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BackTable / MSK / Podcast / Episode #37

Cryoneurolysis Pearls & Pitfalls

with Dr. Alexa Levey

In this episode of the BackTable Podcast, host Dr. Jacob Fleming and Dr. Alexa Levey have an in-depth discussion about the current uses and potential future applications of cryoneurolysis in interventional radiology. Dr. Levey is an interventional radiologist at the Memorial Hermann Health System in Houston, TX.

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Cryoneurolysis Pearls & Pitfalls with Dr. Alexa Levey on the BackTable MSK Podcast)
Ep 37 Cryoneurolysis Pearls & Pitfalls with Dr. Alexa Levey
00:00 / 01:04

BackTable, LLC (Producer). (2023, December 18). Ep. 37 – Cryoneurolysis Pearls & Pitfalls [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Alexa Levey discusses Cryoneurolysis Pearls & Pitfalls on the BackTable 37 Podcast

Dr. Alexa Levey

Dr. Alexa Levey is an interventional radiologist, interventional pain proceduralist, and assistant clinical professor in Houston, Texas.

Dr. Jacob Fleming discusses Cryoneurolysis Pearls & Pitfalls on the BackTable 37 Podcast

Dr. Jacob Fleming

Dr. Jacob Fleming is a diagnostic radiology resident and future MSK interventional radiologist in Dallas, Texas.

Synopsis

The doctors discuss how cryoneurolysis differs from radiofrequency (RF) ablation, highlighting the increased precision and gentleness to surrounding tissues. Dr. Levey describes the specifics of stellate ganglion procedures and cryoneurolysis techniques. They delve into the importance of research and collaboration in advancing the field, as well as the necessity of being patient-centered. They also address the need for financial discussions in medicine and the prospect for cryoneurolysis as desmoid tumor treatments. Additionally, Dr. Levey shares her journey in building a career as a female in a male-dominated space and emphasizes the importance of physician availability to patients and colleagues.

Timestamps

00:00 - Introduction to RF Ablation and Cryoneurolysis
03:20 - Dr. Alexa Levey’s Journey and Inspiration
07:00 - Building a Pain Practice
14:03 - Advantages of Cryoneurolysis over RF
21:09 - Patient Selection and Planning for Cryoneurolysis
32:02 - Understanding Patient’s Condition and Treatment Options
36:21 - Role of Stellate Ganglion Procedures in PTSD and Anxiety Management
37:48 - Challenges and Impact of Long COVID
41:34 - The Future of Cryoneurolysis in Medical Practice
54:55 - Future of Cryo Treatment in Medical Practice

Resources

Safety and Effectiveness of Stellate Ganglion Cryoablation in Complex Regional Pain Syndrome:
https://doi.org/10.1016/j.jvir.2023.09.030

Treating phantom limb pain: cryoablation of the posterior tibial nerve:
https://pubmed.ncbi.nlm.nih.gov/35801126/

Stellate Ganglion Block for Psychiatric Disorders: A Systematic Review of the Clinical Research Landscape:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8664306/

The Efficacy of the Stellate Ganglion Block as a Treatment Modality for Posttraumatic Stress Disorder Among Active Duty Combat Veterans: A Pilot Program Evaluation:
https://pubmed.ncbi.nlm.nih.gov/33242072/

Stellate Ganglion Block in the Treatment of Post-traumatic Stress Disorder: A Review of Historical and Recent Literature:
https://pubmed.ncbi.nlm.nih.gov/27739175/

Stellate ganglion block reduces symptoms of Long COVID: A case series:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8653406/

Stellate Ganglion Block Relieves Long COVID-19 Symptoms in 86% of Patients: A Retrospective Cohort Study:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10498998/

Transcript Preview

[Dr. Alexa Levey]
I'm going to tell you. It's challenging. I've built both practices from scratch, honestly, without a lot of help, just with a lot of grit, a lot of making relationships. It just takes one relationship to get you started. I did the first Y-90 ever at Memorial Hermann Sugar Land. They didn't have it. In three months, I was able to do it, and I'm very proud of that. It's hard. When you go out to a place that doesn't know what you have, you have to give them a reason to support you.

With cryo, number one, they already had access to cryo in general. Normally the rep can just sit there and bring the machine, they can bring the probes, but there has to be a Lawson number, at least as far as Memorial Hermann goes, so that they can adequately bill for it. Then you have to show them, Okay, if I'm going to do this, am I going to use anesthesia? Am I not going to use anesthesia? Is the CT scan able to accommodate anesthesia cases? Does the CT scanner have CT fluoro? Because CT fluoro will cut down on the case time by 25%, and time is money. They can be scanning patients in those times, and those are adequate RBUs. How many probes am I going to be using? Am I going to do more cryoneurolysis versus tumor ablation, which I think those are two completely different things, and actually important to touch on as well. It's a hard thing to grasp that you don't need to do 10-8, 10-8, 10-8 for everything, that you can just do eight minutes and be done. Is there the correct anesthesia hookups? I think I already said that. Are we going to be able to bill for it? Is my private practice group going to be able to bill for the professional fee while the hospital bills for the technical fee? That was something I actually didn't even expect to cross. What is the actual take-home product? is it something that's profitable for the hospital?

I'm actually cringing and feeling knives go in my tummy as I talk about costs in patient care because you don't want to do it. I think it's gross, but it's very important because medicine is still a business. You can help people and still do something that is profitable for the hospital. You need to be able to show them that it is profitable for them to want to support you.

That is a Reader's Digest version of all the things that you need to think about when you're going into it. Now that I've been through it a couple times, it's definitely something that is totally feasible. Don't even mind the insurance and these T-codes. I thought the T-codes were fine and great. T-codes are not good if you're in private practice. There's a lot more work of what you have to do, which is why I'm now even more focused on trying to do research towards this. I just did a paper in JVIR on complex regional pain syndrome and cryoablation of the stellate ganglion, and it was a small group, but at least it's something. There's nothing getting published because it's so hard nowadays to do research as well as the things that people don't realize.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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