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Dr. Ritter-Lang


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Selective Endoscopic Discectomy

Selective Endoscopic Discectomy or SED is a method of spinal surgery that uses a minimally invasive approach and enables painless surgeries performed under local anesthesia. Surgeries are performed on disc herniations. This is an outpatient surgery with rapid recovery, a timely start of physical therapy and prompt return to normal activities.

Benefits of Selective Endoscopic Discectomy compared to standard open spine surgery:
Local anesthesia is much safer than general anesthesia.
There is almost no bleeding.
Only the abnormal disk material is removed so there is less chance of disc space collapse.
Your recovery should be much quicker since nothing other than your skin is cut.
The endoscope provides more light and better magnification than open surgery.
We are able to see the traversing and exiting nerve roots better.

Selective Endoscopic Discectomy is a minimally invasive spine surgery technique that utilizes an endoscope to treat herniated, protruded, extruded, or degenerative discs that are a contributing factor to leg and back pain. The endoscope allows the surgeon to use a "keyhole" incision to access the herniated disc. Muscle and tissue are dilated rather than being cut when accessing the disc. This leads to less tissue destruction, less postoperative pain, quicker recovery times, earlier rehabilitation, and avoidance of general anesthesia. The excellent visualization via the endoscope permits the surgeon to selectively remove a portion of the herniated nucleus pulposus that is contributing to the patient's pain.

Thermal annuloplasty is an adjunctive procedure that uses bipolar electro-thermal energy (radiofrequency and/or laser) to ablate or depopulate the sensitized pain nociceptors in the annulus, ablate any inflammatory/grannualtion tissue that has grown into the annulus, and to shrink and tighten the stretched or torn collagen fibers of the annulus. The annulus is the outer portion of the disc and is composed of many concentric layers that are arranged similarly to the plies of a radial tire. Thus, the weakened annulus or defect left by the disc herniation is contracted and possibly sealed from within the disc.

This combination procedure and the endoscopic system used to perform the unique procedure is pioneered and developed by Dr Anthony Yeung, with instruments developed with the Richard Wolf Instrument Company (YESS Yeung Endoscopic Spine Surgery system). This state of the art technique is an evolution from the technique originally described by Parviz Kambin called Arthroscopic Microdiscectomy (AMD).

There are other electro-thermal techniques utilized for painful, bulging degenerative discs and annular tears called IDET and Nucleoplasty/Coblation. Selective Endoscopic Discectomy and Thermal annuloplasty, however, is NOT the same. Selective Endoscopic Discectomy is different because it is a visualized endoscopic surgical method (like knee arthroscopy) that is designed to visualize the patho-anatomy of the disc, spinal canal, and the adjacent nerves. These other percutaneous procedures are only fluoroscopically guided and are termed "blind" procedures. Consequently, Selective Endoscopic Discectomy can be used for pain caused by contained or non-contained (extruded) disc herniations, and sometimes works as well for discogenic back pain that is not responsive to non-operative treatment. Patients who are otherwise destined for fusion may have a minimally invasive alternative for pain relief without fusion in selected patients.

Please contact us for more details.

We use fully accredited facilities and have an outstanding world-wide reputation in the field of spinal intervention and spinal fusion and disc replacement.