Episodios

  • Ep. 80 Cryoneurolysis in Pain Management: Anatomy and Technique with Dr. Alexa Levey

    Ep. 80 Cryoneurolysis in Pain Management: Anatomy and Technique with Dr. Alexa Levey
    Jul 1 2025
    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/
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    49 m
  • Ep. 79 Managing Vertebrogenic Pain: Ablation Procedures & Outcomes with Dr. Luigi Manfre

    Ep. 79 Managing Vertebrogenic Pain: Ablation Procedures & Outcomes with Dr. Luigi Manfre
    Jun 17 2025
    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/
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    1 h y 5 m
  • Ep. 78 MSK Embolization: Techniques, Outcomes, and Referral Strategies with Dr. Ahmed Farag

    Ep. 78 MSK Embolization: Techniques, Outcomes, and Referral Strategies with Dr. Ahmed Farag
    Jun 3 2025
    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
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    45 m
  • Ep. 77 Treatment of Lumbar Radiculopathy with Intradiscal Ozone with Dr. Alexis Kelekis

    Ep. 77 Treatment of Lumbar Radiculopathy with Intradiscal Ozone with Dr. Alexis Kelekis
    May 20 2025
    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/
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    32 m
  • Ep. 76 Culture and Leadership: Enhancing the Training Experience and Beyond with Dr. Wayne Olan and Mr. David Tilton

    Ep. 76 Culture and Leadership: Enhancing the Training Experience and Beyond with Dr. Wayne Olan and Mr. David Tilton
    May 6 2025
    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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    1 h y 1 m
  • Ep. 75 Genicular Artery Embolization: Current Controversies and Insights with Dr. Sid Padia and Dr. Osman Ahmed

    Ep. 75 Genicular Artery Embolization: Current Controversies and Insights with Dr. Sid Padia and Dr. Osman Ahmed
    Apr 22 2025
    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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    1 h y 27 m
  • Ep. 74 Diagnosis and Treatment of Tarlov Cysts with Dr. Kieran Murphy

    Ep. 74 Diagnosis and Treatment of Tarlov Cysts with Dr. Kieran Murphy
    Apr 8 2025
    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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    47 m
  • Ep. 73 Understanding Basivertebral Nerve Ablation (BVNA) with Dr. Asad Baig

    Ep. 73 Understanding Basivertebral Nerve Ablation (BVNA) with Dr. Asad Baig
    Mar 25 2025
    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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    46 m