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DAVID W. LEE, M.D.
PAIN MEDICINE PHYSICIAN
ASSOCIATE CLINICAL PROFESSOR, UCI PM&R
PROCEDURES
EPIDURAL INJECTIONS (ESI)
Epidural steroid injections (ESIs) are a common treatment option for many forms of low back pain and leg pain. An epidural injection is an injection of medication into the space around the spinal cord, also known as the epidural space, to provide prolonged relief from pain or inflammation of the disc and/or adjacent nerve. There are two separate approaches performed by Dr. Lee; both interlaminar and transforaminal epidurals injections.
FACET JOINT & SACROILIAC (SI) INJECTIONS
A cervical, thoracic or lumbar facet joint injection involves injecting a small amount of local anesthetic and/or steroid medication, which can anesthetize the facet joints and block the pain. The facet joints are typically a cause of neck and lower back pain.
The sacroiliac (SI) joint connects the sacrum (triangular bone at the bottom of the spine) with the pelvis (iliac bone that is part of the hip joint) on each side of the lower spine. A sacroiliac joint injection is an injection of local anesthetic and steroid medication into the sacroiliac joint.
RADIOFREQUENCY ABLATION (RFA)
Radiofrequency ablation (RFA) is a procedure used to reduce pain coming from peripheral joints (knee, shoulder, hip), peripheral nerves and the spinal facet joints.During RFA an electrical current produced by a radio wave is used to heat up a small area of nerve tissue adjacent to the joint, thereby decreasing pain signals from that area.
SACROILIAC (SI) JOINT FUSION
Sacroiliac joint fusion is a minimally-invasive procedure used to treat chronic low back pain. The sacroiliac joint is the area where the tailbone (sacrum) connects to the pelvis (ileum). Pain from the sacroiliac joint is usually localized below the waist, adjacent to the buttock area. Sacroiliac joint fusion is typically offered to patients who only report temporary relief with injections. Fusing the joint may provide immobilization and durable pain relief.
NEUROMODULATION (SCS & PNS)
Spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS) are treatments used to help manage chronic pain when other therapies have not provided enough relief. Both work by sending small electrical signals to the nervous system to change how pain signals are sent to the brain.
In spinal cord stimulation, thin wires are placed near the spinal cord to help reduce pain signals, often for chronic back or leg pain. Peripheral nerve stimulation targets a specific nerve responsible for pain in a particular area of the body, such as the shoulder, knee, or arm.
KYPHOPLASTY/VERTEBROPLASTY
Kyphoplasty and vertebroplasty involves injecting special cement into your vertebrae when one has sustained a fracture in the spine. A fracture in the spine can be extremely debilitating as a result of pain with rest and/or movement. Fractures may occur from trauma, injury or in patients with osteoporosis/osteopenia. Typically advanced imaging may help determine whether a patient is a candidate for cement stabilization.
PERCUTANEOUS LUMBAR DECOMPRESSION - MILD® PROCEDURE
Percutanous lumbar decompression is indicated for diagnosis of lumbar spinal stenosis resulting in both back and leg pain symptoms. It is "percutaneous" because it is done through the skin without need for a large incisions, as seen with traditional surgical decompression. This allows for the procedure to be done in an outpatient setting and with a faster recovery time. The posterior ligament and bone is decompressed through a small hole in the skin with x-ray guidance.
BASIVERTEBRAL NERVE (BVN) ABLATION - INTRACEPT® PROCEDURE
The Intracept® procedure relieves vertebrogenic pain, a specific type of chronic low back pain. The procedure involves heating (or ablating) the basivertebral nerve (BVN) with a radiofrequency probe to disrupt pain signals coming from the vertebral endplates.
RESTORATIVE MULTIFIDUS MUSCLE STIMULATION - REACTIV8®
Restorative multifidus stimulation therapy (otherwise known as Reactiv8®) is a novel treatment of back pain which involves placing leads in back to provide stimulation to the multifidi muscles. Stimulation of the back muscles is intended to restore strength and function; resulting in reversal of muscles wasting/instability and reversing the course of chronic low back pain symptoms.
ELECTRODIAGNOSTIC (EMG) STUDIES
Electromyography (EMG) and nerve conduction velocity (NCV) are electrodiagnostic tests that measure the electrical activity of muscles and nerves. Some patients report unexplained symptoms which may include numbness, tingling, muscle cramping, or weakness in an extremity (eg, one or both arms, legs). Electrodiagnostic nerve studies may assist in the diagnosing the cause of said symptoms and is often an integral part of a thorough work-up.
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