Episode # 43 • 27 Feb 2024
Cutting Edge Techniques in MSK Oncology: Cryoablation & Beyond
In this BackTable MSK episode, host Dr. Jacob Fleming interviews interventional radiologist Dr. Alan Sag about techniques and advancements in bone cryoablation.
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Timestamps
00:00 - Introduction
03:20 - Collaboration with Orthopedic Surgery
08:57 - FDA Clearance for Cryoablation
14:47 - Cement Augmentation after Cryoablation
19:22 - Approach to the Cryoablation Procedure
26:57 - The Value of Same Session Biopsy
29:11 - Coordinating Cross-Specialty Oncologic Care
33:30 - Side Effects of Cryoablation
38:03 - Cryoneurolysis for Pain Reduction
45:40 - Skin Safety During Cryoablation
50:58 - Preferred Imaging Modalities
57:28 - Neuromodulation with Intrathecal Pain Pumps
Resources
- Symposium on Clinical Interventional Oncology (CIO)
- BackTable VI Ep. 221- Building a Musculoskeletal Oncology Service Line with Dr. Alan Sag
- IlluminOss Photodynamic Bone Stabilization System
- BackTable VI Ep. 401- The MOTION Study: Cryoablation for Painful Bony Metastases with Dr. Jack Jennings
- BackTable VI Ep. 284- Ortho/IR Collaboration in Private Practice with Dr. Tony Brown & Dr. Daniel Lerman
- BackTable MSK Ep. 25- Advanced Minimally Invasive Pain Interventions with Dr. David Prologo
- Pneumodissection for Skin Protection in Image-Guided Cryoablation of Superficial Musculoskeletal Tumors
- BackTable MSK 40- Innovating Pain Management: The Role of Spinal Cord Stimulators in Outpatient Care with Dr. Doug Beall
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More about this episode
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.
Bone cement: Serious adverse events, some with fatal outcome, associated with the use of bone cements for vertebroplasty, kyphoplasty and sacroplasty include myocardial infarction, cardiac arrest, cerebrovascular accident, pulmonary embolism and cardiac embolism. Although it is rare, some adverse events have been known to occur beyond one year post-operatively. Additional risks exist with the use of bone cement. Please see the IFU for a complete list of potential risks.
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