Dr. Anthony Yeung: Mastering endoscopic spine surgery to avoid fusion

MIS

Anthony Yeung, MD, of Phoenix-based Desert Institute for Spine Care, published an editorial in Journal of Spine, "Moving Away from Fusion by Treating the Pain Generator: The Secrets of an Endoscopic Master."

Here are seven takeaways:

 

1. Impacting hundreds of millions around the globe, chronic back pain is often the result of intervertebral deterioration caused by trauma or aging.

 

2. Various minimally invasive surgical techniques exist for treating chronic pain, so patients do not have to prematurely undergo fusion. Dr. Yeung highlights transforaminal endoscopic surgery as a viable option for trained surgeons, which pinpoints and treats the pain generators. Surgeons perform the transforaminal endoscopic approach under local anesthesia with or without sedation.

 

3. Dr. Yeung argues the "surgeon factor" proves critical in performing endoscopic spine surgery. That is, a surgeon must be equipped with extensive experience and skill to choose the appropriate technique for a patient. He notes a surgeon should:

 

• Use the most effective, least invasive surgical procedure to treat the pain generator
• Adopt more than one of your mentor's technique or surgical philosophy
• Learn the technique and advance slowly and deliberately

 

4. Each surgeon will master the endoscopic transforaminal technique at their own pace, often taking about two years to five years to learn. Dr. Yeung recommends surgeons seek mentor surgeons to help them along the learning curve.

 

5. Dr. Yeung argues fusion as the standard care for chronic pain does not offer a perfect solution. Without motion, adjacent level deterioration continues rapidly. Advanced technology now provides stabilization without eliminating motion. Ultimately, he says fusion for pain is unnecessary for long-term clinical success, and predicts non-fusion technology will be the greatest growth area in the spinal pathology treatment industry.

 

6. Intradiscal therapy targets the disc, and currently several FDA-approved techniques exist. Dr. Yeung suggests surgeons begin intradiscal decompression and thermal annuloplasty.

 

7. To meet MIS goals, Dr. Yeung suggests surgeons:

 

• Understand pain's patho-physiology
• Identify and visualize the patho-anatomy of pain
• Surgically treat the pain generator in a staged manner
• Turn to fusion as the last option, except for gross instability and deformity


More articles on MIS:
Dr. Anthony Yeung on adopting transforaminal endoscopic spine surgery — 7 takeaways
Key thoughts on a hybrid endoscopic spinal decompression and dorsal rhizotomy alternative to fusion
SI-BONE iFuse patients 11x less likely to take opioids compared to non-surgical patients — 4 insights

 

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Featured Webinars

Featured Podcast

Featured Whitepapers