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. 59 Minimally Invasive Bone Grafting and Orthopedic Innovation with Dr. Jim Marino
Tuesday, October 1, 2024 • Duration 01:17:21
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.
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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.
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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
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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
Ep. 58 Genicular Artery Embolization: How I Do It with Dr. Osman Ahmed
Friday, September 20, 2024 • Duration 36:46
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.
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This podcast is supported by an educational grant from Guerbet.
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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.
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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
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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/
Ep. 54 Managing Sarcomas: A Multidisciplinary Approach with Dr. Yvette Ho and Dr. Jessica Jones
Tuesday, July 16, 2024 • Duration 54:07
In this episode of The Back Table MSK Podcast, Dr. Alexa Levey discusses the importance of multidisciplinary treatment planning for sarcomas with Dr. Yvette Ho and Dr. Jessica Jones.
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CHECK OUT OUR SPONSOR
Stryker Interventional Spine
https://www.strykerivs.com
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SYNPOSIS
The conversation explores the necessity of a multidisciplinary approach and the challenges associated with managing both osseous and soft tissue sarcomas. Dr. Jones highlights recent advancements in precision medicine, including a novel drug, nirogacesta, for desmoid tumors. Dr. Ho addresses common misconceptions surrounding desmoid tumors, emphasizing their potential for significant tissue destruction, and shares insights from her experience in limb salvage surgery. Dr. Levey discusses the considerations involved in needle biopsy and presents case studies where cryoablation effectively reduced desmoid tumor sizes.
The doctors also discuss strategies for managing nociceptive and mechanical pain, such as intrathecal pain pumps, radiation therapy, and kyphoplasty.
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TIMESTAMPS
00:00 - Introduction
03:51 - Challenges in Sarcoma Management
13:06 - Precision Medicine in Treatment Planning
16:44 - The Role of Biopsy
20:51 - The Importance of Specialized Oncology Care
25:13 - Collaboration Throughout Treatment Course
31:03 - Cryoablation and Case Studies
35:13 - New Drug Development for Desmoid Tumors
39:06 - Limb Salvage Considerations
41:13 - Metastasis, Recurrence, and Pain Management
49:57 - Final Thoughts
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RESOURCES
OGSIVEO (Nirogacestat):
https://www.ogsiveo.com/
BackTable Brief: Basivertebral Nerve Ablation II: Technique with Dr. Olivier Clerk-Lamalice
Tuesday, July 2, 2024 • Duration 12:41
Basivertebral nerve ablation is a potential solution for anterior column spine pain. Dr. Olivier Clerk-Lamalice outlines a typical ablation procedure and discusses alternative approaches for challenging target locations.
The procedure generally uses a transpedicular approach with an 8-gauge introducer needle, visualized under fluoroscopy. The needle angle should ensure that the probe can later be placed in the center of the vertebral body. The basic technique is similar to that of vertebral augmentation, employing an aneural and avascular approach. A bipolar ablation probe is aimed 1-cm ventral to the posterior wall of the vertebral body to establish a safe ablation zone and avoid neural structures. The ablation is performed at 85°C for 15 minutes. It is important to ablate the nerve at the vertebral bodies both above and below the target level.
For challenging targets, such as at L5, S1, high-riding pelvis, or in cases with prior transpedicular screw placement, the goal is to take the straightest path possible, which can require the transiliac approach.
TIMESTAMPS
00:00 - Standard Procedure Walkthrough
05:54 - Alternate Approaches for Challenging Targets
CHECK OUT THE FULL EPISODE
BackTable MSK Ep. 13- Basivertebral Nerve Ablation
https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation
BackTable Brief: Basivertebral Nerve Ablation I: Procedure Basics with Dr. Olivier Clerk-Lamalice
Tuesday, June 25, 2024 • Duration 10:20
The basivertebral nerve has gained recognition over the past decade as a source of vertebrogenic pain. Dr. Olivier Clerk-Lamalice explains both the anatomy of the nerve and his treatment algorithm for basivertebral nerve ablation.
