BackTable MSK

When it comes to spinal oncology, no single specialty holds all the answers. In this episode of the BackTable Podcast, host Dr. Alexa Levey, an interventional radiologist from Yale School of Medicine, is joined by Dr. Mark Amsbaugh, a radiation oncologist, and Dr. Ran Lador, an orthopedic spine surgeon, both from the University of Texas McGovern Medical School. The discussion explores complexities and innovations in the multidisciplinary treatment of spinal tumors. --- SYNPOSIS Dr. Ambsbaugh and Dr. Lador highlight their cohesive, patient-centered approach at Memorial Hermann, integrating various specialties including surgery, radiation oncology, and interventional radiology. The episode emphasizes the importance of collaborative techniques, advances in minimally invasive surgeries, the role of stereotactic radiosurgery, and the critical nature of personalized patient care in improving outcomes for patients with spinal tumors. --- TIMESTAMPS 00:00 - Introduction01:20 - Multidisciplinary Approach to Spinal Tumors at Memorial Hermann10:22 - Surgical Techniques and Timing for Radiation Treatments 12:25 - Approach to Collaborative Treatment Planning25:45 - Connection Between Surgical and Radiation Oncology in Patient Care31:08 - The Role of Vertebral Augmentation in Spinal Oncology40:08 - Multimodal Pain Management Strategies47:35 - Thoughts on Future Directions in Spinal Oncology and Conclusion --- RESOURCES Dr. Mark Amsbaugh, MDhttps://med.uth.edu/neurosciences/dr-mark-j-amsbaugh-md/ Dr. Ran Lador, MDhttps://med.uth.edu/ortho/2022/11/02/ran-lador-md/ Dr. Alexa Levey, MDhttps://medicine.yale.edu/profile/alexa-levey/

Shownotes Who is the ideal candidate for genicular artery embolization (GAE)? In this BackTable Brief, Dr. Osman Ahmed and Dr. Sid Padia share how they work up and select GAE patients. Dr. Padia and Dr. Ahmed discuss the challenges of patient selection in genicular artery embolization, specifically debating the necessity and utility of MRI with contrast. The discussion also explores the pros and cons of femoral vs. pedal access techniques, considering patient characteristics such as BMI and the practicality of these approaches in various clinical settings. Episode Outline 00:00 - Introduction 00:20 - Use of MRI with Contrast in Patient Selection 04:22 - Challenges and Future Directions of MRI in GAE 07:46 - Pros and Cons of Femoral vs. Pedal Access 10:00 - Practical Considerations Resources Dr. Venkatesh, “Kavi”, Krishnasamy, MD https://www.uab.edu/medicine/radiology/faculty/intervent-radiology/profile/krishnasamy Dr. Osman Ahmed, MD https://bucksbauminstitute.uchicago.edu/bio/osman-ahmed-md/ Dr. Siddarth, “Sid”, Padia, MD https://www.uclahealth.org/providers/siddharth-padia

Where does cryoneurolysis fit in contemporary pain management? In this episode of Backtable MSK, host Jacob Fleming is joined by Dr. Alexa Levey to discuss the role of cryoneurolysis in various pain presentations, covering indications, anatomical targets, and techniques in different clinical scenarios. --- SYNPOSIS This episode offers practical guidance on how to take a detailed patient history, how to use cryoneurolysis for pain management, and the significance of multidisciplinary collaboration. The conversation also highlights the importance of setting proper patient expectations, understanding different types of pain, and the need for standardizing cryoneurolysis procedures through structured research and education.Dr. Levey also shares her recent career move to Yale, her passion for research, and the challenges she faced returning to academia from private practice. --- TIMESTAMPS 00:00 - Introduction03:49 - Discussion of Dr. Levey’s Recent Research Paper09:35 - The Fine Details of Pain and Pain Management 18:42 - Patient Quality of Life Assessment in Regards to Pain Management28:28 - Game Plan for Managing Neuritis37:19 - Collaboration Between Different Specialists40:16 - Offering Patient Education and Support 42:31 - Final Reflections and Gratitude --- RESOURCES Dr. Alexa Leveyhttps://medicine.yale.edu/profile/alexa-levey/ Common Cryoneurolysis Targets in Pain Management: Indications, Critical Anatomy, and Potential Complicationshttps://pubmed.ncbi.nlm.nih.gov/40376212/

