Endoscopic Discectomy (Selective Endoscopic Discectomy)

(SED™)

A Selective Endoscopic Discectomy™ (SED™) is an ultra minimally 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.
Video Credit: Arthrex

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.

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.

What are the Advantages of Endoscopic Spine Surgery?

Endoscopic Spine Surgery is a remarkable improvement over another ultra 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.

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

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.

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.)