Transforaminal Selective Endoscopic Discectomy: Recovery, Complications, Procedure and Contraindications

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Doctor speaking with Elderly Female PatientPost-Operative Recovery and Patient Satisfaction
The patient is released home the same day of the procedure. Use of ice packs and a mild oral analgesic for a few days will help to minimize post-operative swelling and pain. Many patients are able to resume work within a few days.

Prior to the procedure, patients are provided with outcome statistics. For example, good to excellent results are expected in 86% of patients if pre-operative pain is primarily low back pain. If the patient's pain was back and leg pain, good to excellent results should approach 92%.

It is important to remember that surgery is not guaranteed to resolve all symptoms or problems. All surgical procedures have potential risks and possible complications and those associated with selective endoscopic surgery are similar but less common than those associated with open back surgery. The most common complications are:

1. Persistent nerve root pain due to either minor manipulation of the nerve or nerve regeneration of a nerve damaged prior to surgery. This can occur in 5% to 15% of patients and is usually transient.

2. Infection may occur in the disc. This risk is small as the incision is small and the patient receives antibiotics intravenously (IV) during the procedure.

3. Persistent back pain may continue/occur if the facet joint was damaged prior to surgery.

4. Minor leg weakness may be present for several months after surgery especially if leg weakness was a long-time symptom prior to surgery.

5. Transient headaches.

Why Does SED Work?
In post-operative follow-up visits, patients report improvement in symptoms and want to know why this procedure works. Selective Endoscopic Discectomy has been performed by Anthony Yeung, M.D. more than 2,000 times and he originated SED using the YESS endoscope. Dr. Yeung believes SED is successful for the following reasons:

1. The abnormal portion of the disc that creates internal pressure against the annulus and nerve root is removed.

2. The fissures in the annulus that allow leakage of disc fluid and material are sealed and tighten up using the Ellman Radiofrequency device and the laser.

3. A constant flow of irrigating saline through the endoscope washes out the irritating damaged metabolites (prostaglandins, histamines and substances P & X).

4. No deep tissue is cut and generally no bone has to be removed.

The following patients are not candidates for SED:

1. A patient with a fully extruded disc that has migrated up into the spinal canal. This is a rare occurrence.

2. A patient with extensive spinal stenosis. In some cases, an open surgical procedure is required to remove bone that is compressing the nerves.

3. When spinal instability is extensive and the patient requires a spinal fusion using an open surgical procedure.

For patients who wish to avoid extensive spine surgery (open back) and have been told they will have to live with their low back pain, SED may be an option. This minimally invasive surgical alternative is a procedure that can be performed under local anesthesia with a high rate of patient satisfaction.

1. Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation-surgical technique, outcome, and complications in 307 consecutive cases. Spine 2002; 27(7): 722-31.

2. Tsou PM, Yeung AT. Transforaminal endoscopic decompression for radiculopathy secondary to intracanal noncontained lumbar disc herniations: outcome and technique. The Spine Journal 2002; 2(1): 41-8.

Updated on: 01/05/16
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Stewart G. Eidelson, MD
In his article about Selective Endoscopic Discectomy, Dr. Gross provides patients with valuable information about this minimally invasive procedure that was developed by Dr. Anthony T. Yeung. Although SED is considered controversial, the outcomes seem to suggest a new role in the use of this technology. Further studies will help to better understand the best possible application for spine specialists.
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