Paging all neuroradiologists and spine specialists interested in enhancing their vertebral nerve ablation practice. In this special ESNR edition of Backtable MSK, host Jacob Fleming welcomes neuroradiologist Dr. Luigi Manfre to discuss the intricacies of vertebral nerve ablation, focusing on patient selection, technical approaches, and emerging practice trends. --- SYNPOSIS The physicians discuss the importance of careful diagnosis using MRI, SPECT scanning, and nerve block tests to improve treatment efficacy. Dr. Manfre emphasizes the need for strict patient selection to mitigate failures and highlights the variability in vertebral innervation between patients that can affect outcomes. The conversation also explores the nuances of conducting procedures under CT guidance and addresses challenges in treating different spinal levels, including L5 and S1. BONUS: Details on the ESNR Hands-On Spine Course held in Catania, Italy from October 16th-18th, 2025. --- TIMESTAMPS 00:00 - Introduction02:43 - Upcoming Hands-On Spine Course 08:40 - The Rundown: Basivertebral Nerve Ablation15:18 - Understanding Modic Changes and Their Implications26:03 - Unique Innervation and Corresponding Challenges in Ablation38:13 - Technical Approaches and Difficulties in BVNA51:16 - Patient Selection and Procedure Efficacy for Ablative Procedures01:00:29 - Conclusion and ESNR Course Information --- RESOURCES Dr. Luigi Manfre https://www.linkedin.com/in/luigi-manfre-20b61284/?originalSubdomain=it European Society of Neuroradiology (ESNR)https://www.esnr.org/

Musculoskeletal (MSK) embolization is emerging as a transformative, minimally-invasive option for various chronic pain conditions. In this week’s episode of Backtable MSK, host Dr. Jacob Fleming talks with Dr. Ahmed Farag, an interventional radiologist with expertise in MSK embolization. The conversation covers practice building, tools, and techniques. --- SYNPOSIS Dr. Farag shares insights from his journey beginning with a career in engineering to now a career in medicine and private practice. He emphasizes how good patient outcomes, networking, and continuous learning all work synergistically as a marketing tool. He also touches upon the challenges and triumphs in practice management and the future prospects of outpatient musculoskeletal interventional radiology. This episode provides valuable advice for both veteran practitioners and trainees looking to carve their own paths in this evolving field. --- TIMESTAMPS 00:00 - Introduction 10:53 - Developing a Referral Network in Private Practice15:54 - Discussing the Variety of MSK Embolization Procedures19:39 - Sampling Products and Techniques for MSK Embolization 24:52 - Optimizing Relationships with Hospitals28:05 - Advice for New IR Practitioners33:39 - Keeping Up to Date: Training and Conferences37:10 - Future Directions of Outpatient MSK IR40:52 - Conclusion and Final Thoughts --- RESOURCES Dr. Ahmed Faraghttps://www.flvascular.com/about

Intradiscal ozone offers a minimally invasive approach to disc pain that can reduce inflammation and restore function. How well does it work and where does it fit in the lumbar radiculopathy treatment algorithm? In this episode of the Backtable MSK Podcast, host Jacob Fleming speaks with Dr. Alexis Kelekis about the contemporary role of intradiscal ozone and emerging innovations in interventional spine treatment.---SYNPOSISDr. Kelekis, a prominent figure in radiology and interventional pain management, shares insights from the 2025 GRIBOI meeting held in Banff, AB, Canada. Topics discussed include the development and possibility of bone augmentation polymers, intradiscal ozone therapy, and various interventional treatments for degenerative disc disease and vertebral fractures. Dr. Kelekis also touches on the need for specialized training in interventional radiology and the future of personalized medicine in pain management.---TIMESTAMPS00:00 - Introduction06:40 - Ozone Treatment: Mechanism and Efficacy13:23 - Challenges and Innovations in Spine Treatments20:09 - Treatment Algorithm in Patients with Lower Extremity Radiculopathy 24:00 - Future Directions in Interventional Spine Treatments 30:28 - Closing Remarks---RESOURCESSpinaFx:https://spinafx.com/GRIBOI:https://www.griboi.org/

