Expanded Indications

Expanded Indications

Dr. Yeung’s transforaminal techniques are evolving along with improvements in endoscopes, instruments, and devices that facilitate the learning process for other similarly minded and dedicated surgeons.

Dr. Yeung served as the editor of a special issue in the International Journal of Spine Surgery that contain updated studies by Dr. Yeung and other blinded peer reviewed articles by MIS spine contributors. The articles are now published in the free access Journal and online.

The special issue can be accessed at:

International Journal of Spine Surgery: Percutaneous and Endoscopic Special Issue

The articles in this issue contain articles that summarize the results of procedures performed by the surgeons at DISC trained by Dr. Yeung, who also had the transforaminal decompressive procedures performed on himself by his DISC associates. The articles include articles written by Dr. Yeung.

Surgical management of back and leg pain is evolving and changing due to a better understanding of the patho-anatomy well correlated with its pathophysiology. Pain is better understood with in vivo visualization and probing of the pain generators using an endoscopic access rather than just relying on symptoms diagram and image correlation. This has resulted in a shared decision making involving patient and surgeon, focused on a broader spectrum of surgical as well as non-surgical treatments, and not just masking the pain generator. It has moved away from decisions based on diagnostic images alone, that, while noting the image alterations, cannot explain the pain experienced by each individual as images do not always show variations in nerve supply and patho-anatomy. The ability to isolate and visualize “pain” generators in the foramen and treating persistent pain by visualizing inflammation and compression of nerves, serves as the basis for transforaminal endoscopic (TFE) surgery. This has also resulted in better pre surgical planning with more specific and defined goals in mind. The “Inside out” philosophy of TFE surgery is safe and precise. It provides basic access to the disc and foramen to cover a large spectrum of painful pathologies.


Conventional fluoroscopically guided continuous radiofrequency (CRF) and pulsed Radiofrequency (PRF) lesioning of the medial branch, dorsal ramus, a standard technique to treat facet pain, is compared to an endoscopic visually guided technique. The endoscopic technique (Figure 1) is designed to ablate a larger area of the transverse process where the medial branch crosses to innervate the facet. Endoscopically guided visualization provides confirmation of nerve ablation or transection in the most common location of the branches of the dorsal ramus innervating the facet joint.


The most common causes of failed back surgery are residual or recurrent herniation, foraminal fibrosis and foraminal stenosis that is ignored, untreated, or undertreated. Residual back ache may also be from facetal causes or denervation and scarring of the paraspinal muscles. The original surgeon may advise his patient that nothing more can be done on the basis of his opinion that the nerve was visually decompressed by the original surgery, supported by improved post-op imaging and follow-up studies such as EMG and conduction velocity studies. Post-op imaging or electrophysiological assessment may be inadequate to explain all the reasons for residual or recurrent symptoms. Treatment of Failed back surgery by repeat traditional open revision surgery usually incorporates more extensive decompression causing increased instability and back pain, therefore necessitating fusion. The authors, having limited their practice to endoscopic MIS surgery over the last 15-20 years, report on their experience gained during that period to relieve pain by endoscopically visualizing and treating unrecognized causative patho-anatomy in FBSS.


These articles serve to provide the spine literature references to the YESS SED philosophy and technique.

75% of patients who are candidates for traditional MIS decompression and fusion have been able to avoid fusion if their spinal condition meets Dr. Yeung’s criteria for MIS Decompression and Ablation, and Irrigation.

Now, having over 24 years experience with Dr. Yeung’s technique, Our extensive experience with this evolving innovative transforaminal technique developed and evolved by Dr. Yeung is has demonstrated excellent results for conditions such as Failed Back surgery syndrome from recurrent disc herniations, lateral foraminal stenosis, and even scarring in the foramen to relieve your back pain and sciatica by focusing on decompressing, ablating, and irrigating the patho-anatomy of your pain generators.

It is not designed nor guaranteed to “cure” your condition indefinitely. The aging process continues and recurrent pain occurs as your spine deteriorates with age. That is true especially if previous spine surgery was successful, but symptoms have returned.

The conditions we treat now include painful conditions that, if relieved temporarily by transforaminal epidural blocks, but the pain recurs frequently enough that more than three blocks / year are required to continue the relief, transforaminal endoscopic surgical decompression will provide longer periods of pain relief.

Previously we considered transforaminal surgery only if the blocks failed. This technique in experienced hands with all the surgeons at DISC can treat the painful condition effectively if needed for quality of life. It is also cost effective compared with more extensive and more surgically morbid surgery considered the “gold standard”, or multiple pain injections and pain meds that only provide temporary limited relief.

Advanced, Safe Techniques Enhanced by Operating With Minimal or Local-only Anesthesia

The ability for the surgeon to see and probe the pain generators adds to the safety and efficacy of treating these pain generators that is often missed if only imaging studies are relied upon. This offers new evidenced-based guidelines that most spine surgeons are not aware of unless they can demonstrate probing and communication with an awake patient.

These videos offer new information that showcases the YESS technique and how advanced it is in experienced hands that allow the surgeon to see patho-anatomy not illustrated with any other Endoscopic technique.