BackTable MSK BackTable

In this episode, Dr. Aron Chary provides an in-depth look into endovascular and minimally invasive treatments for pain management, specifically focusing on cryoneurolysis. He shares his experience of implementing the technology for both benign and malignant conditions in an independent private practice setting.

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CHECK OUT OUR SPONSOR

Boston Scientific Visual ICE Cryoablation System
https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html

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SYNPOSIS

The discussion covers various aspects, including collaboration with Boston Scientific for the VISUAL ICE cryoablation system, Dr. Chary’s personal journey from academics at Emory to private practice in Memphis, the effectiveness of cryoneurolysis in different areas such as genicular nerve and palliative care, and the operational dynamics between hospital and outpatient settings. The doctors delve into the procedural specifics, patient response, and outcomes with cryoneurolysis, including Dr. Chary’s efforts to navigate insurance and reimbursement challenges.

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TIMESTAMPS

00:00 - Introduction
07:04 - Evolution of Pain Intervention Techniques
11:08 - Building a Pain Intervention Service
16:16 - Versatility of Cryoablation in Pain Management
23:54 - Expectations and the Future of Pain Management Research
31:41 - Cryoneurolysis Insights and Patient Management
42:10 - Techniques in Celiac Cryoneurolysis
52:33 - Pain Management in the Outpatient Setting

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RESOURCES

Percutaneous CT-Guided Cryoablation of the Celiac Plexus: A Retrospective Cohort Comparison with Ethanol:
https://www.jvir.org/article/S1051-0443(20)30349-3/abstract

BT VI Episode 199 - Advanced Minimally Invasive Pain Interventions with Dr. David Prologo:
https://www.backtable.com/shows/vi/podcasts/199/advanced-minimally-invasive-pain-interventions

BT VI Episode 433 - Kyphoplasty Evolution: Steering Toward Targeted Therapy with Dr. David Prologo:
https://www.backtable.com/shows/vi/podcasts/433/kyphoplasty-evolution-steering-toward-targeted-therapy

Boston Scientific, VISUAL ICE:
https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html

In this episode, Dr. Blake Parsons talks through the role of spinal cord stimulation in treating vascular issues and diabetic neuropathy. He also discusses the growing presence of vascular specialists in clinics, the transition from procedural work to clinical involvement, and the significance of building a strong patient-doctor relationship.

The doctors highlight the effectiveness of Nevro 10 kHz therapy in providing long-term pain relief and sensory improvements for patients struggling with painful diabetic neuropathy, even after conventional treatments fail. Additionally, they touch upon reimbursement updates, the rise of outpatient care, and the future of spinal cord stimulation - emphasizing its potential beyond just pain relief to include improvements in patients’ overall quality of life, reducing risks related to diabetic foot wounds, and incidental falls. The need for a multidisciplinary approach in treating vascular and neuropathic conditions is also discussed, along with the role of interventional radiologists in managing these complex cases.

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CHECK OUT OUR SPONSOR

Nevro HFX Spinal Cord Stimulator
https://www.hfxforpdn.com

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SHOW NOTES

00:00 - Introduction
06:00 - Demystifying Spinal Cord Stimulation for Pain Management
17:11 - Optimizing Patient Care: Trials, Techniques, and Insurance
26:03 - Leveraging Telehealth and Support Teams for Patient Success
30:22 - Challenges and Solutions in Managing Peripheral Neuropathy
35:19 - Collaboration and Referral Dynamics in Vascular and Interventional Radiology
39:19 - Exploring the Future of Neuropathy Treatment and Quality of Life Improvements
43:46 - Addressing the Challenges of Permanent Implant Procedures
48:46 - Role of Technology and AI in Patient Management
56:31 - Concluding Thoughts on Neuropathy Treatment and Practice Dynamics

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RESOURCES

Nevro 10 kHz Therapy:
https://nevro.com/English/en/providers/HFX-Advanced-Therapies/default.aspx

