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Introduction: 25 years experience in transforaminal endoscopic surgery from a personal and spine group database is reviewed relating to treatment of discogenic pain and disc herniations.
Method: An ongoing IRB study approved in 1997 resulted in a continued study using a transforaminal endoscopic procedure with an endoscope designed for intradiscal transforaminal decompression of painful traumatic and degenerative conditions of the lumbar spine. The system developed was named the Yeung Endoscopic Spine System (YESS™) by Richard Wolf Surgical Instrument Company Vernon Hills, Illinois. The technique accompanying the system has evolved over 25 years as indications were stratified over multiple studies published in peer reviewed journals that resulted in the indications promoted and validated known as the YESS™ technique. Results of the treatment of discogenic pain and disc protrusions are provided in this summary. The vast majority of the data was generated by one surgeon (ATY) but since 2001, the co-author (CAY) and 2 other spine surgeons of the spine group practice contributed to the maintained database.
Results: A summary of the stratified results are listed in the text of the article. Indications and results provide validation of the conclusion that SED™ is the least invasive technique for surgical treatment of disc herniations, especially if treated early in the disease process.
Conclusion: With evolving techniques that continue to advance, such as diagnostic and therapeutic injections using the same trajectories to target the patho-anatomy of the pain generator, indications can be further stratified for patient selection to the extent that 90% prediction of transforaminal surgical decompression results using the “YESS” technique can be “warranteed” to improve the painful condition once the learning curve is reached and stabilized for each individual surgeon. Each surgeon stratifies their patient selection by depending on their individual patient selection criteria.