Percutaneous Laser Disc Decompression for the Treatment of Discogenic Lumbar Pain and Sciatica: A Preliminary Report with 3-Month Follow-Up in a General Pain Clinic Population

Abstract

Objective: Our aim was to evaluate the short-term efficacy of percutaneous laser disc decompression (PLDD) for the treatment of lumbar discogenic pain and sciatica. Background Data: PLDD has been reported to be a safe, effective, minimally invasive treatment option for patients with lumbar spinal pain associated with herniated disc, as an alternative to open spinal surgery. The present study was designed to evaluate the effectiveness of the procedure in patients attending a comprehensive interventional pain management clinic. Materials and Methods: Thirty-two consecutive patients with discogenic lumbar spinal pain with or without sciatica were identified by MRI scanning and discography. Patients with symptoms attributable to a herniated or degenerated lumbar disc were treated with PLDD utilizing the neodymium-YAG laser. The primary endpoint of the study was the standardized symptom score on the American Academy of Orthopedic Surgery (AAOS) Outcomes Assessment Questionnaire for neurogenic and back pain symptoms at pre-treatment baseline, and at 3 months after laser treatment. Results: Of the 30 patients with sciatica at baseline, 24 (80%) reported improvement in sciatica symptoms at three months, with a mean improvement of 68% (p = 0.001 from baseline values). Of the 32 patients with discogenic pain at baseline, 24 (75%) reported improvement at 3 months, with a mean improvement of 44% (p = 0.0005 from baseline values). No instances of infection, nerve injury, or clinically significant bleeding were identified during the 3-month follow-up period. Similar results were also seen in seven patients undergoing PLDD for residual back pain and sciatica following open spinal surgery. Sixty-three percent of patients complained of new-onset or worsening of mechanical low back pain following PLDD, thought to be related to the procedure. Back pain was considered mild to moderate and was self-limited, or responsive to analgesics and lumbar facet block with or without lumbar rhizotemy. Conclusion: PLDD with the neodymium-YAG laser is a safe and effective treatment for discogenic lumbar pain and sciatica during a preliminary 3-month follow-up period in a general pain management practice setting. Post-procedural mechanical low back pain is common and easily treated without sequellae. No instances of infection, neural injury, or other serious complications were observed.