The basivertebral nerve is intraosseous, non-myelinated, and located in the central portion of the vertebral body within the basivertebral canal. It does not regenerate after ablation. This nerve transmits afferent pain signals to the central spinal cord, and MRI is the primary diagnostic tool used for evaluation.
During the physical exam, back pain originating from the anterior column is assessed through maneuvers such as sitting at a 15-degree angle, bending forward, and experiencing vibrations from car or plane travel. MRI findings are reviewed for Modic changes: Type 1, characterized by edematous endplates, is highly correlated with pain, while Type 2 shows early and later changes, with early changes generally being less painful.
To confirm that a patient will benefit from basivertebral nerve ablation, an anesthetic discogram is performed to identify the specific disc level causing pain. Dr. Clerk-Lamalice performs the discogram for every patient, and improvements are tracked based on patient-reported pain scores.
TIMESTAMPS
00:00 - Basivertebral Nerve Anatomy and Vertebrogenic Pain
04:15 - Modic Type 1 and 2 Definitions
05:51 - Utility of Anesthetic Discograms
CHECK OUT THE FULL EPISODE
BackTable MSK Ep. 13- Basivertebral Nerve Ablation
https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation
Ep. 53 AI Scribes: Enhancing Patient and Physician Interaction with Elie Toubiana
Friday, June 21, 2024 • Duration 43:43
Dr. Aditya Bagrodia sits down with Elie Toubiana, founder and CEO of ScribeMD.ai, to discuss the transformative potential of artificial intelligence (AI) in medical documentation.
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SYNPOSIS
Their conversation covers the capabilities and benefits of using an AI-driven medical scribe that ensures HIPAA compliance, reduces physician burnout, and enhances patient interactions. Elie also shares his insights about the technology’s adaptability across various medical fields. Finally, Dr. Bagrodia and Elie discuss ethical considerations surrounding applications of AI in other aspects of healthcare, such as medical workup and diagnosis.
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TIMESTAMPS
00:00 - Introduction
06:00 - How ScribeMD AI Works
14:14 - Integration with EMR
20:31 - Legal Considerations with AI Technology
26:34 - Cost Implications of AI Scribes
38:46 - Future of AI in Medical Diagnosis
41:45 - Conclusion and Final Thoughts
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RESOURCES
ScribeMD.ai
https://www.scribemd.ai/
Ep. 52 Sacroplasty II: Technique, Pearls, and Training Opportunities with Dr. Doug Beall
Thursday, June 20, 2024 • Duration 41:23
Dr. Jacob Fleming and Dr. Douglas Beall dive into the intricacies of sacroplasty, including considerations for selecting cement volume, efficacy of small versus large needles, and biomechanics of the pelvis.
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CHECK OUT OUR SPONSOR
Stryker Interventional Spine
https://www.strykerivs.com
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SYNPOSIS
The doctors review evidence from the SAKOS trial on pain relief and highlight the complexities of billing. They also emphasize proactive treatments for aging populations suffering from fractures and the need for more training and propagation of sacroplasty techniques. Listeners are encouraged to stay informed about new educational opportunities and advancements in sacroplasty through ongoing updates and courses.
