The future of MSK interventions

Abstract

Interventional radiology has become so successful that it is easy to forget that it is a relative newcomer. Prior to 1980, arthrography was the only musculoskeletal intervention that was performed in most radiology departments. Arthrography is an old procedure, first introduced in 1905 when air was used as the injected contrast agent [1]. Positive contrast was introduced three decades later, and the introduction of fluoroscopic control took several decades more. Members of the society made significant contributions to the development of arthrography. One of the pioneers in this work was Dr. Robert Frieberger of the Hospital for Special Surgery (New York). Percutaneous bone biopsy is also an old procedure, although it was largely the province of orthopedic surgeons for many years. Invention of the trephine needles (such as the Ackerman needle and the Craig needle) in the late 1950s, and the recognition of the value of image guidance, made it feasible for radiologists to perform this procedure. By the late 1970s this was a common practice, although the limitations of fluoroscopic guidance meant that many anatomical sites were inaccessible or unsafe to biopsy. Several factors have contributed to the advance of musculoskeletal interventions. Perhaps chief among them has been improved technology. Better visualization of anatomy yields more anatomical information. Spinal pain management was greatly improved when C-arm fluoroscopy became common in radiology practice. However, the axial plane is particularly valuable for procedure guidance, since it demonstrates the passage of a needle. The introduction of CT guidance in the 1970s, combined with improvements in the ability to handle smaller tissues samples did much to expand the safety and effectiveness of percutaneous biopsy. Radiologists have adapted to increasing capabilities by becoming more specialized. Greater specialization has fostered more detailed anatomical and functional knowledge and therefore greater confidence to undertake procedures that were previously thought to be hazardous or impossible. Finally, progress in materials and in biology has lead to more effective interventions. Therapeutic (as opposed to diagnostic) interventions have become increasingly important. In some respects, the prospects for the future have never been brighter. Three major trends support the continued development and prosperity of the field.