What sets apart those who are good from those who are great? This episode of Backtable MSK features a profound discussion on leadership and legacy with Dana Dunleavy, MD, Wayne Olan, MD, and David Tilton. Dr. Olan, Director of Minimally Invasive Neurosurgery at George Washington University Medical Center, and David Tilton, a former Navy SEAL and current business and racing professional, share their unique experiences and insights surrounding perseverance in success.---SYNPOSISThe doctors discuss the importance of mentorship, collaboration, and cultivating a culture of growth and accountability. The conversation highlights how nurturing leaders can impact both professional and personal development, emphasizing that the best measure of success lies within the success of those you lead.---TIMESTAMPS00:00 - Introduction10:50 - Learning from Those Around You16:56 - The Value of Continuous Learning and Avoiding Complacency31:43 - The Importance of Teamwork and Mentorship 50:07 - The Role of Failure in Success 52:45 - Closing Remarks: Support and Courage

Who is the ultimate candidate for GAE, which technical approach is best, and how do you set your patients up for success? Tune into this week’s episode of BackTable to hear from interventional radiologists Dr. Osman Ahmed (University of Chicago Medicine) and Dr. Siddharth Padia (UCLA Health) as they discuss everything from patient selection to follow-up care, covering pre-procedure imaging, access, embolics, technical challenges, clinical data, and the future of genicular artery embolization. --- This podcast is supported by: Guerbet --- SYNPOSIS Dr. Ahmed and Dr. Padia debate their approaches to patient selection criteria, the use of MRI and cone beam CT, permanent vs. resorbable embolic materials, how many arteries to embolize, and the relevance of pain metrics post GAE. They also delve into follow-up considerations and the potential for GAE as a long term treatment. --- TIMESTAMPS 00:00 Introduction 01:08 MRI for Patient Selection in GAE 08:53 Access Techniques: Femoral vs. Pedal 17:07 Cone Beam CT in GAE Procedures 27:20 Embolization Strategies 39:30 Challenges and Complications in Embolization 44:50 Follow-Up and Pain Metrics in Clinical Practice and Research 01:06:30 Repeat GAE Procedures: When and Why? 01:11:13 Post-Total Knee Replacement and GAE 01:21:01 Advice for IRs Looking to do GAE 01:24:32 Conclusion and Final Thoughts --- RESOURCES GENESIS Trial: https://pubmed.ncbi.nlm.nih.gov/33474601/ Landers et al Trial: https://pubmed.ncbi.nlm.nih.gov/37051829/

Attention radiologists: Were you trained to look for Tarlov cysts when reading spine MRI? In this episode of Backtable MSK, interventional neuroradiologist Dr. Kieran Murphy joins the studio to discuss the serious issue of chronic pain related to Tarlov cysts, a condition often overlooked in both diagnosis and treatment. Tarlov cysts, also known as perineural cysts, are fluid-filled sacs that form due to the dilation of the subarachnoid space around spinal nerve roots, most commonly at the base of the spine. --- SYNPOSIS Dr. Murphy highlights the high risk of depression and suicide among patients, who are often misdiagnosed and overprescribed ineffective pain medications. He explains how to identify and treat Tarlov cysts through aspiration and fibrin sealing, addresses the historical dismissal of their significance, and underscores the need for a better understanding of CSF leaks. Additionally, Dr. Murphy emphasizes the importance of institutional responsibility in occupational radiation safety for interventionalists, advocating for improved lead protection and antioxidant use to mitigate radiation damage. The episode concludes with a humbling reminder of the implicit biases present in medical practice and the ongoing need for more inclusive and attentive patient care. --- TIMESTAMPS 00:00 - Introduction 01:24 - Challenges in Diagnosing and Treating Tarlov Cysts 04:05 - Patient Experiences and Misdiagnoses 06:06 - Cyst Aspiration Techniques 15:12 - Improved Diagnosis of CSF Abnormalities 22:10 - Allergic Reactions to Fibrin 25:30 - Implicit Bias in Medicine 34:50 - Radiation Safety in Radiology 43:47 - Final Thoughts and Reflections

