What is SED/YESS?
Selective Endoscopic Discectomy™ (SED™) is a minimally invasive spine surgery technique that utilizes an endoscope to treat herniated, protruded, extruded, or degenerative discs that are a contributing factor to leg and back pain. The endoscope allows the surgeon to use a “keyhole” incision to access the herniated disc. Muscle and tissue are dilated rather than being cut when accessing the disc. This leads to less tissue destruction, less postoperative pain, quicker recovery times, earlier rehabilitation, and avoidance of general anesthesia. The excellent visualization via the endoscope permits the surgeon to selectively remove a portion of the herniated nucleus pulposus that is contributing to the patients’ leg and back pain.
Thermal annuloplasty is an adjunctive procedure that uses bipolar electro-thermal energy (radiofrequency and/or laser) to ablate or depopulate the sensitized pain nociceptors in the annulus, ablate any inflammatory/grannualtion tissue that has grown into the annulus, and to shrink and tighten the stretched or torn collagen fibers of the annulus. The annulus is the outer portion of the disc and is composed of many concentric layers that are arranged similarly to the plies of a radial tire. Thus, the weakened annulus or defect left by the disc herniation is contracted and possibly sealed from within the disc.
This combination procedure and the endoscopic system used to perform the unique procedure is pioneered and developed by Dr. Anthony Yeung, with instruments developed with the Richard Wolf Instrument Company (YESS – Yeung Endoscopic Spine Surgery system). This state of the art technique is an evolution from the technique originally described by Parviz Kambin called Arthroscopic Microdiscectomy (AMD). The technique has been validated with a study monitored by the Institutional Review Board at St. Luke’s Medical Center, Phoenix. Dr. Yeung’s procedure is published in peer reviewed literature and a current topic of interest in national and international spine meetings. (See Dr. Yeung’s CV)
There are other electro-thermal techniques utilized for painful, bulging degenerative discs and annular tears called IDET and Nucleoplasty/Coblation. SED™ and thermal annuloplasty, however, is NOT the same. SED™ is different because it is a visualized endoscopic surgical method (like knee arthroscopy) that is designed to visualize the patho-anatomy of the disc, spinal canal, and the adjacent nerves. These other percutaneous procedures are only fluoroscopically guided and are termed “blind” procedures. Consequently, SED™ can be used for pain caused by contained or non-contained (extruded) disc herniations, and sometimes works as well for discogenic back pain that is not responsive to non-operative treatment. (See FAQ’s for more information about the differences.)
Patients who are otherwise destined for fusion may have a minimally invasive alternative for pain relief without fusion in selected patients. Dr. Yeung is currently teaching the FDA approved procedure to other surgeons, and it is becoming available in other states and countries as the surgeons trained by Dr. Yeung are converting from the open to the endoscopic technique. In Arizona, it is currently being performed only in Phoenix at the Squaw Peak Surgical Facility that Dr. Yeung operates.