Advanced Interventional Procedures
The board certified interventional pain specialists at Premier Pain Treatment Institute are expertly trained in the most advanced and cutting edge interventional procedures and minimally invasive surgeries to relieve chronic pain. We are comfortable evaluating and finding solutions for complex and advanced painful conditions.
Spinal Cord Stimulation
Spinal cord stimulation, also known as neuromodulation, is an advanced and well-established treatment modality. It was approved by the FDA in 1989 and there have been many cutting edge advances in neuromodulation since that initial introduction. As the name implies, this treatment involves stimulation of the spinal cord with an electrical current to reduce or block your sensation of pain. The therapy has two stages. The first stage is an office-based trial procedure. One or two injections are performed to access the epidural space and one or two stimulator leads are advanced into the epidural space to the desired position in the spine. Your physician will coordinate with a representative from the stimulator company to adjust the electrical current until you feel a vibration that covers your pain. The temporary trial leads will remain in place for 3-7 days to provide time to assess your response to the therapy. This first stage is considered to be successful if you feel at least a 50% improvement in your pain level and you are able to obtain some level of functional improvement, such as increased activity, better sleep, reduced opioid usage, and improved mood.
If you have a successful trial stage, then your provider will recommend the second stage, which is the surgical implantation of the spinal cord stimulator. This is an outpatient surgery during which the stimulator leads and a generator are implanted under the skin. The surgery is performed at an outpatient surgery center or hospital and the anesthesia team will be involved in your care. A successful implantation should reproduce the results of your trial to provide those benefits long-term.
Dorsal Root Ganglion Stimulation
Dorsal root ganglion stimulation is another form of neuromodulation used to treat focal neuropathic pain after conservative treatment options have failed. By targeting the dorsal root ganglion of one or more spinal nerve roots, this form of neurostimulation can deliver more targeted stimulation to specific painful areas of the lower extremities. Dorsal root ganglion stimulation is FDA-approved for the treatment of Complex Regional Pain Syndrome and Causalgia. It can also be an effective treatment for chronic pelvic pain and peripheral neuropathy. Like spinal cord stimulation, this route of neurostimulation also has a 3-7 day trial phase to help determine whether to proceed with permanent device implantation.
Peripheral Nerve Stimulation
Nerve pain that can be isolated to the distribution of one or two nerves can be effectively treated with perpheral nerve stimulation. After conservative treatment options have failed, the patient will undergo a 3-7 day temporary office-based trial procedure to determine whether the peripheral nerve stimulation can effectively reduce pain and improve function. Upon completion of a successful trial, the patient will proceed with permanent implantation. In certain patients, the painful condition may be able to be treated with a 2-month temporary trial without the need for a permanent device implantation.
Targeted Drug Delivery
Advanced cases of cancer and non-cancer pain may not be adequately controlled with conventional medication management, interventional procedures, surgeries, physical therapy, chiropractic care, or other modalities. For these people, targeted drug delivery can be an effective means of controlling their pain. Implantation of an intrathecal pain pump provides a means for the targeted delivery of opioid and non-opioid medication directly to the intrathecal space, spinal cord, and spinal nerve roots. By utilizing this delivery mechanism, it can be possible to attain superior pain control and quality of life compared to conventional treatment.
A vertebral compression fracture occurs when a vertebral body in the spine collapses, producing significant pain and disability. The most common cause of a compression fracture is osteoporosis. When a fracture is identified through imaging, initial treatment is conservative with rest, medications, and bracing. When the pain persists, many fractures in the thoracic and lumbar spines can be successfully treated with vertebral cement augmentation. Depending on the specific method for delivering the cement to treat the fracture, this is also called vertebroplasty or kyphoplasty.
Percutaneous Lumbar Discectomy
Lumbar radiculopathy is a painful condition in which compression or irritation of a lumbar nerve root causes radiating pain down one or both legs. One common cause for lumbar radiculopathy is a lumbar disc herniation with the herniated disc material causing nerve root compression. Many times this problem can be effectively treated through a minimally invasive lumbar discectomy. This is an outpatient procedure to remove a portion of the herniated disc to relieve pressure on the affected nerve root.
