Treatments and conditions
Mr Lee is highly regarded for his wealth of experience in performing spinal surgery in adults with degenerative disease, spondylolisthesis or scoliosis. He is a specialist in sacroiliac joint fusion surgery and uses minimally invasive methods to ensure his patients have the fastest possible recovery times.
He also routinely treats patients who require revision spinal surgery due to problems experienced after having procedures carried out elsewhere.
Mr Lee specialises in the following areas:
- Adult scoliosis
- Back pain
- Complex adult degenerative disease
- Computer-navigated spinal surgery
- Decompressions
- Minimally invasive spinal surgery
- Pars repairs
- Revision spinal surgery
- Sacroiliac joint fusion
- Spondylolisthesis
A personalised approach
Mr Lee believes strongly that it is the duty of a surgeon to ensure their patients are well-informed. He will provide you with all the relevant information regarding your condition before you decide whether to undergo a surgical procedure. He makes sure his consultations allow enough time for you to ask as many questions as you need to.
Mr Lee considers every patient as an individual, and will ensure that you receive the appropriate treatment for your unique circumstances. He will recommend a surgical procedure only where it is necessary.
If surgery is not indicated Mr Lee can refer you on to local therapists or pain management specialists who can help with your symptoms.
Your spine
There are many things that can contribute to the ill health of the spine, such as poor posture during your daily activities and when you are at rest. Back pain is an extremely common symptom and the majority of people improve with simple measures such as rest, stretching, analgesia and alternative treatments (including physiotherapy, osteopathy, chiropractic treatment and acupuncture). Activities such as yoga, Pilates and swimming can help build your core stability and prevent recurrent problems with back pain. Abnormalities on MRI scans are common and do not necessarily correlate with back pain.
Decompression and discectomy
When one or more nerves is trapped within your lower back (lumbar spine) and causes pain, you may require a decompression or discectomy procedure to relieve the pressure.
A decompression is a surgical procedure to remove any bone or soft tissue that is compressing the contents of your spinal canal or nerve root.
A discectomy operation is performed to remove part of a herniated (prolapsed) disc that is compressing the nerve root and producing nerve pain.
More information about these procedures together with downloadable information leaflets is available on the British Association of Spinal Surgeons website.
Spinal fusion
A lumbar fusion is designed to stop movement between vertebrae. This procedure is performed to treat conditions such as spondylolisthesis, scoliosis, fractures, and to relieve back and leg pain attributed to degenerative disc disease.
In spinal fusion surgery, a bone graft or a bone graft substitute is used to create a biological response so that bone grows between two vertebrae. Implants, such as cages, rods or screws, are commonly used to provide support to the vertebrae while waiting for the bone to grow. This stops movement in that area of the spine.
There are multiple approaches for this procedure including ALIF, OLIF (or ATP), LLIF, PLIF and TLIF. The chosen approach for your spine will depend on your individual circumstances.
ALIF
With Anterior Lumbar Interbody Fusion (ALIF), an incision is made through the abdomen. The bowels are carefully moved to the side and the blood vessels kept safe before reaching the disc space. An implant with bone graft is placed directly into the space made after removing disc material.
These images show an example of an L5/S1 ALIF in a patient who had a collapsed L5/S1 disc space.
ALIF before surgery
ALIF Lateral
ALIF AP
OLIF / ATP
With Oblique Lumbar Interbody Fusion (OLIF) or Anterior to Psoas approach (ATP), an incision is made in the side of the abdomen, the psoas muscle (muscle which flexes your hip) is moved out of the way. Implants with bone graft are inserted after removing the disc space material.
These images show an example of an L4/5 OLIF and posterior L4/5 fusion in a case of a patient who had an L4/5 spondyolisthesis and left sided leg pain.
OLIF before surgery
OLIF post op AP
OLIF postop Lateral
LLIF / XLIF / DLIF
With Lateral Lumbar Interbody Fusion (LLIF – also known as XLIF or DLIF), an incision is made in the side of the abdomen and instruments are used to push through the psoas muscle. The disc space is then cleared and implants and bone graft are inserted. Because the nerves are close to the psoas muscle, neuromonitoring is used to test whether nerves are being damaged or irritated.
