Neurorads procedures - dumb question

[ilovecostco]

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Can / do diagnostic neuroradiologists perform kyphoplasties? I know the IR neruo fellowships are an option after a nero DR fellowship, but I have no desire to perform those other endovascular procedures

 

[Cognovi]

Can / do diagnostic neuroradiologists perform kyphoplasties? I know the IR neruo fellowships are an option after a nero DR fellowship, but I have no desire to perform those other endovascular procedures

answer:

Like all things, these are locally defined and determined by the local practice patterns.

Example:
I know of radiologists at the practice across town who are mostly diagnostic neuroradiology but also do spine procedures. In my current place, the neuroradiologist who does kyphoplasties doesn't do diagnostic neuroradiology.

 

[yungspleen]

answer:

Example:
I know of radiologists at the practice across town who are mostly diagnostic neuroradiology but also do spine procedures. In my current place, the neuroradiologist who does kyphoplasties doesn't do diagnostic neuroradiology.

What other spine procedures do radiologists do? Also, are kyphoplasties more in the realm of neurorads or MSK?

 

[chudat]

^anybody can do kyphos...IR, msk, neuro, ortho, neurosurg, pain

 

[yungspleen]

^anybody can do kyphos...IR, msk, neuro, ortho, neurosurg, pain

Good to know! Are there other spine procedures that doing a diagnostic neurorads fellowship prepares you for? how about an interventional neurorads fellowship? Interested in those fields.

 

[Cognovi]

Good to know! Are there other spine procedures that doing a diagnostic neurorads fellowship prepares you for? how about an interventional neurorads fellowship? Interested in those fields.

The most common diagnostic neuroradiology invasive procedure is the lumbar puncture (under fluoroscopic guidance) with variations of what you do with that needle: diagnostic LP for CSF sampling and pressure measurement, large volume LP for diagnostic/temporary therapeutic effect in normal pressure hydrocephalus and other causes of communicating hydrocephalus, instillation of contrast for fluoro and CT myelography to evaluate stenoses or CSF leaks, instillation of intrathecal chemotherapy for CNS lymphomas or other malignancies, instillation of the oligonucleotide nusinersen for treatment of spinal muscular atrophy, and maybe placement of a lumbar drainage catheter. Every diagnostic neurorads should be competent doing this.

Many spine procedures are niche enough that not every fellowship in these fields will prepare you. Some diagnostic neurorad programs do a bunch of spine procedures, whereas at other institutions, it's the MSK rads or the IRs. Maybe the anesthesiology interventional pain docs take most of the volume. The involvement of interventional neurorads probably depends on the balance of rads vs. neurosurgeons or neurologists involved in the program; the more radiologists, the more likely to have spine procedures while the more non-rads, the more exclusively endovascular it is.

Those other spine procedures include vertebral augmentation (kyphoplasty, vertebroplasty, sacroplasty), epidural steroid/anesthetic injection, nerve root steroid/anesthetic injection, facet joint/medial branch steroid/anesthetic injection, epidural blood patch injection, facet cyst aspiration or rupture, vertebral biopsy, vertebral tumor ablation.

 

[yungspleen]

The most common diagnostic neuroradiology invasive procedure is the lumbar puncture (under fluoroscopic guidance) with variations of what you do with that needle: diagnostic LP for CSF sampling and pressure measurement, large volume LP for diagnostic/temporary therapeutic effect in normal pressure hydrocephalus and other causes of communicating hydrocephalus, instillation of contrast for fluoro and CT myelography to evaluate stenoses or CSF leaks, instillation of intrathecal chemotherapy for CNS lymphomas or other malignancies, instillation of the oligonucleotide nusinersen for treatment of spinal muscular atrophy, and maybe placement of a lumbar drainage catheter. Every diagnostic neurorads should be competent doing this.

Many spine procedures are niche enough that not every fellowship in these fields will prepare you. Some diagnostic neurorad programs do a bunch of spine procedures, whereas at other institutions, it's the MSK rads or the IRs. Maybe the anesthesiology interventional pain docs take most of the volume. The involvement of interventional neurorads probably depends on the balance of rads vs. neurosurgeons or neurologists involved in the program; the more radiologists, the more likely to have spine procedures while the more non-rads, the more exclusively endovascular it is.

Those other spine procedures include vertebral augmentation (kyphoplasty, vertebroplasty, sacroplasty), epidural steroid/anesthetic injection, nerve root steroid/anesthetic injection, facet joint/medial branch steroid/anesthetic injection, epidural blood patch injection, facet cyst aspiration or rupture, vertebral biopsy, vertebral tumor ablation.

Thank you for the informative comment!

 

[NDcienporciento100]

Can / do diagnostic neuroradiologists perform kyphoplasties? I know the IR neruo fellowships are an option after a nero DR fellowship, but I have no desire to perform those other endovascular procedures

Then do MSK fellowship were they do Kyphoplasty

 

[guytakingboards]

Can / do diagnostic neuroradiologists perform kyphoplasties? I know the IR neuro fellowships are an option after a neuro DR fellowship, but I have no desire to perform those other endovascular procedures

Yes, diagnostic neurorad's can do kyphoplasty.

Caveat: in all my hospital credentialing kyphoplasty was listed under interventional neuroradiology, not diagnostic neuroradiology. Most places will not rubber stamp a solely diagnostic trained neurorad to do kypho's but if you got (and documented) enough cases in training to show competency then the hospital would probably grant you privileges. Hospitals aren't in the business of denying privileges for procedures that people can safely do(/bring money to the hospital).

 

[NDcienporciento100]

So I’m going to throw a wrench in this. Let me start off by saying I love Kyphoplasty’s. Super cool procedure. I’ve done half dozen already in my training. The reality is the data behind them is suspect and some would even say poor. There was actually a New England journal of medicine study that highlighted horrible results. That study had its own issues on credibility such taking patients with chronic back pain etc. what I’m trying to say is it really is not that great of a procedure. Certainly not a procedure to plan your career around.