BackTable MSK

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BackTable MSK is for all things Musculoskeletal and Interventional; covering tools, techniques, and expert guidance. It's the meeting after the meeting.

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    Ep. 90 Thermoprotection Techniques in Musculoskeletal Ablations Part II with Dr. Alan Sag

    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. --- 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. --- TIMESTAMPS 00:00 - Introduction00:55 - Ganglion Impar and Pelvic Pain Strategies09:08 - The Active Thaw Phenomenon18:20 - Nerve Protection During Ablations23:16 - Motor and Sensory Neuromonitoring34:06 - Temperature Management in Ablative Procedures40:28 - Dosing Strategies for Gabapentin and Lyrica in Nerve Injuries42:33 - Future Directions --- RESOURCES Dr. Alan Alper Sag, M.D., FSIRhttps://med.miami.edu/faculty/alan-alper-sag-md-fsir Thermal Protection: Heightened Safety for Minimally Invasive Percutaneous Ablation of Musculoskeletal Tumorshttps://pubs.rsna.org/doi/10.1148/rg.240238 Intraoperative Neuromonitoring for Peripheral Nerve Surgeryhttps://mayoclinic.elsevierpure.com/en/publications/intraoperative-neuromonitoring-for-peripheral-nerve-surgery/

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    Ep. 89 Thermoprotection Techniques in Musculoskeletal Ablations Part I with Dr. Alan Sag

    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. --- 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. --- TIMESTAMPS 00:00 - Introduction02:49 - Thermoprotection 10112:37 - Skin Injury and Mitigation Strategies18:57 - Avoiding Bottlenecks with Hydrodissection23:49 - Practical Recommendations for Cold Skin Protection 29:36 - Managing Complications and Wound Care38:12 - Heating up with RFA and Microwave Ablations --- RESOURCES Dr. Alan Alper Sag, M.D., FSIRhttps://med.miami.edu/faculty/alan-alper-sag-md-fsir Thermal Protection: Heightened Safety for Minimally Invasive Percutaneous Ablation of Musculoskeletal Tumorshttps://pubs.rsna.org/doi/10.1148/rg.240238 Intraoperative Neuromonitoring for Peripheral Nerve Surgeryhttps://mayoclinic.elsevierpure.com/en/publications/intraoperative-neuromonitoring-for-peripheral-nerve-surgery/

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    Ep. 88 Bone Tumor Ablation: Techniques & Outcomes with Dr. Damian Dupuy

    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. --- 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 --- 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. --- TIMESTAMPS 00:00 - Introduction02:07 - Dr. Dupuy’s Start in Bone Ablation06:29 - Cryo vs. Microwave Therapies08:25 - Dr. Dupuy’s Clinical Trial and Research Involvement 12:49 - Patient Selection and Treatment Strategies25:54 - Sedation and Anesthesia Practices in Bone Ablation28:46 - Treatment Approach: Oligometastases vs. Progressive Disease36:22 - Microwave Ablation in Bone: Future Prospects37:30 - Techniques for Treating Sclerotic and Lytic Lesions40:01 - Skin Protection Methods in Superficial Lesion Treatments41:49 - Reviewing Recent Clinical Trials: MOTION, OPuS One, and More52:35 - Case Studies: Achieving Effective Ablation Techniques01:08:08 - Final Thoughts and Recommendations --- RESOURCES Dr. Damian E. Dupuy, MD, FACRhttps://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 studyhttps://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 Studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC10156864/ Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Studyhttps://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

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    Ep. 87 Advanced Techniques in Orthopedic Oncology: Bone Ablation for Skeletal Metastases with Dr. Francis Lee

    “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. --- This podcast is supported by an educational grant from Medtronic. --- 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. --- TIMESTAMPS 00:00 - Introduction 01:39 - Crash Course: Orthopedic Oncology 10113:24 - The Important Role of Biomechanics20:10 - Dr Lee’s Training and Interdisciplinary Collaboration28:13 - Intraoperative Imaging and Techniques in AORIF40:15 - Cannulated Screws for Access and Fixation 42:24 - Case Study: Sacral Insufficiency Fracture and Cement Injection44:17 - Understanding Cement Properties and Application46:45 - Case Study Series: Approach to Reconstruction57:58 - Decision Making in Complex Procedures01:08:40 - The Power of Bone Regeneration01:12:31 - Final Thoughts --- RESOURCES Dr. Francis Lee, MD, PhD, FAAOS, MBAhttps://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 Boneshttps://pubmed.ncbi.nlm.nih.gov/32139256/

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    Backtable Brief: Pain Management Strategies in Spine Oncology with Dr. Ran Lador and Dr. Mark Amsbaugh

    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/

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    Ep. 86 Neuromodulation: Past, Present & Future with Dr. Timothy Deer

    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.---This podcast is supported by:Medtronic Osteocoolhttps://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-2-0-bone-tumor-ablation-system.html---SYNPOSISThe 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.---TIMESTAMPS00:00 - Introduction02:52 - What is Neuromodulation?06:03 - Evolution of Neuromodulation08:49 - Use of Closed Loop and AI 13:58 - DRG Stimulation Explained19:58 - Progression of Peripheral Nerve Stimulation26:26 - Handheld Navigation and Reducing Radiation Exposure 30:18 - The Umbrella of Specialties within ASPN35:15 - Obtaining MIS Certification and Fellowship Program Outlook44:07 - Future Directions of Neuromodulation48:09 - Concluding Thoughts---RESOURCESDr. Timothy Deer, MDhttps://centerforpainrelief.com/doctor-timothy-deer/ American Society of Pain and Neuroscience (ASPN)https://aspnpain.com/

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    Backtable Brief: Surgical and Radiation Strategies in Spine Oncology with Dr. Ran Lador and Dr. Mark Amsbaugh

    “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/

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    Backtable Brief: Multidisciplinary Care Approaches for Spinal Tumors with Dr. Ran Lador and Dr. Mark Amsbaugh

    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/

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BackTable MSK is for all things Musculoskeletal and Interventional; covering tools, techniques, and expert guidance. It's the meeting after the meeting.

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