The great historian, David McCullough, told a North American Spine Society audience a few years ago that there is nothing inevitable about history. History is made by people who make the best decisions they can with no visibility of the future. Only their character guides their decisions.
Yeung Endoscopic Center Dedicated in New Mexico
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It wasn’t inevitable almost 30 years ago that Anthony Yeung, M.D. would take the concept of the knee scope and bring it to the spine, using a transforaminal approach and visualized endoscopic instrumentation. It wasn’t inevitable that he would develop the FDA-approved Yeung Endoscopic Spine Surgery System (YESS), allowing for outpatient surgery, significantly smaller incisions, preservation of muscle and bone and a quicker recover.
Those decisions led to the dedication on April 25, 2014 of the first academic spine center dedicated to endoscopic spine surgery. The Anthony T. and Eileen K. Yeung Endoscopic Spine Center of the University of New Mexico’s (UNM) School of Medicine is located at the Sandova Regional Medical Center in Albuquerque, New Mexico.
Validating the Field
J. Fred Harrington, M.D., assistant professor of neurosurgery at the medical school and director of the center, told OTW that he believes that transforaminal endoscopic spine surgery as practiced by pioneering surgeons such as Dr. Yeung and other endoscopic spine surgeons in Europe and Asia has demonstrated the potential to improve both the subjective patient experience and outcomes after spinal surgery.
“However, ” added Harrington, “there is a need to increase the amount of scientific data available to validate the field. By carefully studying our patients, we hope to put endoscopic spine surgery in its proper place amongst the tool that spine surgeons can use to alleviate pain and suffering.”
Dr. Yeung, a graduate of the UNM Medical School, said he was guided by his own personal experience when his mother had spine surgery when he was a resident and she got worse. “I thought there had to be a better way; I wanted to bring this to UNM because there is already a team of like-minded physicians in place here who are interested in working with patients to find the source of their pain.”
A Better Way
Dr. Yeung’s better way was to develop a multi-channel device which marries the laser and the endoscope to allow surgeons to visualize and selectively remove portions of a herniated nucleus contributing to back and leg pain. The 2.7mm operating channel uses a keyhole incision to access the damaged disc, dilating rather than cutting muscle and tissue, resulting in less tissue destruction, no need for general anesthesia, and a quicker recovery. This procedure is used to treat herniated, protruded, extruded, or degenerative discs in the lumbar spine, a very common condition.
“Endoscopic foraminal spine surgery offers the least invasive surgical solution to visualizing and treating the pain generators without burning any bridges for traditional more invasive procedures that have higher surgical morbidity, ” said Dr. Yeung.
Multi-Disciplinary Approach
Howard Yonas, M.D., chairman of the department of neurosurgery at UNM explained, “Because we have a very cohesive multi-disciplinary group in our spine program, it is clear that each part of the breadth of Dr. Yeung’s work will be embraced by all members of the team.
“Every patient who comes to us is evaluated by a multi-disciplinary team, ” added Dr. Harrington. He explained that the Sandoval Regional Medical Center facility is part of the UNM Interdisciplinary Center for Spine Health.
The Interdisciplinary Center for Spine Health at UNM holds a close affiliation with the UNM Pain Center which includes an interdisciplinary team of specialists in neurology, psychiatry, physical medicine and rehabilitation, anesthesia/interventional pain, neurosurgery, internal medicine, family practice, psychology, pharmacy and physical and occupational therapy and chiropractic services.
UNM has equipped a SRMC surgical suite with the unique instruments needed for the surgery and provided special training to operating room nurses assisting with the procedures. UNM surgeons have been operating at SRMC since March.
Leaving a Legacy
Dr. Yeung, who practices at the Desert Institute for Spine Care in Phoenix, and his wife, contributed $2.5 million to the Center. “I hope that this is a legacy, ” said Dr. Yeung.
The decisions which led to the Yeung Center may not have been inevitable, but they are now history.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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