Anthony Yeung, MD, an orthopedic spine surgeon at the Phoenix-based Desert Institute for Spine Care, discusses the future of spine technology.
Question: What sparked your interest in minimally invasive spine surgery?
Dr. Anthony Yeung: I saw the need for minimalism in spine surgery when my mother sustained a nerve injury and destabilizaton of her spine, following a traditional open decompression and partial removal of her facet joint for a central disc herniation in a congenitally small spinal canal. I became interested in subsequent minimally invasive techniques and technologies that might have spared her spinal progression to a grade 2 spondylolisthesis — and years of pain and disability. I was interested in any less invasive method, to decompress her herniation and to minimize her progressive slip subsequent to the discectomy and facet decompression. When I had the opportunity to learn the transforaminal decompression concept of Parviz Kambin, I realized that the ability to see what I was removing with the endoscope may be the answer I was looking for.
Q: What is unique about the Yeung Endoscopic Spine System?
AY: I developed the Yeung Endoscopic Spine System in 1997, which was designed specifically for performing a "selective" discectomy that was unique for its time by using a vital indigo carmine dye to stain the degenerative nucleus for removal. At the same time, laser was FDA approved, and when I combined the use of laser with discectomy, I realized that it created a relatively bloodless field, so I could actually see the tissue I was removing and use the laser for very controlled removal of disc and bone. I therefore designed the "Yeung endoscope," developing a multichannel irrigation endoscope that was oval rather than round, in order to fit into a narrowed disc.
I originally focused on intradiscal therapy, after recognizing that there should be some guidance for the amount of herniation to remove and to visualize the patho-anatomy in the disc, like painful annular tears. I was able to visualize the nucleus pulposus during discectomy, to see what a normal nucleus pulposus looks like, as compared to a degenerative nucleus. I then recognized that a selective, targeted decompression of the disc by adding vital staining of the degenerative disc via discography allowed me to be more "selective" in disc removal, when I was able to see which parts of the disc were normal or abnormal.
I soon developed the beveled, instead of round, cannula to facilitate looking into the epidural space, and I also had German engineers produce hinged discectomy instruments to facilitate discectomy and visual inspection of the epidural space to confirm decompression of the traversing and exiting nerve. The various cannula configurations in the YESS system, hinged and flexible discectomy instruments, also provided more flexibility in reaching the patho-anatomy intradiscally. Other competing endoscope companies subsequently copied, and in some cases even improved, accessing the epidural space. The competition has brought endoscopic surgery to a new level on minimalism that is just catching on as academic interventalists are helping us understand pain and how to treat it.
Q: What is the biggest challenge facing the spinal care industry today?
AY: There is a concerted pushback by payers, and competing "providers," to decrease reimbursement, with the main goal to decrease payout for multiple innovative surgical approaches — partly by competing specialties all protecting their own innovative technology, surgical and nonsurgical, but at the same time adding expense to treatment.
Learn more from Dr. Yeung at the 15th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference + The Future of Spine in June 2017! Click here for more information.
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