Bill Harper (Host): This is CheckupChat with EvergreenHealth. I'm Bill Harper and thank you for listening. In this episode, I'll be talking with Dr. Yung Lee about a promising new, minimally invasive treatment option for low back pain called Intracept. In 2021, EvergreenHealth became the first medical center in the Northwest to offer Intracept to its patients.

And here you'll hear why Dr. Lee is so optimistic about the relief it can offer.

Hi Dr. Lee.

Yung Lee, DO: Hey, how are you?

Host: I'm good. How are you?

Yung Lee, DO: Good.

Host: Yeah. Thanks so much for taking the time. I just heard from Karen Matthews that the new Intracept procedure is kind of a new and exciting thing. Yes. And yeah, I'd just love to hear from your perspective, kind of the impact on patients that that'll have and or is having and yeah, a bit of background. I'd love to share the story.

Yung Lee, DO: Yes. What it is, is for, low back pain. And so it's not for low back pain with sciatica, but it's specific for low back pain. And why that's important is because when people have sciatica, generally it responds pretty well to steroid injections and surgical intervention.

Unfortunately, if you just have low back pain, the treatments are very limited on what is very effective, and it is a, you know, it costs, I think like couple hundred billion dollars per year in our country to treat low back pain in general. I don't know exact figures, but, now we have a biomarker, which is on an MRI, which shows that when patients have what's called modic changes or endplate edema, which just means because the disc is failing and there is swelling within the bone itself, that we could target a specific nerves inside the vertebrae to basically burn, to get rid of the pain. And oftentimes it doesn't a hundred percent get rid of the pain, but the data show that most patients get at least about 50% relief.

Which is a dramatic change in their pain and improves their function. So, we were the first, center in this area that started the procedure about 2021. And I, believe we've done over 70 patients and there's varying degrees of responses, but had some really good success and low back pain, something that has a very poor track record in, what we can do for them.

Host: Yeah, that sounds amazing. I know tons of people that have low back pain, myself included. Yeah. That's terrific. So you've been, how long have you been doing the procedure for?

Yung Lee, DO: 202Since 2021.

About about four years.

Host: So, like, what are some of the things kinda that come to mind like, patient's responses in the, post-surgical appointments you have like where the kind of the response has been.

Yung Lee, DO: The response has been fairly good. Obviously there's been varying degrees of responses, so I always tell them that, you know, expect to get about 50% relief, but I've had some patients who had complete relief and they've had back pain for many years. So it's not like everybody has this condition, so they have to have that specific biomarker.

And it is really only FDA approved for certain levels in the back. And so we number the vertebrae one through five, and it's really the number three and below are the ones that are FDA approved. So it's not like we can do this on everybody, but my understanding in the whole country, there's only been 50,000 of these procedures that have been done so far might even be less than that, and there potentially is between 30 to 50 million people in our country alone that may need the procedure.

Host: Wow. So it's kind of, yeah,

Yung Lee, DO: it's up and coming. Brand new a bit

Host: more than up and coming, but yeah.

Yung Lee, DO: And so there's a lot of patients out there that doesn't even know that they have a treatable condition and it's minimally invasive. So we do most of these under general anesthesia, which is more than just doing it in your office.

So we do it in the operating room. Because we have to place a thick needle inside the center of the vertebrae, and then we target it with a probe that gets heated up to 75 degrees centigrade, and we hold it there for about 15 minutes of a burn and it permanently burns the nerve, so it does not come back, but it is the nerve that only goes to the specific vertebrae.

As long as the procedure is done properly, it doesn't affect any of the other structures that could cause nerve damage down the leg, for instance, or cause other issues. So, and there's no real long-term ramifications of doing this that we know of as yet, and it has a very good safety record with at least five year data.

And a lot of these patients who've done this for even longer than I have, they've had a really good success record with doing the procedure.

Host: Yeah. So then it sounds like it's just kind of complications, side effects, risks are pretty low then?

Yung Lee, DO: Yeah, very low. So I haven't had any major complication, which means nerve damage or obviously death or paralysis or, even an infection. Temporarily increased pain is the most common side effect, which is what I tell them is to be expected. Most people are getting these procedures done, let's say on a Thursday, and if they're not in a labor work, they could go back to work the Monday after?

 It's an outpatient procedure and then your recovery is at home and you're able to do most activities the next day. You know, you can go out for shopping and go out to dinner and all those things.

