In this BackTable MSK episode, host Dr. Jacob Fleming interviews Dr. Alan Sag about techniques and advancements in bone cryoablation. Dr. Sag is an interventional radiologist at Duke University Medical Center.

To start, Dr. Sag discusses his current practice and collaboration with orthopedic surgeons. He highlights IlluminOss, a new photodynamic bone stabilization system that uses similar concepts to endovascular balloons. Then, the doctors move onto discussing cryoablation, which was recently cleared by the FDA for use in pain palliation in bone metastases. Dr. Sag describes the procedural steps of cryoablation, pneumodissection with carbon dioxide, when to use polymethylmethacrylate (PMMA) augmentation, the value of same session biopsy, and education for referrers and patients.

Cryoneurolysis and intrathecal pain pumps are also discussed, as they can offer additional pain relief for patients and reduce opioid dependence.

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SHOW NOTES

00:00 - Introduction03:20 - Collaboration with Orthopedic Surgery08:57 - FDA Clearance for Cryoablation14:47 - Cement Augmentation after Cryoablation19:22 - Approach to the Cryoablation Procedure26:57 - The Value of Same Session Biopsy29:11 - Coordinating Cross-Specialty Oncologic Care33:30 - Side Effects of Cryoablation38:03 - Cryoneurolysis for Pain Reduction45:40 - Skin Safety During Cryoablation50:58 - Preferred Imaging Modalities57:28 - Neuromodulation with Intrathecal Pain Pumps

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RESOURCES

Symposium on Clinical Interventional Oncology (CIO):https://www.hmpglobalevents.com/cio

BackTable VI Ep. 221- Building a Musculoskeletal Oncology Service Line with Dr. Alan Sag:https://www.backtable.com/shows/vi/podcasts/221/building-a-musculoskeletal-interventional-oncology-service

IlluminOss Photodynamic Bone Stabilization System:https://www.illuminoss.com/eu

BackTable VI Ep. 401- The MOTION Study: Cryoablation for Painful Bony Metastases with Dr. Jack Jennings:https://www.backtable.com/shows/vi/podcasts/401/the-motion-study-cryoablation-for-painful-bone-metastases

BackTable VI Ep. 284- Ortho/IR Collaboration in Private Practice with Dr. Tony Brown & Dr. Daniel Lerman:https://www.backtable.com/shows/vi/podcasts/284/ortho-ir-collaboration-in-private-practice

BackTable MSK Ep. 25- Advanced Minimally Invasive Pain Interventions with Dr. David Prologo:https://www.backtable.com/shows/msk/podcasts/25/advanced-minimally-invasive-pain-interventions

Pneumodissection for Skin Protection in Image-Guided Cryoablation of Superficial Musculoskeletal Tumors:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5499669/

BackTable MSK 40- Innovating Pain Management: The Role of Spinal Cord Stimulators in Outpatient Care with Dr. Doug Beallhttps://www.backtable.com/shows/msk/podcasts/40/innovating-pain-management-the-role-of-spinal-cord-stimulators-in-outpatient-care