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TIMESTAMPS
00:00 - Introduction
02:33 - Expanding Sacroplasty Training and Curriculum
04:50 - Walkthrough of Sacroplasty Technique
10:36 - Mechanical Stabilization and Cement Volume
21:41 - Choosing Hardware and Needle Size
27:37 - Industry-Sponsored Trials and Bias
32:47 - Navigating Billing and Reimbursement
38:05 - Closing Thoughts on Sacroplasty and Osteoporotic Fractures
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RESOURCES
BackTable VI Ep. 51- Sacroplasty: Principles & New Data in the Treatment of Sacral Insufficiency Fractures:
https://www.backtable.com/shows/msk/podcasts/51/sacroplasty-i-principles-new-data-in-the-treatment-of-sacral-insufficiency-fractures
Seattle Science Foundation Annual Image Guided Interventional Spine Procedures Course:
https://ssf.cloud-cme.com/course/courseoverview?P=5&EID=1149
Dr. Doug Beall’s Twitter: @dougbeall
Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation:
https://www.amazon.com/Vertebral-Augmentation-Comprehensive-Vertebroplasty-Kyphoplasty/dp/1684200156
An Interim Analysis of the First 102 Patients Treated in the Prospective Vertebral Augmentation Sacroplasty Fracture Registry (Beall, 2023):
https://www.jvir.org/article/S1051-0443(23)00356-1/fulltext
Ep. 51 Sacroplasty I: Principles and New Data in the Treatment of Sacral Insufficiency Fractures with Dr. Doug Beall
Wednesday, June 19, 2024 • Duration 51:43
In this episode of the BackTable MSK Podcast, Dr. Jacob Fleming and Dr. Douglas Beall discuss the challenges and advancements in treating sacral insufficiency fractures (SIF), the importance of real-world data in evaluating treatment efficacy, and the need to increase awareness of sacral fractures and sacroplasty.
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CHECK OUT OUR SPONSOR
Stryker Interventional Spine
https://www.strykerivs.com
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SYNPOSIS
Dr. Beall emphasizes the underrecognition and undertreatment of sacral insufficiency fractures, pointing out the high mortality and chronic pain rates associated with non-treatment. He urges providers to consider this diagnosis, especially if the patient is describing symptoms of pain with position changes with standing, sitting, and laying, has pubic rami fractures, or reports a history of pelvic radiation. Even with imaging, the diagnosis can remain elusive, since it is not commonly recognized on x-ray and may not show obvious cortical disruption on CT or MRI.
We also review the current literature on sacroplasty efficacy in lowering patient-reported pain scores and adverse events associated with treatment versus conservative management. Dr. Beall speaks about the importance of real-world data collection in the form of patient registries and the insight that these resulting studies have on applications of sacroplasty in specific patient populations.
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TIMESTAMPS
00:00 - Introduction
03:01 - Sacral Fractures and Sacroplasty
15:17 - Treatment Options for Sacral Fractures
17:34 - Consequences of Untreated Sacral Fractures
28:32 - Sacroplasty Registry and Current Research
38:08 - Imaging Modalities: CT vs. Fluoroscopy
40:49 - Complications of Sacroplasty: Extravasation
43:21 - Bone Quality and Fracture Healing
45:42 - Growing Awareness of Sacral Fractures and Treatment Options
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RESOURCES
Spontaneous osteoporotic fracture of the sacrum. An unrecognized syndrome of the elderly (Lourie, 1982):
https://pubmed.ncbi.nlm.nih.gov/7097924/
Percutaneous cementoplasty for pelvic bone metastasis (Marcy, 2000):
https://pubmed.ncbi.nlm.nih.gov/11094996/
Safety and Efficacy of Sacroplasty for Sacral Fractures: A Systematic Review and Meta-Analysis (Chandra et al, 2019):
https://pubmed.ncbi.nlm.nih.gov/31587952/
Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study (Frey et al, 2008):
https://pubmed.ncbi.nlm.nih.gov/17981097/
Sacroplasty: A Ten-Year Analysis of Prospective Patients Treated with Percutaneous Sacroplasty: Literature Review and Technical Considerations (Frey et al, 2017):
https://pubmed.ncbi.nlm.nih.gov/29149151/
Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation (Beall, 2020):
https://www.thieme-connect.de/products/ebooks/book/10.1055/b000000226
An Interim Analysis of the First 102 Patients Treated in the Prospective Vertebral Augmentation Sacroplasty Fracture Registry (Beall et al, 2023):
https://pubmed.ncbi.nlm.nih.gov/37207812/
Clinical Effect of Balloon Kyphoplasty in Elderly Patients with Multiple Osteoporotic Vertebral Fracture (Liu et al, 2019):
https://journals.lww.com/njcp/fulltext/2019/22030/clinical_effect_of_balloon_kyphoplasty_in_elderly.1.aspx
BackTable Brief: Desmoid Tumors II with Dr. Jack Jennings
Tuesday, June 4, 2024 • Duration 13:13
Musculoskeletal radiologists can be highly involved in cryoablation for desmoid tumors. Interventional radiologist Dr. Jack Jennings from Washington University in St. Louis shares the finer points of his approach to this procedure.