You asked, and we delivered – here’s a comprehensive episode on Basivertebral Nerve Ablation (BVNA) for vertebrogenic lumbar pain! In this episode of Backtable MSK, our host Dr. Christopher Beck is joined by Dr. Asad Baig, Director of Interventional Spine at Columbia University, to discuss BVNA patient selection and procedural techniques. --- SYNPOSIS Dr. Baig begins by sharing his journey from residency to his current role, including his initial exposure to spine procedures and the mentors who guided him. He offers examples of his workup for back pain, covering detailed patient history and key MRI findings. Dr. Baig emphasizes the importance of understanding risks and alternatives, as well as how to effectively counsel patients on these topics. Additionally, he walks through the BVNA procedure and shares his technical pearls. The episode concludes with Dr. Baig highlighting valuable resources for those interested in starting BVNA procedures and recognizing the supporting role of industry partners. --- TIMESTAMPS 00:00 - Introduction 10:14 - Patient Selection for BVNA 14:45 - Imaging Findings 19:38 - Consent Process and Risks 22:18 - Procedural Technique 28:32 - Sedation and Pain Management 34:03 - Post-Procedure Care and Follow-Up 37:09 - Challenges and Troubleshooting 40:34 - Resources and Mentorship

We’ve had many discussions about the technical aspects of vertebroplasty and kyphoplasty on BackTable MSK. However, in this episode, we take a deeper look into the history of these procedures, exploring early research controversies and the challenges that threatened their existence. Our host, Dr. Jacob Fleming, is joined in the BackTable Studio by interventional neuroradiologist Dr. Joshua Hirsch, who was in San Diego for the ASSR 2025 meeting. Dr. Hirsch is the Chief of the Interventional Spine Service at Massachusetts General Hospital. --- This podcast is supported by: Medtronic MVP https://www.medtronic.com/en-us/healthcare-professionals/products/spinal-orthopedic.html#aq=%40pagetype%3D%22product-model%22&cq=%40products_category%3D%22Spinal%20and%20orthopedic%22%20OR%20%40ontology_isa%3D%22Spinal%20and%20orthopedic%22 --- SYNPOSIS Dr. Hirsch begins by outlining the historical origins of radiologists using cement injection and how this practice evolved into vertebroplasty. He then highlights early research on the procedure, focusing on key 2009 NEJM papers that sparked both scientific and public controversy, leading to setbacks in research and disparities in access to life-changing care. Since that time, newer studies have demonstrated the clear benefits of spinal augmentation for patients with vertebral insufficiency fractures, including Dr. Hirsch’s own research showing a mortality benefit compared to nonsurgical treatment. Overall, the doctors discuss how far this field has advanced and the exciting developments currently in progress. --- TIMESTAMPS 00:00 - Introduction 03:09 - Historical Origins of Vertebroplasty 07:08 - Development and Evolution of Vertebroplasty 10:21 - Controversy Over 2009 Randomized Control Trials 16:35 - Disparities in Access to Vertebroplasty 21:01 - Dr. Hirsch’s Research on Mortality Benefit of Vertebroplasty 32:31 - Opportunities for Patient Education 35:29 - Vertebroplasty vs. Kyphoplasty 37:34 - Challenges in Research Interpretations and Insurance Coverage 42:26 - Future Directions in Vertebral Augmentation --- RESOURCES Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects (Jensen et al, 1997): https://pmc.ncbi.nlm.nih.gov/articles/PMC8337380/ Simplicity of randomized, controlled trials of percutaneous vertebroplasty (Hirsch et al, 2003): https://pubmed.ncbi.nlm.nih.gov/16880881/ INvestigational Vertebroplasty Efficacy and Safety Trial (INVEST): a randomized controlled trial of percutaneous vertebroplasty (Gray et al, 2007): https://pubmed.ncbi.nlm.nih.gov/18096050/ A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures (Buchbinder et al, 2009): https://pubmed.ncbi.nlm.nih.gov/19657121/ A Randomized Trial of Balloon Kyphoplasty and Nonsurgical Management for Treating Acute Vertebral Compression Fractures (FREE) (Meirhaeghe et al, 2013): https://pmc.ncbi.nlm.nih.gov/articles/PMC3678891/ A Randomized Trial of Vertebroplasty for Osteoporotic Spinal Fractures (Kallmes et al, 2009): https://www.nejm.org/doi/full/10.1056/NEJMoa0900563 A Randomized Trial of Epidural Glucocorticoid Injections for Spinal Stenosis (Friedly et al, 2014): https://www.nejm.org/doi/full/10.1056/NEJMoa1313265 Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial (Clark et al, 2016): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31341-1/abstract Number Needed to Treat with Vertebral Augmentation to Save a Life (Hirsch et al, 2020): https://pmc.ncbi.nlm.nih.gov/articles/PMC6975314/ Major Medical Outcomes With Spinal Augmentation vs Conservative Therapy (McCullough et al, 2013): https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1710123 Harvey L. Neiman Policy Institute: https://www.neimanhpi.org/

