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Advanced Spine And Pain Treatment In Washington

Our leading pain and spine clinic in Washington offers advanced, minimally invasive treatments to help you overcome pain and spinal conditions.

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Treatments Offered at Our Washington Pain and Spine Clinic

Injection Therapies

Advanced Nerve Procedure

Minimally Invasive Surgical Procedure

Restorative Therapies

Injection Therapies

These procedure are safely performed by the doctor with visual guidance using an X-ray or Ultrasound. Injection Therapies involve delivering medications directly into joints, muscles, or soft tissues to reduce pain, inflammation, and promote healing. Commonly used for arthritis, sports injuries, and chronic pain, these therapies offer targeted relief with faster results than oral medications.

Medial Branch Blocks (MBB’s)

The spinal cord acts as a central support column that localises much of the body’s nerves. From there, many individual nerves spread out and enervate the rest of the body; helping control various other muscles and parts of the body. These nerves may sometimes be damaged and cause pain. Medial Branch Blocks (MBBs) help address this pain by injecting local anaesthetic to the target nerve. To ensure accuracy, patients are recommended to have two trial injections before the main procedure: one diagnostic and one confirmatory. This is to ensure that the nerve targeted is indeed the source of pain. Patients can expect pain to return a few days after a diagnostic procedure.

Facet Joint Injections:

In a similar fashion to MBB. This injection is specifically placing steroid (anti-inflammatory) into the inflamed spinal joints.

Musculoskeletal Injections

Joint Injections
Muscle Injections

Sacroiliac Joint Steroid Injection

This procedure is meant for alleviating and/or diagnosing pain in the sacroiliac joint. The joint connects the sacrum (spine) and ilium (hip) bones and is usually a source of lower back, hip, and buttock pain. Providers use a varying combination of local anaesthetic (to relieve pain) and steroids (to reduce inflammation), usually some form of corticosteroid, to help address the pain. During the procedure, the provider may use x-ray fluoroscopy or ultrasound to help ensure accuracy and precision of the injection site.

Epidural Steroid Injection (ESI)

An epidural steroid injection is a medical procedure commonly used to relieve pain and inflammation in the spine, particularly in the areas around the spinal nerves and disc areas. A small amount of Steroid which is an anti-inflammatory that is very helpful in specifically reduce inflammation and thereby pain.

Advanced Nerve Procedure

Our pain and spine specialist in Washington offers advanced nerve procedures like nerve blocks and ablation to treat chronic pain. These minimally invasive solutions target nerves directly for long-lasting relief.

Radiofrequency Ablation (RFA)

This procedure uses heat from radio waves to treat painful facet joints in your spine. For the procedure you lie on your stomach. You may be given medicine to relax you. We numb the skin and tissue of your neck. Next, we guide a tube called a “cannula” to your spine. A video x-ray device called a “fluoroscope” helps guide the tube to the medial branch nerves.

These tiny nerves carry pain signals from your facet joints to your brain. Now, we push an electrode through the cannula and down to these nerves. We test its position with a weak jolt of energy. If this recreates your pain, we know it’s in the right place. Then, we heat the nerves with radio waves. Heating them blocks their ability to carry pain signals. We may need to treat several nerves. After the procedure you will get a small bandage on your skin. There may be some soreness following the procedure which should dissipate within the next few days.

It is indicated for the fusion of the sacroiliac joint for sacroiliac joint dysfunction including sacroiliac joint disruption and degenerative sacroiliitis.

SCS Trial

Spinal cord stimulation (SCS) uses electrical impulses to relieve chronic pain of the back, arms and legs. It is believed that electrical pulses prevent pain signals from being received by the brain. SCS candidates include people who suffer from neuropathic pain and for whom conservative treatments have failed. Trial Implantation consists of one or more insulated wire leads inserted through an epidural needle or through a small incision into the space surrounding the spinal cord, called the epidural space. Electrodes at the end of the lead produce electrical pulses that stimulate the nerves, blocking pain signals. The patient gives feedback to help the physician determine where to place the stimulators to best block the patient’s pain. The leads are connected to an external trial stimulator, which will be used for approximately one week to determine if SCS will help the patient. If the patient and the physician determine that the amount of pain relief is acceptable, the system may be permanently implanted. At the end of the trial implantation, the leads are removed.