These images show an example of an L3/4 LLIF in a case of a patient who had a focal degenerative scoliosis
LLIF before surgery
LLIF AP
LLIF Lateral
PLIF
With Posterior Lumbar Interbody Fusion (PLIF), an incision is made through the back. Implants and bone graft are placed directly in the disc space supplemented by screws into the vertebrae.
These X-rays show an example of an L5/S1 PLIF in a case of a patient who had L5/S1 degeneration with bilateral nerve compression.
PLIF preop SPECT
PLIF Lateral
PLIF AP
TLIF
With Transforaminal Lumbar Interbody Fusion (TLIF), two small incisions are made through the back. This procedure is similar to PLIF, but also includes the removal of the facet joint.
These images show two examples of TLIFs:
An L5/S1 TLIF where the patient had previously unsuccessful decompression surgery
TLIF preop
TLIF AP view
TLIF Lateral View
A two level L4/5 and L5/S1 TLIF in the case of a Grade 2 to 3 spondylolisthesis
2 level TLIF before surgery
2 level TLIF AP postop
2 level TLIF Lateral postop
More information about these procedures together with downloadable information leaflets is available on the British Association of Spinal Surgeons website.
Deformity Correction Surgery
Mr Lee specialises in adult deformity correction using a combination of OLIF, ALIF and posterior fusion techniques to provide not only correction of the deformity, but also decompression of the nerves. Major cases are often split into stages (no more than a week apart) with the anterior implants inserted during the first operation and the posterior screws inserted during the second operation. This allows Mr Lee to assess the degree of correction from the anterior cages before planning the second stage.
Care is taken to ensure good restoration of lumbar lordosis to match the patient’s individual pelvic incidence with correction of any sagittal imbalance. Cases are planned using bespoke surgical planning software. Mr Lee’s patients have been shown to have superior outcomes when this approach is used, as shown by his patient’s outcomes scores on the British Spine Registry. This funnel plot shows his patient outcomes compared to others.
These X-rays show a patient who had 2 stage degenerative scoliosis surgery with a combination of OLIFs, ALIFs and posterior fusion.
Deformity Case Lateral Before Surgery
Deformity Case Lateral After Surgery
Deformity Case AP Before Surgery
Deformity Case AP After Surgery
More information about these procedures together with downloadable information leaflets is available on the British Association of Spinal Surgeons website.
Sacroiliac Joint Fusion
It is estimated that 25% of low back pain actually comes from the sacroiliac joint (the joint that connects your spine to your pelvis). This joint does not move very much but can be problematic if injured, inflamed or moves more than usual. Patients who have had previous lumbar fusion surgery are also more susceptible to sacroiliac joint pain due to the increased load on the joint.
If conservative treatment for sacroiliac joint pain does not work, then a minimally invasive sacroiliac joint fusion is an option. In this procedure, an incision is made in the buttock, and two or three cages (implants) are inserted to stabilise and fuse the joint. Mr Lee is one of the few surgeons in the country that does this under computer navigation to ensure accuracy of the implants.
These images show a patient who had a sacroiliac joint fusion.
SIJ Fusion preop SPECT
SIJ Fusion AP
SIJ Fusion Lateral
More information about this procedure can be found in this patient information leaflet.
Pars repairs
A pars defect is where the junction between the vertebral body and joint is broken. This can lead to back pain and leg pain (from nerve compression) and it can progress to a slip between the vertebral bodies. Acquired pars defects are common in athletes such as cricketers and footballers. Treatment is usually conservative in nature with focused rehabilitation, but, if this fails, the pars defect can be repaired with a minimally invasive compression screw across the fracture. Mr Lee performs this under computer navigation to ensure accuracy of the screw.
These X-rays show a patient who had a unilateral pars repair.
Pars repair before surgery
Pars Repair AP
Pars Repair Lateral
Injections
Injections are often an option for relieving back pain and nerve pain. Sometimes injections are used for diagnostic reasons if there are multiple potential sources of pain. Some injections can be done while you are awake under CT guidance by a consultant radiologist. Otherwise, they can be performed as a day-case procedure under sedation.
There are a wide variety of injections including:
- Nerve root injections (also known as transforaminal epidural injections)
- Caudal epidural injections
- Pars injections
- Coccyx injections for coccydynia
- Facet joint medial branch blocks (which if beneficial can lead to denervation treatment)
More information about these procedures together with downloadable information leaflets is available on the British Association of Spinal Surgeons website
Book a consultation
Please call or email Mr Lee’s office to book your consultation.