Percutaneous Lumbar Decompression
Percutaneous lumbar decompression is a treatment for lumbar spinal stenosis with intermittent neurogenic claudication. A person with neurogenic claudication will report pain, numbness, and/or leg weakness with standing and walking. The symptoms will improve with sitting or leaning forward. The person will typically present with the classic “shopping cart sign.” Percutaneous lumbar decompression is an outpatient procedure to debulk or remove a portion of the ligamentum flavum at the level(s) of stenosis that are causing the patient’s symptoms. This procedure can be performed through one or more small incisions and has a very high safety profile. Patients are able to resume normal activities quickly following the procedure.
Indirect Lumbar Decompression
Indirect lumbar decompression is a treatment for lumbar spinal stenosis with intermittent neurogenic claudication. A person with neurogenic claudication will report pain, numbness, and/or leg weakness with standing and walking. The symptoms will improve with sitting or leaning forward. The person will typically present with the classic “shopping cart sign.” Indirect lumbar decompression is an outpatient procedure during which an implant is placed between the spinous processes of the affected spinal segment to distract the space and prevent spinal element compression associated with standing and walking.
Interspinous or Interlaminar Lumbar Fusion
Interspinous or interlaminar lumbar fusion is a treatment for lumbar spinal stenosis with intermittent neurogenic claudication, symptomatic lumbar degenerative disc disease, and grade 1 lumbar spondylolisthesis. Patients commonly present with back and/or leg pain, numbness, or weakness that is worsened by standing and walking. The condition is typically diagnosed with lumbar flexion-extension x-rays and a lumbar MRI or CT scan. Interspinous or interlaminar lumbar fusion is an outpatient procedure during which an implant is placed at the affected segment to fixate and fuse the segment to treat the patient’s symptoms.
Facet Joint Fusion
Facet joint fusion is an outpatient procedure performed to treat facetogenic low back pain, symptomatic lumbar degenerative disc disease, and lumbar spinal stenosis with intermittent neurogenic claudication. This procedure involves fixation of the lumbar facet joints of the affected lumbar spinal segment. A fusion is created at this segment to augment the fixation and prevent spinal segment motion.
Posterior Sacroiliac Joint Fusion
Sacroiliitis is a common condition of pain generated by the sacroiliac joint. Initial treatment includes diagnostic or therapeutic sacroiliac joint injections and conservative treatments, such as physical therapy and anti-inflammatory medications. Persistent sacroiliac joint pain following two diagnostic sacroiliac joint injections can be successfully treated with posterior sacroiliac joint fusion. This is a minimally-invasive outpatient procedure. Patients typically report a quick resolution of symptoms with a short post-procedure recovery.
Intervertebral Allograft Implantation
Lumbar degenerative disc disease can be a cause of axial low back pain. People with symptomatic lumbar degenerative disc disease have pain that is typically continuous and worse with bending, twisting, and leaning forward. The low back pain can intensify with prolonged sitting. Patients with symptomatic lumbar degenerative disc disease can benefit from a restorative therapy called intervertebral allograft implantation. This is a non-surgical injection of allograft that utilizes allogeneic tissue and micronized disc material to repair damaged degenerative discs to provide pain relief and improve function.
Basivertebral Nerve Ablation
Vertebrogenic low back pain is a type of low back pain that is generated from the vertebral body of the spine. This condition causes vertebral endplate nerve dysfunction and can be diagnosed by a combination of symptoms, physical examination findings, and MRI imaging of the lumbar spine. The MRI finding associated with vertebrogenic low back pain is called Type 1 or Type 2 Modic changes. Basivertebral nerve ablation is an outpatient procedure in which the vertebral body is accessed at the base of the basivertebral nerve and a radiofrequency ablation is performed to ablate the nerve.