Dr. John Smirniotopoulos, an interventional radiologist at Georgetown/MedStar Washington Hospital Center, discusses the intricacies of genicular nerve ablation (GNA) for pain management in patients with osteoarthritis and post-surgical knee pain. He delves into the history and evolution of GNA, outlines the neurovascular anatomy, and explains his specific rationale for targeting various nerves for ablation. --- SYNPOSIS Dr. Smirniotopoulos also compares GNA with other procedures such as corticosteroid injections, hyaluronic acid injections, and genicular artery embolization (GAE). He emphasizes the importance of managing patient expectations, the role of physical therapy, and explores different modalities of GNA, including the use of cryoablation versus radiofrequency technology. The episode offers a comprehensive overview of expert insights for evaluating knee pain and performing effective GNA. --- TIMESTAMPS 00:00 - Introduction 03:13 - Understanding Genicular Nerve Anatomy 12:06 - Tailoring GNA Treatment to Each Patient 22:39 - Comparing Ablation Devices and Methods 28:06 - GNA in Surgical and Post-Traumatic Patients 33:19 - Patient-Centered Decision Making 38:50 - Evaluating Functional Outcomes 43:39 - Comparing Treatment Modalities 49:34 - Post-Procedure Counseling and Expectations 58:40 - Future Directions in GNA Research --- RESOURCES Safety and efficacy comparison of three- vs four-needle technique in the management of moderate to severe osteoarthritis of the knee using cooled radiofrequency ablation (Wong, et al 2021): https://pubmed.ncbi.nlm.nih.gov/32968824/

Musculoskeletal embolization is generating significant excitement in the field of chronic pain management. In this episode, Dr. Jacob Fleming hosts a discussion with Dr. Yuji Okuno from Japan, a pioneer in both basic science and clinical practice within the field of musculoskeletal embolization. --- This podcast is supported by: Medtronic MVP https://www.medtronic.com/mvp --- SYNPOSIS The conversation delves into Dr. Okuno's groundbreaking work using embolization to treat chronic pain from conditions such as frozen shoulder, knee osteoarthritis, plantar fasciitis, and various sports injuries. Dr. Okuno discusses the development of new temporary embolic agents and compares different approaches to embolization treatments, including the innovative use of antibiotics as embolic material. The doctors also cover the intriguing concept of differential recanalization, where abnormal inflammatory vessels are less likely to recanalize than normal vessels after embolic treatment. Identifying hypervascularity through MRI, ultrasound, or angiogram is a crucial step before attempting embolization. Overall, Dr. Okuno offers valuable insights into his clinical practice and the potential for groundbreaking advancements in musculoskeletal care worldwide. --- TIMESTAMPS 00:00 - Introduction 01:54 - Origins of Embolization for Pain 04:15 - Basic Science Research Discoveries and Clinical Trials 09:02 - Temporary Embolic Materials 15:28 - Techniques for Embolization 17:33 - Plantar Fasciitis Treatment 24:04 - Future of Embolization in Sports Injuries 28:11 - Diagnostic Imaging in Embolization 36:10 - Global Expansion and Collaborations

Vertebral augmentation for degenerative disc disease has traditionally been performed using cement injections. However, new biomaterials are emerging that may offer more precise targeting of the vertebral discs, potentially leading to higher patient satisfaction. In this episode of Backtable MSK, Dr. Olivier Clerk-Lamalice discusses significant advances in the treatment of degenerative disc disease, with a particular focus on disc augmentation using intradiscal hydrogel. This episode marks the third and final installment in our series on degenerative disc disease with Dr. Clerk-Lamalice. --- This podcast is supported by: Medtronic Interventional https://www.medtronic.com/interventional --- SYNPOSIS Dr. Clerk-Lamalice begins by exploring the history of hydrogel use for degenerative disc disease, highlighting the different iterations of this biomaterial. As an experienced practitioner in this field, he shares valuable tips on injection volume and technique. His work is especially meaningful to him because the procedure provides significant pain relief for patients. The doctors also delve into patient selection criteria and ongoing clinical trials aimed at obtaining FDA approval in North America. Additionally, the episode offers a preview of the upcoming GRIBOI conference, which will focus on the use of injectable osteoarticular biomaterials in bone augmentation. --- TIMESTAMPS 00:00 - Introduction 02:28 - History and Current Use of Intradiscal Hydrogel 07:19 - Technical Insights for Injection 12:51 - Clinical Outcomes and Patient Satisfaction 15:33 - Ongoing FDA Clinical Trials 16:38 - Future Research and GRIBOI Conference Details --- RESOURCES BackTable MSK Ep. 67- Introduction to the Treatment of Discogenic Back Pain: https://www.backtable.com/shows/msk/podcasts/67/introduction-to-treatment-of-discogenic-back-pain BackTable MSK Ep. 68- BackTable Basics: Lumbar Access and Discography https://www.backtable.com/shows/msk/podcasts/68/backtable-basics-lumbar-disc-access-discography GRIBOI Conference: https://www.griboi.org/annualconference Hydrogel Augmentation of the Lumbar Intervertebral Disc: An Early Feasibility Study of a Treatment for Discogenic Low Back Pain (Beal et al, 2024): https://www.jvir.org/article/S1051-0443(23)00694-2/fulltext

