to provide an introduction to GAE. He shares his experience with the procedure and compares it to other treatments, such as steroid injections and surgery. Dr. Little also discusses the disease process of osteoarthritis and explains how GAE targets abnormal blood vessels to reduce inflammation and alleviate pain. TIMESTAMPS 00:00 - Introduction 03:38 - Understanding Knee Osteoarthritis 06:57 - Patient Selection for GAE 08:57 - Challenges and Opportunities in GAE 12:18 - Safety and Procedure Details CHECK OUT THE FULL EPISODE Exploring GAE: Clinical Insights & Outcomes with Dr. Mark Little https://www.backtable.com/shows/msk/podcasts/50/exploring-gae-clinical-insights-outcomes

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. --- This podcast is supported by an educational grant from: Medtronic https://www.medtronic.com/ --- 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. --- 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 --- 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. --- 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. --- 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 --- 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. --- This podcast is supported by an educational grant from: Medtronic https://www.medtronic.com/en-us/index.html --- 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. --- 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 --- 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. --- 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. --- 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

More often than not, a surgical innovation is not the result of an overnight success, but rather the result of iterative improvements on a tool or technique that leads to better outcomes. In this episode of the BackTable MSK Podcast, we interview Dr. Jim Marino, a retired orthopedic surgeon and prolific medtech innovator. Dr. Marino gives us an inside look at his extensive career, detailing his role in orthopedic device innovation and the trials and tribulations that he faced along the way. --- SYNPOSIS Having trained in an era where joint arthroscopy was emerging, Dr. Marino had a vision to build devices for minimally invasive spine surgery that paralleled developments in peripheral joint surgery. Alongside venture capitalists, he founded the company NuVasive, and eventually Trinity Orthopedics. He discusses the COREX device, a percutaneous autologous bone harvester that rivals the use of biologics. COREX maintains the gold standard of using cancellous bone grafts and significantly decreases donor site pain. Applications for this device started with bone grafting for spinal fusion surgery, but are now expanding to foot and ankle procedures. Throughout this episode, Dr. Marino also shares valuable advice for aspiring physician innovators on maintaining a clinical practice during the entrepreneurship journey and balancing patient safety with innovative practices. --- TIMESTAMPS 00:00 - Introduction 14:34 - Reflections on Spine Innovation 25:03 - Clinical and Radiographic Evaluation 31:50 - Founding NuVasive: From Ideas to Reality 43:28 - Minimally Invasive Bone Grafting with COREX 1:00:06 - Future Applications of COREX 01:10:21 - Advice for Aspiring Physician Innovators --- RESOURCES NuVasive: https://www.nuvasive.com/ COREX Minimally Invasive Bone Harvester: https://trinityorthodevice.com/ YODA Project for rhBMP-2 safety and efficacy : https://yoda.yale.edu/about/data-holders/medtronicrhbmp-2/ Seattle Science Foundation YouTube: https://www.youtube.com/channel/UChIIig54yF9aQYvpWGe1DPg

Genicular artery embolization (GAE) is quickly emerging as a treatment option for knee osteoarthritis when other therapies have failed. In this episode of the BackTable Podcast, Dr. Osman Ahmed discusses the origins of GAE and how he employs it in his practice. --- This podcast is supported by an educational grant from: Guerbet https://www.guerbet-us.com --- SYNPOSIS Dr. Ahmed, an interventional radiologist at the University of Chicago, shares details about the procedure, his journey in adopting it, and his thoughts on the current landscape of GAE. Topics include procedural techniques, patient selection, anatomical considerations, potential complications, and the importance of ongoing research in this field. --- TIMESTAMPS 00:00 - Introduction 04:43 - Knee Osteoarthritis and Current Treatments 07:54 - Building a GAE Practice 13:23 - Tools and Procedure: Step-by-Step 25:05 - Post-Procedure Care and Complications 30:26 - Future of GAE and Other Applications 34:03 - Conclusion and Contact Information --- RESOURCES BackTable INN Ep. 46- New Innovations in Treatment of PE: The Flow Medical Story with Founders Dr. Osman Ahmed and Dr. Jonathan Paul: https://www.backtable.com/shows/innovation/podcasts/46/new-innovations-in-treatment-of-pe-the-flow-medical-story BackTable VI Ep. 429- Tackling Upper GI Bleeds: Techniques and Tools with Dr. Osman Ahmed: https://www.backtable.com/shows/vi/podcasts/429/tackling-upper-gi-bleeds-techniques-tools BackTable VI Ep. 447- Exploring GAE: Clinical Insights & Outcomes with Dr. Mark Little: https://www.backtable.com/shows/vi/podcasts/447/exploring-gae-clinical-insights-outcomes GEST MSK Conference 2025 (Paris): https://www.gestmsk.com/ Okuno Y et al. Transcatheter arterial embolization as a treatment for medial knee pain in patients with mild to moderate osteoarthritis (2014): https://pubmed.ncbi.nlm.nih.gov/24993956/ Little MW et al. Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS 1) Using Permanent Microspheres: Interim Analysis (2021): https://pubmed.ncbi.nlm.nih.gov/33474601/ Little MW et al. Genicular Artery Embolisation in Patients with Osteoarthritis of the Knee (GENESIS 2): Protocol for a Double-Blind Randomised Sham-Controlled Trial (2023): https://pubmed.ncbi.nlm.nih.gov/37337060/ Correa MP et al.GAUCHO - Trial Genicular Artery Embolization Using Imipenem/Cilastatin vs. Microsphere for Knee Osteoarthritis: A Randomized Controlled Trial (2022): https://pubmed.ncbi.nlm.nih.gov/35304614/ Sapoval M et al. Genicular artery embolization for knee osteoarthritis: Results of the LipioJoint-1 trial (2024): https://pubmed.ncbi.nlm.nih.gov/38102013/

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 CHECK OUT THE FULL EPISODE 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. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- 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. --- 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 CHECK OUT THE FULL EPISODE 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 CHECK OUT THE FULL EPISODE 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. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- 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. --- 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 --- 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. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- 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. --- 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 --- 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