PNS Trial

Peripheral nerve stimulation (PNS) is a drug-free pain management approach that uses mild electrical impulses to block pain signals from various parts of your body before they get to your brain. To begin the trial, you will undergo a small surgical procedure to place thin wires (leads) near the nerve(s) identified by your physician and connect them to an external stimulator. During the therapy trial period, you and your physician will evaluate the amount of your pain relief and improvements in sleep and daily activities. After the therapy trial, the wires will be removed and you and your physician will decide if peripheral nerve stimulation is appropriate for you.

ITP Trial

An intrathecal pump (ITP) relieves chronic pain. It uses small amounts of medicine applied directly to the intrathecal space (the area surrounding the spinal cord) to prevent pain signals from being perceived by the brain. Pump candidates include people for whom conservative treatments have failed and surgery is not likely to help. A trial procedure consists of a catheter inserted through a needle or small incision into the intrathecal space. This catheter is connected to a temporary pump. It will be used for several days to determine if the system will help the patient. If pain decreases during the trial period, a permanent system may be implanted.

Minimally Invasive Surgical Procedure

We offer Minimally Invasive Surgical Procedures as part of our advanced pain treatment in Washington. These techniques reduce tissue damage, speed up recovery, and effectively relieve chronic pain with less downtime and fewer risks.

SI Joint Fusion

The iFuse Implant System is a minimally invasive surgical (MIS) technique designed to stabilize and fuse the SI joint. The iFuse procedure involves inserting typically three titanium implants across the SI joint to maximize stability, reduce pain, and improve function. The procedure is done through a small one-inch incision and takes about an hour.

It is indicated for the fusion of the sacroiliac joint for sacroiliac joint dysfunction including sacroiliac joint disruption and degenerative sacroiliitis.

SCS Implantation

The permanent implantation consists of one or more permanent leads inserted through an epidural needle or a small incision into the predetermined location in the epidural space.

Next, a small incision is created, and the implantable pulse generator (IPG) battery is positioned beneath the skin. It is most often implanted in the buttocks or the abdomen. The leads are then connected to the IPG battery. The implant’s electrical pulses are programmed

with an external wireless programmer. The patient can use the programmer to turn the system on or off, adjust the stimulation power level and switch between different programs.

PNS Implantation

This is a minimally invasive surgical procedure to place permanent leads under the skin near the nerves that are associated with the pain and the implantable pulse generator (IPG) in the optimal location for your specific pain. The leads are connected to the IPG to provide electrical impulses. Your physician’s prescribed therapy will be programmed into the PNS system and you will be trained on how to control your peripheral nerve stimulator through the remote control app on your smartphone.

MILD

Minimally Invasive Lumbar Decompression (MILD) is an early treatment option to consider when conservative therapies (e.g., physical therapy, pain medication, chiropractic) are not providing adequate relief. The MILD procedure addresses a major root cause of lumbar spinal stenosis by removing excess ligament tissue to restore space in the spinal canal. The MILD procedure typically takes less than an hour and can be performed through a single, tiny incision to decompress the lumbar spine, which can relieve pressure on nerves and reduce pain.

ITP Implantation

The temporary catheter is removed and, through a needle or incision, a permanent catheter is implanted. The pump is implanted under the skin, usually in the abdomen or flank region. The catheter is then connected to the pump. The pump’s battery may last three to five years, after which a new pump is implanted. The amount of medication dispensed by the pump is programmed with an external unit. Regular visits to the doctor are needed to refill the pump. After surgery, patients may experience mild discomfort and swelling at the incision sites for several days. Over time, the catheter may move or become damaged from strenuous activity and require repositioning or replacement.

