Innovative Procedures

Welcome to this issue of Seminars in Musculoskeletal Radiology on “Innovative Procedures.” This is a timely topic of interest because radiologists are performing an increasing variety and volume of interventional procedures in the appendicular and axial musculoskeletal system. These procedures may be diagnostic, therapeutic, or both. The field of image-guided therapy has become a priority for numerous academic musculoskeletal imaging sections including ours, and this interest is also manifested in the number of publications and funding opportunities for research in this domain.

Although numerous articles have been written on musculoskeletal interventions, it is the intention of this monograph to provide a new perspective by describing cutting-edge innovative procedures and novel applications and modalities with a view toward the future. For radiologists looking to expand into these areas, we describe several emerging techniques and technologies. For radiologists seeking to be familiar with available procedures, we summarize the recent advances to help you in discussing these procedures with referring clinicians and an increasingly well-informed patient population, particularly from the Internet, often a non-peer-reviewed data source. We find that diagnostic radiology colleagues can be a good referral source to interventional radiologists because of their interaction with primary care providers, who rely on the radiologist not only for diagnosing but also for providing treatment recommendations. This relationship allows them to influence medical decision making at the point of care (as a good decision support system should).

We are fortunate to have an esteemed group and variety of radiologists contributing articles on these topics. In the first article Dr. Roberto Blanco Sequeiros and I from Brigham and Women's Hospital (BWH) review the exciting and rapidly expanding domain of bone augmentation including vertebroplasty, kyphoplasty, and nonspine applications. Another burgeoning area of spine intervention is the treatment of intervertebral disc disorders. Dr. Joshua A. Hirsch, a cross-town interventional neuroradiology colleague at the Massachusetts General Hospital, has long been a proponent and pioneer in this field; he and Dr. Stuart R. Pomerantz discuss state-of-the-art intradiscal therapies. Tumor ablation is yet another growth area. Damian Dupuy from Brown Radiology was an early adopter of radiofrequency ablation for bone lesions; he and Dr. Caroline Simon share their insight and extensive knowledge. Vascular lesions of the musculoskeletal system can be challenging to treat and this has been the purview of the vascular interventional radiologist. Orhan Konez has accumulated much expertise in dealing with these lesions and will share his know-how based on the large referral base at the Cleveland Clinic Foundation. Magnetic resonance (MR) imaging has become the mainstay for many musculoskeletal diagnoses, particularly internal joint derangement. MR has also started playing a role in guiding diagnostic, therapeutic, and operative procedures. Roberto Blanco from University of Oulu, Finland (currently a research fellow at Harvard and the BWH Image Guided Therapy Program) will share his considerable experience (he has performed several hundred MR-guided musculoskeletal interventions), which served as the basis of his doctoral thesis. As the clinical director of the Magnetic Resonance Therapy at BWH, I will add the operational perspective from the world's first dedicated intraoperative and interventional magnet (Signa SP, GE Healthcare) as well as our own experience with performing a variety of musculoskeletal procedures.

Finally, I would like to thank Dr. David Karasick and Dr. Mark Schweitzer who entrusted me with assembling this issue. I hope you find the information in these articles intriguing and provocative as well as an adjunct to your knowledge on the repertoire of available therapies for patients with a variety of musculoskeletal disorders.