Effect of High-frequency (10-kHz) Spinal Cord Stimulation in Patients With Painful Diabetic Neuropathy: A Randomized Clinical Trial (JAMA Neurology RCT 2021):
https://pubmed.ncbi.nlm.nih.gov/33818600/

Long-term efficacy of high-frequency (10 kHz) spinal cord stimulation for the treatment of painful diabetic neuropathy: 24-Month results of a randomized controlled trial (SENZA-PDN RCT 2023):
https://pubmed.ncbi.nlm.nih.gov/37536514/

Electrical spinal-cord stimulation for painful diabetic peripheral neuropathy (Lancet RCT 1996):
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(96)02467-1/abstract

In this episode of the BackTable MSK Podcast, Dr. Dana Dunleavy interviews Dr. David Prologo about his perspective on current advancements in MSK interventions, including steerable spine needles, thermocouples for radiofrequency ablation, and the growing importance of advocacy and longitudinal follow up for patients with chronic pain. Dr. Prologo is an interventional radiologist at Emory University.

Dr. Prologo starts by describing the evolution of interventional radiology’s role in MSK interventions. He explains that establishing solid referral networks is crucial to building this service line, and he gives examples of how new interventionalists can highlight their skills to others. Then, he describes a new steerable needle that allows operators to safely enter the vertebral body with a transpedicular approach and subsequently navigate directly to the location of interest. This device is especially useful when lesions are located in tricky areas where the trajectory of a straight needle would have difficulty reaching. He also discusses different devices for bone tumor ablation and his preferred methods for targeting lesions that are located at varying locations in the spine. For lesions below T5, he uses fluoroscopy for better visualization of the axial plane. For lumbar lesions, he emphasizes the importance of correlating and cross-checking vertebral levels with pre-procedural MRI.

Dr. Prologo also discusses lessons learned from his extensive experience in spine interventions, especially from prior complications. He explains how thermocouple monitoring can give real time feedback on internal temperature during radiofrequency ablation, the necessity of understanding the ablation zone, and the importance of longitudinal follow up. He cites specific cases of patients struggling with chronic pain and how he advocated for each case.

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CHECK OUT OUR SPONSOR

Merit Spine
https://www.merit.com/merit-spine/

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SHOW NOTES

00:00 - Introduction
02:09 - Dr. Prologo’s Career and Leadership Roles
09:52 - Interventional Radiology’s Role in MSK Interventions
13:37 - A Primer for Steerable Vertebral Needles
21:40 - Increasing Standardization and Accessibility of Bone Tumor Ablation
26:37 - Advanced Pain Management in Interventional Radiology’ Book
30:24 - Thermocouples in Radiofrequency Ablation
35:45 - Prior Complications and Importance of Longitudinal Care
44:24 - SIR EDGE 2024
52:31 - Accessing Targets for Basivertebral Nerve Ablation
1:01:17 - The Role of Advocacy in Patient Care

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RESOURCES

Osseoflex Steerable Needle:
https://www.merit.com/product/osseoflex-sn-steerable-needle/

STAR Tumor Ablation System:
https://www.merit.com/product/star-tumor-ablation-system/

Osteocool OsteoCool Radiofrequency Ablation System:
https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/tumor-management/osteocool-ablation-system-rf.html

OptaBlate Bone Tumor Ablation System:
https://providers.strykerivs.com/products/optablate

‘Advanced Pain Management in Interventional Radiology’ by J. David Prologo and Charles E. Ray Jr:
https://shop.thieme.com/Advanced-Pain-Management-in-Interventional-Radiology/9781684201402

Ablation zones and weight-bearing bones: points of caution for the palliative interventionalist:
https://pubmed.ncbi.nlm.nih.gov/24745905/

SIR EDGE 2024:
https://www.sirweb.org/learning-center/meetings/sir-edge/

‘The Catching Point Transformation’ by J. David Prologo:
https://www.catchingpoint.com/