The lumbar discogram is a cornerstone of musculoskeletal (MSK) radiology, as it enables interventionalists to pinpoint the exact level of discogenic back pain. In this episode of Backtable MSK, the Dr. Olivier Clerk-Lamalice and host Dr. Jacob Fleming explore the techniques and applications of the discogram, a procedure highly valued for its effectiveness in both diagnosis and pain management. --- This podcast is supported by: Medtronic Interventional https://www.medtronic.com/interventional --- SYNPOSIS They discuss the fluoroscopically guided approach, focusing on techniques like Kambin’s triangle and the far-lateral approach. The doctors also cover their preferred contrast agents and injection methods, along with concurrent therapeutic injections. The conversation delves into the varied disc anatomies that require different approaches, including adjustments in needle angulation. They also emphasize the importance of prophylactic antibiotics, potential challenges, and the evolving landscape of therapeutic options, including intradiscal platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC). --- TIMESTAMPS 00:00 - Introduction 01:17 - Overview of Lumbar Discogram Technique 04:56 - Contrast Injection and Pain Response 07:40 - Therapeutic Injections 10:00 - Discography Under CT Guidance 12:43 - Strategies for Challenging Cases 17:52 - Protocol for Infection Prevention 20:15 - Post-Discogram Treatment Options 21:30 - Emerging Therapies --- RESOURCES BackTable MSK Ep. 68- Introduction to the Treatment of Discogenic Back Pain: https://www.backtable.com/shows/msk/podcasts/67/introduction-to-treatment-of-discogenic-back-pain BackTable MSK Ep. 62- Exploring Intradiscal PRP for Back Pain Relief with Dr. Guilherme Ferreira Dos Santos: https://www.backtable.com/shows/msk/podcasts/62/exploring-intradiscal-prp-for-back-pain-relief

Degenerative disc disease, a major cause of low back pain, is the most common musculoskeletal issue worldwide, affecting an estimated 15-30% of the population. In this episode of BackTable MSK, interventional radiologists Dr. Olivier Clerk-Lamalice and Dr. Jacob Fleming cover symptomatic degenerative disc disease, focusing on its diagnosis and treatment with anesthetic injections. This is the first episode in a two-part series on discogenic back pain. --- Get $100 off of your GRIBOI Conference registration using this link: www.eventbrite.com/e/1027273521757/?discount=BackDoorGRIBOIPromoCode Visit the GRIBOI website for special hotel rates, available until March 11, 2025: https://www.griboi.org/annualconference --- This podcast is supported by: Medtronic Interventional https://www.medtronic.com/interventional --- SYNPOSIS Dr. Clerk-Lamalice begins by explaining the pathophysiology of disc degeneration, which can lead to painful annular tears and loss of disc height. The doctors also reflect on the history of discography, from provocative discograms to the more recent anesthetic and CT discograms. They review the modified Dallas Discogram Classification for annular tears, the vacuum disc phenomenon, and the importance of dynamic imaging to assess treatment candidacy. Dr. Clerk-Lamalice emphasizes the need to correlate imaging with physical examination to better identify the symptomatic disc level. The episode also discusses the challenges of managing multi-level disc degeneration and underscores the importance of early-stage intervention. --- TIMESTAMPS 00:00 - Introduction 02:44 - Pathophysiology of Disc Degeneration 06:49 - Evolution of Discography 12:55 - Classification of Annular Tears 09:01 - Diagnostic Tools and Techniques 14:00 - CT Discogram and Annular Tear Classification 17:12 - Dynamic Aspects and Instability 22:20 - Identifying Symptomatic Disc Level 28:25 - Treatment Approaches and Patient Selection --- RESOURCES BackTable MSK Ep. 13- Basivertebral Nerve Ablation with Dr. Olivier Clerk-Lamalice: https://www.backtable.com/shows/msk/podcasts/13/basivertebral-nerve-ablation Modified Dallas Discogram Classification System: https://pubmed.ncbi.nlm.nih.gov/2954226/