Vertiflex

Vertiflex is a minimally invasive solution that is designed to deliver long-term relief from the leg and back pain associated with lumbar spinal stenosis. Spinal stenosis is a narrowing of the space around your spinal nerves and spinal cord. A small inch-long incision is usually made. An implant is placed between the spinous processes of your vertebrae that are the bony protrusions at the rear of your spine. The implant expands, pushing apart your vertebrae and locking securely into position in your spine. This relieves pressure on your nerves and spinal cord.

Why Choose US?

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Patient Testimonials

I have been going to Bellevue Surgery Center for the past few years for procedures for chronic pain with Dr Malmalbaum and staff they are wonderful caring people.

Judy L

I have Dr. Mambalam as my doctor and he is the best most professional physician that I have ever had the pleasure of meeting. He is amazing! I have read what some others have written about him, but, I'm sorry, I went thru at least 6 other doctors before I got the chance to get in with Dr. Mambalam, he is the only one that took the time to listen and set up a treatment that made my life improve by leaps and bounds!!!! It's about treatments and medications that work together! I have gotten my life back without the pain I was living thru!!!!! I have referred others to him and they can't thank me enough for the referral. Absolutely the best care, and doctors I have met in a long time, they listen, they are friendly, very professional, and really care about you as a patient. I have been going to Pain Management for the last 5 years, and from the first visit till today they are still the best doctors, and staff you will ever have the pleasure of meeting.

Marilyn S

Dr. Mambalam has been the most amazing doctor, truly managing my husband's back pain for the first time in 20 yrs. He is completely thorough in his treatment plans, explaining them in depth and gaining our trust. He always makes time for us and instills complete confidence in his work and plan. Only complaint I have is that it can be very difficult to get to a live person on the phone when calling the clinics at either location. That needs work.

Anne P

I have had a professional, courteous experience from all the staff every time I go here. Dr. M takes the time to explain everything and options. He and Bonnie (the nurse) listens to my concerns with my pain. I have read the negative reviews and wonder if they are talking about the same people.

Perkins D

First visit and the staff are friendly and Dr. Mambalam was great! He listened to me and my concerns.

Doug M

Everyone at the Washington Pain Center for Management is always kind, caring and professional. Dr. Mambalam makes sure you understand what procedure he is doing, any possible risks involved and checks to see if You have any questions. I've been very happy with the care of the entire team.

Chelsey V

People Ask Every Time

Do you offer MIS?

Yes Dr. Mambalam has extensive experience in many minimally invasive procedures for spine pain. He is an advisor for Neuromodulation techniques.

Can you provide information on spine treatments that are offered?

click here to know over treatment

How long does recovery take from spinal surgery?

Most of the spinal surgeries that we offer are minimally invasive and scheduled electively as an outpatient. Therefore, the patient will be able to go home a few hours after the procedure.

Do I need to arrive early for my appointment?

Yes. Generally 30-60 minutes before appointment time. You will be given a specific period of time when your appointment is confirmed.

How can we help?

Learn more about our two new locations here

Advanced Spine And Pain Treatment In Washington

Treatments Offered at Our Washington Pain and Spine Clinic

Injection Therapies

Advanced Nerve Procedure

Minimally Invasive Surgical Procedure

Restorative Therapies

Injection Therapies

Medial Branch Blocks (MBB’s)

Facet Joint Injections:

Musculoskeletal Injections

Sacroiliac Joint Steroid Injection

Epidural Steroid Injection (ESI)

Advanced Nerve Procedure

Radiofrequency Ablation (RFA)

SCS Trial

PNS Trial

ITP Trial

Minimally Invasive Surgical Procedure

SI Joint Fusion

SCS Implantation

PNS Implantation

MILD

ITP Implantation

Vertiflex

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