In this review, we analyze our effort to demonstrate the effectiveness of a new approach to the treatment of herniated disc disease using Nd:YAG laser energy introduced into a herniated disc under fluoroscopic control and local anesthesia. 2400 PLDD procedures (combined number of decompressions in cervical, thoracic, and lumbar discs were performed in the past 18(1/2) years in 1275 patients. The overall success rate according to the MacNab criteria was 89%. The complication rate (only infectious disciitis) was 0.4%; all 10 patients with complications were cured with appropriate antibiotics. The recurrence rate was 5%, and usually due to reinjury. There were no deaths, and no cases of nerve or cord damage. PLDD is a safe and effective outpatient procedure for the treatment of herniated disc disease with the advantages of relative non-invasiveness, usually immediate relief of back and sciatic pain, early return to work (generally 5-6 days), and a low complication and recurrence rate. It can also be repeated if necessary as many as five times.

Decompression, Surgical↗

PubMed2004

Cervical disc herniations and percutaneous laser disc decompression: a case report.

OBJECTIVE: This is a report on 178 herniated cervical discs in 93 patients treated with percutaneous laser disc decompression (PLDD) using the Nd:YAG laser at the Laser Spine Center from November 1994 to October 2003. MATERIALS AND METHODS: Patients with MRI documented disc herniations in the cervical spine who had failed conservative treatment and were sufficiently symptomatic to require surgical intervention were included in the study. A Seldinger needle was inserted under fluoroscopic guidance and local anesthesia into the offending cervical disc from an anterolateral approach until the tip was just beyond the annulus. Through an optical fiber connected to an Nd:YAG laser, 300 joules were delivered to the disc. A dressing was applied and the patient sent home, to return to work the following day. RESULTS: According to the MacNab criteria, 90% of the patients improved. All of them were permitted to return to work the following day. One complication (0.6%) occurred: a retro-esophageal abscess that responded to incision and drainage. CONCLUSION: PLDD of cervical disc herniations is effective and relatively non-invasive, and has a low complication rate. Because of the complexity of vital adjacent anatomic structures, it should only be performed after intensive training by a qualified interventionist with appropriate experience.

Cervical Vertebrae↗

PubMed2004

Percutaneous laser disc decompression in the treatment of discogenic back pain.

OBJECTIVE: Our aim was to evaluate the effects of percutaneous laser disc decompression (PLDD) as discogenic pain treatment using the MacNab criteria. BACKGROUND DATA: Discogenic back pain is believed to be produced from tears in the posterior longitudinal ligament and annulus fibrosus. This pain is exacerbated through increases in intradiscal pressure via provocative discograms and transmitted through the sinuvertebral nerve. MATERIALS AND METHODS: A total of 37 patients were selected based on clinical findings and provocative discograms. These patients underwent PLDD to the affected disc and were interviewed via telephone and outcome evaluated based on the MacNab criteria. RESULTS: Survey results revealed that 14 patients (44%) reported a good response, 14 (44%) reported a fair response, and four (12.5%) reported a poor response. The 28 patients (88%) who reported a good and fair response were considered to be successful cases. CONCLUSION: PLDD is a safe, effective, and minimally invasive procedure that can be used to treat patients with discogenic back pain.

Adult↗