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khoff 07-06-2004 01:45 PM

SED for back pain
All -

I originally posted this in the back problems forum, but I know many of you have pain stemming from back problems. If you find you are in this category, I hope this can be of help .....

I wanted to post about a back procedure many have or are thinking about. It is called SED and is one of the only minimally evasive procedures that is said to heal disk tears. SED (selective endoscopic discectomy) uses a visualized procedured to fix herniated disks and thermoplasty (laser heat) to seal tears.
The foremost expert is in Arizona named Dr Yeung. His procedure is called YESS. I am including an article from a friend who is very knowledgeable about spinal techniques and procedures. He went to see Dr yeung and has watched his work first hand and seen the results. So many who are told by doctors that fusion, or open surgery is the only answer, this may be an alternative. If not, Dr Yeung will tell you he cannot help you. There is a fee for his consultation but you have to consider it as part of the entire picture.
I had a few people (kksgirls and bcorica) in mind when posting this as they were ex-nucleoplasty patients whom that procedure did not work.
A google search on YESS will give you more info. I Hope this can be of benifit to others.

- Ken

I spent most of last week in Phoenix attending a preceptorship for surgeons learning how to perform Dr. Yeung’s SED with Thermal Annuloplasty procedure. What an incredible opportunity this was for me to continue to learn more about spine. Many of you will remember that I was able to observe several of these procedures last January. (Read about it here.) As I continue to see more, I understand more about what I am seeing.

The first 2 days of the class were spent in the classroom and in the OR. There were many presentations about the surgery as well as presentations by the manufacturers of the YESS system (scope), lasers (2), RF probe, and post-op treatment device (Sequential Stimulator, RS Medical). Both days included observation of many surgeries, both in the OR, and in the training room via live video feed. Dr. Yeung’s facilities are first rate and I could not imagine how the surgeons could have had better access to his knowledge and experience (other than one on one training.) Both days included meeting many pre-op and post-op patients, including most of the patients who were operated on during the training.

Dr. Yeung did not pull any punches. These were not hand-picked patients with perfect indications. Some of them were clearly marginal candidates, who elected to try SED with thermal annuloplasty and a minimally invasive ‘first step’, knowing full well that they may be too far gone to get any lasting benefit, but also understanding that this surgery would not burn any bridges that would eliminate any of the more invasive options. The odds were very clearly explained and patients made informed decisions.

One example of Dr. Yeung’s incredible openness was demonstrated on the first day. Many of the surgeons in the class were astounded. Patient number 2 was a trial attorney. His wife was invited into the class to watch her husband’s surgery live (with audio too.) His surgery went much like all the others I’ve seen. The patient is awake the entire time and is giving pain responses. The discogram is performed with no anesthesia other than the local given. During the procedure, Dr. Yeung had to admonish the patient… he wanted to tell jokes! There was a point in the surgery when the large disc protrusion was removed and the patient indicated that his leg pain just went away. About an hour after the surgery, the patient walked into the classroom and insisted that he get to tell his joke! After a big laugh, he explained how dire his situation had been; the unrelenting leg and back pain making work impossible. The doctors in the class all understood that immediately post-op, the patient still has some local injected into the disc, so there can be a post-op euphoria that can generate some unrealistic expectations. However, they were very surprised when the patient showed up the next day, had lunch with us and told us more jokes. He also had his unfilled prescription for post-op pain meds… didn’t need them.

This went on for three solid days, with patient after patient having the same experience. They were all invited to come back and talk to the class… most did. Others had to travel right away. I can’t tell you how wonderful it was to see the natural smiles on the faces that had the horrible grimace we all have seen or had, way too many times.

Will all the patients be successful? I don’t know. Will some of them move on to more invasive surgeries? Probably so. All I know is that I wish I’d learned about Dr. Yeung before my first of three spine surgeries. This is NOT just an endoscopic discectomy. Look at my other thread (linked above) where I described the procedure back in January. This procedure is done under visual control. The surgeon can see what he’s doing. When he attempts to shrink a tear, he can see if what he’s doing is helping. If the tear gets bigger, he stops. With other forms of intradiscal thermal treatments, they are nuking tissues, but can’t see what is happening. Like JimM2 said on another thread, maybe some of our long lists of surgeries might be shorter if we’d had a chance to address our discogenic low back pain with our discectomies… instead of just doing the traditional discectomy. I often wonder of some of the lingering LBP might be due to collateral damage caused by my 2 open discectomies, where muscle is stripped off of bone during the posterior access.

I also learned more about what motivates the nay-sayers in the medical community. I experienced this first-hand, when I waited an additional 2 years before my surgery because of ‘rumors’ I’d heard about the AlphaKlinik… only to discover that the rumors were not true, not based on recent data and were basically uninformed opinions. Dr. Yeung has 13 years of development and experience with his technique. As would be expected, early experience and success rates were not as high as they are today. In the early days, there was a 20% incidence of dysesthesia (nerve symptoms). Improvements in technique and instrument design (especially a more accurate RF probe) has reduced the incidence to less than 5% with less than 2% having symptoms that last more than a few months. As with ADR, I’ll bet that the nay-sayers and rumor repeaters are dealing with information that is so old, that it is irrelevant.

Another observation is how passionate Dr. Yeung is about what he's doing. His skill, knowledge, and intuition about doing surgery did not happen by accident. He urged the surgeons to study their successes and their failures. He talked about reviewing the tapes of failed patients over and over to look for things he 'should have seen' or issues he might have addressed differently. We should all be lucky enough to have a medical providers that are willing to pour so much of themselves into each and every case.

I won’t tell you everything about the third day of training. Let’s just say that I observed how surgeons learn new techniques performed on people who are not likely to complain or sue if something goes wrong. I’d already known from watching Dr. Yeung and some less experienced endoscopic specialists, how critical experience is. As with ADR, any needle procedure is best done by someone who can get the needle, canula, etc… where he wants and knows exactly where everything is at all times. This is not easy. There is certainly a talent factor too... one surgeon might be more skilled at 100 procedures than another might be at 500. How we sort this out as patients, I don’t know.

While I was in Pheonix, I also spent ½ day with the head of the spine research lab at the very prestigious Barrow Neurological Institute. He’s a PhD. in biomechanics and is not connected to any manufacturer. Watching the test preparations and seeing all the research that’s going on was incredible. I wish I had time to explain it all, but I can’t. I was happy to shake many hands and thank the researchers for the work they are doing. Working at their ‘micro’ level, I don’t know if they truly understand how many lives are touched (and saved) by what they do.

I also got to have dinner with Becca from the MGH forum, and Kristen (who does not post anywhere.) At 47, I’m older than both of them put together, but between the three of us, we have 8 spine surgeries. Becca and I are doing great, but unfortunately, Kristen has more ahead of her. Too much pain for anyone… no less someone so young.

All in all, it was a fantastic trip. I learned so much that will help me to continue to help spine patients. I had a great time.

I’m sending pain free vibes out in all directions.


Shoreline 07-07-2004 10:10 AM

Re: SED for back pain
Hey Ken, I've seen the instrumentation on Spine U, It's pretty amazing. You ought to check it. Minimally inasive surgery that leaves you alternatives is certainly better than being condemened to a life of "live with it" "we can't do anything", "your not a candidate", etc. If you decide to go this route I hope you keep us posted.
Good luck, Dave

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