How to stay cool when a thermal ablation case gets complicated? Your toolbox can make all the difference. In this episode of the BackTable MSK Podcast, Dr. Alan Sag returns with host Dr. Jacob Fleming to continue the discussion on thermal protection in musculoskeletal ablation procedures. Part 2 focuses on real-world cases to provide practical insights and illustrate decision-making in complex thermal ablation cases.

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SYNPOSIS

Dr. Sag and Dr. Fleming discuss thermoprotection strategies in real-world cases, such as radiofrequency ablation (RFA) of inoperable rectal cancer and sacral metastases near nerve roots. They also discuss the importance of interdisciplinary collaboration, emerging technologies in the field, and the role of intraoperative neuromonitoring.

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TIMESTAMPS

00:00 - Introduction
00:55 - Ganglion Impar and Pelvic Pain Strategies
09:08 - The Active Thaw Phenomenon
18:20 - Nerve Protection During Ablations
23:16 - Motor and Sensory Neuromonitoring
34:06 - Temperature Management in Ablative Procedures
40:28 - Dosing Strategies for Gabapentin and Lyrica in Nerve Injuries
42:33 - Future Directions

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RESOURCES

Dr. Alan Alper Sag, M.D., FSIR
https://med.miami.edu/faculty/alan-alper-sag-md-fsir

Thermal Protection: Heightened Safety for Minimally Invasive Percutaneous Ablation of Musculoskeletal Tumors
https://pubs.rsna.org/doi/10.1148/rg.240238

Intraoperative Neuromonitoring for Peripheral Nerve Surgery
https://mayoclinic.elsevierpure.com/en/publications/intraoperative-neuromonitoring-for-peripheral-nerve-surgery/