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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SHOW NOTES

00:00 - Introduction02:09 - Dr. Prologo’s Career and Leadership Roles09:52 - Interventional Radiology’s Role in MSK Interventions13:37 - A Primer for Steerable Vertebral Needles21:40 - Increasing Standardization and Accessibility of Bone Tumor Ablation26:37 - Advanced Pain Management in Interventional Radiology’ Book30:24 - Thermocouples in Radiofrequency Ablation35:45 - Prior Complications and Importance of Longitudinal Care44:24 - SIR EDGE 202452:31 - Accessing Targets for Basivertebral Nerve Ablation1:01:17 - 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/