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Endoscopic Discectomy (Selective Endoscopic Discectomy)

A Selective Endoscopic Discectomy™ (SED™) is a least invasive spine surgery technique that utilizes an endoscope to treat herniated, protruded, extruded or degenerative discs that contribute to leg and back pain. 

This endoscopic discectomy procedure is one of a group of surgical techniques called endoscopic spine surgery. In addition to SED™, the surgeons at DISC also utilize the endoscopic rhizotomy for low back pain and the endoscopic foraminoplasty for severe leg pain caused by lateral recess stenosis.

What is the Yeung Endoscopic Spine System (YESS)?
The Yeung Endoscopic Spine system used to perform the unique SED™ procedure was pioneered and developed by Dr. Anthony Yeung (retired), with the Richard Wolf Instrument Company in 1993. It was the world’s first working-channel endoscopic spine surgical system. It allowed endoscopic spine surgery to be performed with direct visualization. SED™ was a significant advancement over the Arthroscopic Microdiscectomy technique initially described by Parviz Kambin.
SED™/YESS – Validated in Clinical Studies and Practice

The endoscopic discectomy technique and specialized YESS instruments were validated by 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 intense interest in national and international spine meetings. (See Dr. Yeung’s CV)

Over the past 30 years, Dr. Yeung, his son Dr. Christopher Yeung, and their spine surgeon partners have trained many spine surgeons worldwide and revolutionized lumbar spine treatment.

Over 100 studies have been published verifying and expanding the results and indications for treatment in the low back and neck. The expected results for an endoscopic discectomy are similar to that of published results for a microdiscectomy but with quicker recovery and rehabilitation time.

Today, many new spine surgeons train yearly, making endoscopic spine surgery a viable least invasive option for patients to consider.

How is an Endoscopic Discectomy Performed?

The endoscopic spine surgery starts with the patient being comfortably positioned and sedated with IV medication. Numbing medication is injected at the skin incision site.

Our surgeons precisely guide a spine needle and guidewire to the affected herniated disc under fluoroscopic X-ray guidance.

Next, muscle and tissue in your back are dilated through a ¼ inch “keyhole” incision, inserting a small metal dilator and cannula over the guidewire to access the herniated disc.

Finally, an endoscope attached to an HD camera is inserted into the cannula down to the herniated disc’s precise location.

Highly Specialized Micro-Instruments

The endoscopic spine surgeon utilizes multiple micro-instruments through the endoscope to directly visualize, ablate, and decompress the herniated disc, alleviating the pressure on a spinal nerve.

In addition to micro-instruments, a side-firing laser is used through the endoscope as an adjunctive tool to vaporize and remove both soft tissue (disc, synovial cyst, epidural scar) and hard calcified tissue (bone spur/calcified disc) that is compressing the nerve.

A laser is an extremely safe and precise tool for endoscopic surgery, especially when it is difficult to reach the offending pathology with the mechanical micro-instruments.

Beware of many surgeons who market “laser spine surgery” as a specific surgical procedure. A laser is merely one of many helpful tools to perform endoscopic and minimally invasive spine surgery.

Read Dr. Christopher Yeung’s book chapter on “Lasers” in Minimally Invasive Spine Surgery: Surgical Techniques and Disease Management for more information.

Photo of the book Minimally Invasive Spine Surgery Surgical Techniques and Disease Management

What are the Advantages of Endoscopic Spine Surgery?

Endoscopic Spine Surgery is a remarkable improvement over other minimally invasive and traditional spine surgery for patients. Because of the small ¼ inch incision and less invasive muscle sparing impact on patients, endoscopic spine surgery has many benefits over pain management procedures and minimally invasive spine surgery.

Patient Advantages

These least invasive procedures are an excellent first-line surgical option for patients who have failed conservative treatment efforts, and surgical intervention is necessary.

Endoscopic spine surgery provides the following advantages:

  • Less tissue destruction
  • Less blood loss 
  • Less postoperative pain
  • Less need for narcotic medications 
  • Quicker recovery times and return to work
  • Faster rehabilitation
  • Avoidance of general anesthesia. 
  • Avoids the need for spine fusion in many patients

Spine Surgeon Advantages

The excellent visualization via the endoscope permits the surgeon to precisely target and selectively remove a portion of the herniated nucleus pulposus, contributing to the patients’ leg and back pain. The surgeon can maneuver the endoscope to access the pathology up close and from different angles, unlike the traditional line of sight’s limitations with open and microscopic techniques. 

Endoscopic spine surgery also allows the surgeon to access a natural opening to the disc called the foramen. The transforaminal surgical approach allows the surgeon access to the lateral recess, which can be difficult to access from a traditional posterior approach. Failure to fully decompress this lateral recess accounts for thirty percent of traditional failed back surgeries. 

Finally, surgeons can view the spinal canal and nerve roots with minimal tissue manipulation, limiting scar tissue formation compared to traditional posterior laminectomy. In case of a re-operation, endoscopic becomes a very viable approach as previous scar tissue can be avoided. Many times, a more invasive fusion type surgery can be avoided.

Watch a live surgery of an endoscopic discectomy

An extraforaminal herniated disc is ideal for the transforaminal endoscopic approach of selective endoscopic discectomy.

Some of the surgical videos may contain scenes or images that some viewers may find disturbing. Viewer discretion is advised.

How is Low Back Pain Treated with an Endoscopic Discectomy?

For years pain management doctors tried thermal annuloplasty procedures such as an IDET or Nucleoplasty/Coblation. These procedures use bipolar electro-thermal energy (radiofrequency and or laser) to ablate or depopulate the sensitized pain nociceptors in the annulus, inflammatory/granulation tissue that has grown into the annulus, and to shrink and tighten the stretched or torn collagen fibers of the annulus.

These procedures are performed under X-ray guidance and are not directly visualized by the pain management doctor. The studies of these types of procedures have not shown promising results and are not widely used today.

Pain management electro-thermal techniques and the selective endoscopic discectomy however, are NOT the same. Selective endoscopic discectomy is a visualized endoscopic surgical technique (like knee arthroscopy) designed to visualize the patho-anatomy of the disc, spinal canal, and the adjacent nerves.

Pain management percutaneous procedures are only fluoroscopically X-ray guided and are termed “blind” techniques. Consequently, SED™ can be used for pain caused by contained or non-contained (extruded) disc herniations, and sometimes works for discogenic back pain that is not responsive to non-operative treatment. (See FAQ’s for more information about the differences.)

YESS Selective Endoscopic Discectomy procedure showing working sleeve insertion into spine.

YESS Selective Endoscopic Discectomy
(working sleeve insertion)

Spine Fusion Alternatives
Select patients who are destined for a spinal fusion may have a least invasive alternative for pain relief without fusion. Endoscopic spine surgery is becoming available in other states and countries as the spine surgeons trained by DISC are converting from open techniques to endoscopic procedures. In Arizona, it is currently being performed only in Phoenix at the Squaw Peak Surgical Facility.

Schedule an Appointment with DISC and Get Back to Living

Our orthopedic spine specialists in Phoenix are available to help you get an accurate spine diagnosis and customize an innovative treatment plan to get back to enjoying life. Schedule an appointment with one of our compassionate expert spine surgeons today.

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