Host: Yeah, I know. I mean, back pain can be so debilitating. I mean, the outpatients just must be so grateful that, this option exists to them.

Yung Lee, DO: Yes. The biggest challenge is getting insurance authorization. Because it's relatively new. And so what the insurance companies are saying, this is considered experimental, but it is not experimental. There's robust amount of scientific literature that supports it. So now, it really changed, I believe last year when Medicare CMS made a coverage policy in regards to it.

So any traditional Medicare patients are covered to receive this procedure, which is huge, which most of the insurance follow Medicare, it just takes several years for them to follow. So we're getting more and more authorizations. So initially, I still tell my patients that it takes two to four months to go through the authorization process, but with Medicare and certain insurances, it's been very quick turnaround if they really need the procedure done.

Host: Wow, that's amazing. What kind of age group of patients have you been seeing with this procedure?

Yung Lee, DO: I would say the youngest patients are in their thirties. I don't think I've ever done them in a patient in their twenties. Thirties, all the way up to eighties. That's when most people start having back pain is in their thirties and forties. But I've had patients, you know, who I've done this on for 50 years of back pain. One guy, I think he had over 10 years of back pain, we were able to cure his back pain after he's been trying multiple different things. Wow. Yeah.

Host: Cure it, you said?

Yung Lee, DO: Yeah, cure it. Yeah.

Host: Wow, that's incredible. Yeah.

Yung Lee, DO: Yeah.

Host: That's phenomenal news. So, what are your hopes for this procedure kind of going forward?

Yung Lee, DO: The hope is that we are able to provide this procedure to more people. That is the hope. And basically getting the awareness out that this procedure does exist, that if they have a back pain with this specific biomarker, they may be a candidate long as you know, they don't have medical conditions that excludes them. For instance, infections. One of the side effects of this procedure that has been described in literature is a fracture because it weakens the bone temporarily. So we want to make sure that their bone health is good and so long as their bone health is good, and then it meets the biomarker and they have to have done other conservative treatments, and have to have had back pain for at least six months. Those are the criteria to to receive the procedure.

Host: Yeah. And to determine bone health, is that like a DEXA scan or a kind of one of those?

Yung Lee, DO: Usually a DEXA scan or a CT scan. Um, usually we don't get DEXA scans on everybody. Our criteria that we're using in our clinic is 65 and over. But the risk is still very, very low, but we're just being extra cautious.

Host: Yeah, of course. You mentioned a biomarker. Can you explain kind of what that is?

Yung Lee, DO: Yeah, so it's something that we could test to see if, it makes sense that they have a specific disease. So a biomarker could be a blood test, for instance, in this case it's an MRI findings of MRI. Sometimes a bone scan that shows inflammation of the bone is what we're looking for.

Host: Yeah, so it sounds like you listed kind of four or five criteria, then people can get, what you said, potentially curative of this sometimes in many cases, debilitating pain. That's amazing Dr. Lee. Yeah.

Yung Lee, DO: Yes, it is very exciting procedure and so. I perform it. There's another doctor, who just joined our practice, recently, who also performs it. Her name is Dr. Kwan. And then all of our doctors are aware that we do, including our spine surgeon. So we get referrals in fact, we get referrals from outside our center, for instance, the Optum, because a lot of centers don't do this procedure. I believe Swedish just started doing it. There's also another physician who's affiliated with Evergreen, but he performs at his own surgery center, Dr. Dan Nelson. So there's more people doing this procedure now. But certain centers, like for instance, Optum and Everett do not do the procedure, so I've been receiving referrals from them.

Host: Wow. Yeah, it sounds like it's in high demand.

Yung Lee, DO: Yeah, it can be. I'll be honest, we haven't really advertised or marketed around it because our clinic has been so busy.

And so, access is still an issue, but we are having a new doctor join us, in next two weeks. And we also hired, two advanced practice providers to kind of help see the patients to see if they're appropriate candidate for a lot of the procedures that we do. So hopefully we will improve the access so that we can see more patients who need our care.

Host: Access is what it's all about, and get the word out as much as we can. Yeah. Thanks so much for your help, Dr. Lee. I appreciate you, and keep us updated on any new, exciting developments with this.

Yung Lee, DO: Okay. Will do.

Host: Well, that's a wrap for this episode of CheckupChat with EvergreenHealth. Be sure to go to our website, evergreenhealth.com for more information or to connect with one of our providers. And please remember to subscribe, rate and review this podcast and follow us on your social media channels. And as always, thank you for listening.