Many physicians are perfectly positioned to recognize areas of clinical need, so why are so few of them involved in medical innovation? In this episode of BackTable MSK, Dr. Kieran Murphy discusses the ideal circumstances and critical characteristics of physician innovators. Dr. Murphy is an interventional neuroradiologist, a professor at the University of Toronto, and a medical device innovator who has made significant contributions to the field, including the development of the Murphy needle for vertebral augmentation. --- This podcast is supported by an educational grant from: Medtronic https://www.medtronic.com/ --- SYNPOSIS Dr. Murphy talks about his recent book, “The Essence of Invention: Medicine and the Joy of Creativity,” which chronicles key innovations in interventional radiology. The book focuses specifically on the characteristics and circumstances of the innovators themselves. Dr. Murphy became interested in this topic after noticing patterns of innovation that clustered around certain institutions and leaders. He shares his insights on innovation, including the idea that innovation peaks during fellowship, the importance of uninterrupted reflective time for creativity, and how building long-term relationships can be essential for generating ideas and gaining support. He also discusses his work on ozone therapy, the development of the Murphy needle, and the significance of securing small-scale funding through patient donations for research. Additionally, Dr. Murphy touches on his upcoming books and explores the essential fusion of medicine and the liberal arts. --- TIMESTAMPS 00:00 - Introduction to the Podcast 02:05 - The Role of Creativity in Interventional Radiology 09:52 - Inspiration Behind The Book 14:51 - Environments for Inventors to Flourish 25:18 - Use of Honey in Biopsies 31:32 - Advice for Physician Innovators 45:02 - Balancing Career and Family 51:23 - Upcoming Book 56:31 - Innovations in Radiation Protection 59:45 - The Future of Medical Education --- RESOURCES The Essence of Invention: Medicine and the Joy of Creativity: https://www.amazon.com/Essence-Invention-Medicine-Joy-Creativity/dp/1459754034

Robot-assisted technology has revolutionized surgical fields such as general surgery and urology—could interventional radiology be the next frontier? In this episode of the BackTable podcast, host Dr. Jacob Fleming explores the transformative potential of robotic-assisted percutaneous biopsies and ablations with experts Dr. Govindarajan “Raj” Narayanan from the Miami Cancer Institute and Dr. Sean Tutton from UC San Diego. --- This podcast is supported by: Quantum Surgical https://www.quantumsurgical.com/ --- SYNPOSIS Dr. Narayanan begins by sharing his initial interest in robotic applications for tumor ablations, aiming to maximize efficiency in his practice. Dr. Tutton then highlights the advantages of robotics for probe placement, especially in challenging cases. The two doctors discuss the logistics of the robotic system, including setup, imaging, and access choices. They also reflect on the learning curve associated with robotics and how it gradually enhances procedural efficiency while reducing mental fatigue. This improvement allows them to take on more complex cases with confidence. Overall, both experts agree that robotics has the potential to democratize minimally invasive procedures, offering new opportunities for skill development and advancement within the field of interventional radiology. --- TIMESTAMPS 00:00 - Introduction to the Podcast 03:30 - Developing an Interest in Robotics 10:44 - Integration of Robotics in the Procedural Suite 13:27 - Logistics of Robot System 18:38 - Planning for Percutaneous Access 22:39 - Future Implications of Robotics on Training Programs 35:51 - Efficiency and Volume Management with Robotics 40:39 - Learning Curves for Robotic Procedures 48:09 - Conclusion and Final Thoughts --- RESOURCES Quantum Surgical Epione Robot: https://www.quantumsurgical.com/epione/ ACCLAIM Trial: https://www.sio-central.org/ACCLAIM-Trial

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