Transforaminal Endoscopic Decompression of the Lumbar Spine for Stable Degenerative Spondylolisthesis as the Least Invasive Surgical Treatment Using the YESS Surgery Technique

Anthony T. Yeung M.D., has reported his 5-10-year results in a preliminary review of endoscopic transforaminal of isthmic and degenerative spondylolisthesis decompression causing sciatica and back pain at international spine meetings. Fifty-five patients from January 2002-December 2012 served as the database for the clinical presentation in patients who specifically chose to stage Yeung’s endoscopic transforaminal decompressive procedure over fusion. The patients were specifically evaluated for endoscopic spine surgery in a shared clinical decision. This more focused article is subdivided with stratified indications to degenerative spondylolisthesis only, omitting isthmic spondylolisthesis since isthmic spondylolisthesis is traditionally the surgical option of choice for patients who elected to undergo surgical intervention as the standard surgical option versus continuing with non-surgical care. Disc protrusions associated with degenerative spondylolisthesis, disc herniation, patients with concomitant stenosis, who did well with the first study on both degenerative and isthmic spondylolisthesis were analyzed from the first database and stratified for degenerative spondylolisthesis. The patients of the original 10-year follow-up study were 100% satisfied with their decision to try the endoscopic surgery first, even when they subsequently opted for fusion since it would not interfere with a fusion as a secondary staged procedure. There was no attempt to stratify the first patient group who wanted to stage their surgical options, even if fusion became necessary for their pain and activity requirements. In this 10-year study 33% eventually opted to undergo fusion in order to get more symptom relief. Transforaminal foraminoplasty also provided some unanticipated back pain relief as well. When dorsal endoscopic ablation of the medial branch of the dorsal ramus was later added to the endoscopic procedure to address axial back pain, even better clinical outcomes were obtained by this focused study on degenerative spondylolisthesis, with or without disc protrusion and stenosis.