5 key thoughts on endoscopic surgery and spinal pain


Anthony Yeung, MD, founder of Phoenix-based Desert Institute for Spine Care, comments on the use of outpatient spine surgery to alleviate back pain.

In 2013, Dr. Yeung donated $2.5 million to the University of New Mexico in Albuquerque to open the Anthony T. & Eileen K. Yeung Center for Endoscopic Spine Surgery. This center will incorporate programs to educate spine surgeons and pain physicians about effective minimally invasive surgical techniques for spinal pain.


Here are five things to know:


1. Endoscopic surgery can alleviate spinal pain. Pain generators in the lumbar spine can be diagnosed and Dr. Anthony Yeungtreated with endoscopic surgery, through decompression, thermal ablation and irrigation, according to Dr. Yeung. The dorsal root ganglion, for example, has been shown to be the site of severe neuropathic spine pain in the hidden zone between the traversing and exiting nerve.

"I have long advocated for endoscopic surgical treatment of pain as a procedure that is bridging the big gap between traditional spine surgeons and pain management," Dr. Yeung says.


2. Surgery is cost-efficient for many patients. Dr. Yeung says outpatient endoscopic spine surgery may result in long-term cost savings.


"There are too many nonsurgical procedures that do no more than give very temporary relief, waiting for the natural process to resolve," he says. And while other effective surgical treatments exist, like spinal fusion, they are more surgically morbid and expensive than endoscopic surgery.


"We need an effective surgical procedure that successfully identifies and treats the patho-anatomy of pain as a staged procedure, which may eliminate the need for more expensive fusion, except when needed for gross instability and deformity or as a salvage procedure," he says.


3. Successful spine surgeons can integrate endoscopic surgery as part of their skillset. According to Dr. Yeung, some pain physicians looking for procedures to perform have led newly formed endoscopic surgical groups.


However, pain physicians need additional surgical training to recognize complications and to ensure safety; spine surgeons need to collaborate with pain management to bridge the gap between the two fields.


"All stakeholders will have to work together as a team with different skillsets," he says. "With our current knowledge of surgically treating the patho-anatomy of pain, the focus is not just on efficacy and cost effectiveness, but also on safety."


4. Physicians must be adequately compensated. Dr. Yeung says physicians are being inadequately compensated for endoscopic surgery, which discourages them from seeking the additional training and specialized equipment it requires.


"Making reimbursement inadequate with interventional percutaneous codes degrades the complex surgical procedure, which requires additional training and expensive reusable and disposable equipment. Shifting reimbursement to pain procedure codes makes reimbursement so low that there is little incentive on the surgical side," he says. "Inadequate compensation is going to set back the great progress that has already been made in endoscopic surgery."


5. Pathways for proper surgical training. For effective endoscopic spine surgery, one daunting challenge is the lack of training programs.


To address this need, the Anthony T. & Eileen K. Yeung Center for Endoscopic Spine Surgery will offer specialized programs, and Dr. Yeung is also helping James J. Yue, MD — co-chief of the orthopedic spine surgery section at Yale School of Medicine in New Haven, Conn. — develop a training program.


"We desperately need training programs for our young surgeons and pain management physicians in a special academic fellowship program, that ideally involves both disciplines," he says.


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