The SED procedure was developed by Dr. Yeung through the 90's and 2000's. It stands for selective endoscopic discectomy. There is much about it that is different from a traditional discectomy or even another endoscopic discectomy.
The 'selective' part if it has to do with injecting indigo carmine. This is like a PH indicator that stains the degenerated nucleus material as the degenerative tissue has a much more acidic PH than does healthy nucleus tissue. Because his equipment puts him INSIDE the disc with a video camera, he can selectively remove only the degenerated tissues, leaving the healthy tissues.
All references to SED procedures that I've seen (and I've had dozens of clients with SED), have been for SED with Thermal Annuloplasty. The thermal annuloplasty component (TA) is an integral part of SED. Because they are inside the disc and can see the annular tear, they have the capability to apply laser or RF energy to the 'granulation tissue' and posterior annulus UNDER VISUAL CONTROL. The granulation tissue is erratic tissue (not normally present, like erratic boulders that are carried 'downstream' by glaciers) is what causes the pain in painful discs. Naysayers for SED will say that it's like shooting a fly with a machine gun. This in an uninformed concept. I've attended the training for SED and have observed dozens of procedures. There is no shooting of machine guns. They are LOOKING directly at the tissues they are ablating. They are looking at the annular tear. Typically, when they apply energy to the annulus surrounding the tear, the annulus and the tear will shrink. If it does not go in the right direction, they can see it right away and stop. All other forms of TA that I know of like IDET and Biaccuplasty are done blind. They are cooking tissues that they can't see, so they can't be certain about probe placement and cannot see what is happening (real time or not real time.)
Unlike other endoscopic procedures, SED is ‘INSIDE OUT’. They are working inside the disc and can see what they are doing. As discussed above, not only can they be selective about the tissues they remove, but the can also see the annular tears and see what is happening during the TA step. They will be pulling herniations back into the disc, then out through the canula. The more experienced SED surgeons can safely chase sequestered herniations out into the canal area, but this is something that I would not want anyone but Tony Yeung or maybe Chris Yeung attempting on me.
SED naysayers will point to studies that tested ‘cutting’ the annulus, making a hole the size of the SED tools, then relating it to future ‘recurrant hernaiation’. This is a red herring. There is no cutting of the annulus to get into the disc with SED. They start with a needle and use a series of ‘expanding canulas’ to dialate a hole in the annulus. There is no wholesale cutting of fibers as there was in the studies that are pointed to. I’ve seen discography done on SED’d discs with the doctor able to squeeze the syringe as hard as he could with a firm endpoint and no pain. Compelete negative and sealed disc years following SED. (Read Ann C’s story on the GPN story pages.)
There is a HUGE talent factor and experience factor with SED. This is not for the average surgeon or the general spine surgeon. This is for the endoscopic specialist who does these nearly every day. I have observed surgeons with 400 procedures under their belt doing surgeries thinking that would be more than enough experience. There is such a dramatic difference between them and the guys who developed the procedures, made the early mistakes, and have thousands. I don’t know how we can assess the experience level of the other surgeons. I know of many who have purchased the systems, done the training and started doing procedures; but never stayed with it long enough to get through the learning curve…. They ultimately gave up on it. It’s not that the procedure is not excellent, it is that it takes a lot of experience and a very high talent level before you have a chance of getting good at it.
All the best,
Mark
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