History

In the past, the primary approach to diagnostic and therapeutic procedures involving the musculoskeletal (MSK) system has been open surgery by orthopedic surgeons, with the exceptions of joint aspiration and arthrography. Over time an increasingly broad range of these procedures are carried out using image-guided approaches, and consequently interventional radiologists are exercising a larger role, both in procedural collaboration with the orthopedic surgeons, neurosurgeons, rheumatologists, and other related proceduralists, as well as a more substantial role in clinical consultation for evaluation and management of relevant patients. It is in the MSK system that the modular approach to procedure development has worked particularly well, and this has led to an increasing diversity of patient problems that fall within the scope of practice of the pediatric interventionalist and an increasingly fertile area for innovation and collegial development of creative solutions. It is likely that this trend will continue and over time there will be fewer open procedures performed and increasing integration of interventional involvement in the care of these patients.

Interventional radiology and musculoskeletal interventions

Team approach

Interventions for problems that involve the MSK system and soft tissues can often be accomplished with improved out-comes, less surgical trauma, and a shorter recovery time if image-guided techniques are used compared to traditional open surgical approaches. For example, traumatic fracture of the pelvis with both anterior and posterior instability has traditionally been treated using a large anterior incision and plating across the reduced sacroiliac (SI) fracture. The same objective, stabilization of the posterior ring instability, can be accomplished through a small posterolateral incision with image-guided placement of one or more screws across the SI fracture after closed reduction of the dislocation. Details and advantages of this procedure are outlined below under “Orthopedic interventions.” Because of the infrequency of this problem, interventionalists seldom have a depth of experience with the required hardware and delivery systems, while orthopedic surgeons usually lack training with sophisticated cross-sectional image guidance.

Collaboration allows optimal application of asymmetric skill sets to optimize high-quality outcomes not easily achieved by either subspecialty in isolation.