Desmoid tumor cryoablation cases require varying numbers of cryoablation probes, dependant on tumor morphology. The usual number of probes ranges from 5 to 10. To mitigate the risk of rhabdomyolysis, which increases with more than 10 probes, Dr. Jennings typically divides the procedure into two sessions.
His patients are generally admitted for pain control, monitoring for rhabdomyolysis, and management of inflammatory responses, with steroids administered both intraoperatively and postoperatively. Imaging is conducted at 6 to 8 weeks after the procedure, with Initial imaging sometimes showing the tumor as larger due to the inflammatory reaction and ablation zone.
It is important that a multidisciplinary sarcoma tumor board, consisting of medical oncologists, surgical oncologists, and musculoskeletal radiologists, assesses each case. The first consideration is whether the tumor can be resected, based on its proximity to adjacent tissue. Following this, patients are evaluated for candidacy in clinical trials and potential ablation therapy. This multidisciplinary approach leads to better medicine and patient outcomes, as treatment decisions are rarely straightforward and should not be made by a single practitioner.
TIMESTAMPS
00:00 - Planning for Cryoablation Probes
02:32 - Clinical Management after Cryoablation
04:45 - Follow Up Imaging
05:52 - Challenging Cases
08:41 - Multidisciplinary Desmoid Tumor Treatment
CHECK OUT THE FULL EPISODE
BackTable MSK Ep. 7- Desmoid Tumors: IR’s Role in Diagnosis and Management
https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation
BackTable Brief: Desmoid Tumors I with Dr. Jack Jennings
Tuesday, May 28, 2024 • Duration 12:22
Desmoid tumors are a type of benign sarcoma that can be locally aggressive and extremely morbid. Dr. Jack Jennings from Washington University in St. Louis discusses his experience in treating this condition.
Surgical resection is considered the gold standard for treatment; however, the aggressive nature of these tumors can make resection challenging. To address this, Dr. Jennings’ institution began offering ablation for non-surgical candidates, becoming a major referral center for these cancers.
Cryoablation has become the preferred option. It is particularly effective for uncomplicated desmoid tumors that are likely to have clean surgical margins. Ideal tumors for cryoablation are those that do not involve nerves and are located extra-abdominally or in the extremities. Cryoablation allows for visualization of a low attenuation ice ball and the ability to sculpt the ablation zone based on the tumor geometry, with a goal of achieving a 10mm or greater margin around the tumor.
Thermoprotective strategies are essential to protect nearby structures during cryoablation, such as nerves and bowel. Carbon dioxide gas can be used, along with hydrodissection and sometimes balloons. The bowel is particularly sensitive to ice, so careful planning is required to avoid complications. CT is typically used for intraprocedural imaging, with the addition of ultrasound to visualize superficial targets or to avoid streak artifacts. Some facilities also employ MR guidance for this procedure.
TIMESTAMPS
00:00 - Evolution of Treatment for Desmoid Tumors
02:52 - Planning for Ablation
05:38 - Thermoprotective Strategies
07:30 - Carbon Dioxide Use
09:05 - Imaging Modalities for Ablation
CHECK OUT THE FULL EPISODE
BackTable MSK Ep. 7- Desmoid Tumors: IR’s Role in Diagnosis and Management
https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation
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