BackTable MSK

• Ep. 76 Culture and Leadership: Enhancing the Training Experience and Beyond with Dr. Wayne Olan and Mr. David Tilton

  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

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• Ep. 75 Genicular Artery Embolization: Current Controversies and Insights with Dr. Sid Padia and Dr. Osman Ahmed

  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/

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• Ep. 74 Diagnosis and Treatment of Tarlov Cysts with Dr. Kieran Murphy

  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

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• Ep. 73 Understanding Basivertebral Nerve Ablation (BVNA) with Dr. Asad Baig

  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

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• Ep. 72 Vertebral Augmentation: Demystifying the Data with Dr. Josh Hirsch

  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/

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