Percutaneous laser disc decompression (PLDD): twelve years' experience with 752 procedures in 518 patients.

Abstract

Percutaneous laser disc decompression (PLDD) is a procedure in which herniated intervertebral discs are treated by reduction of intradiscal pressure through laser energy. This is introduced by a needle inserted into the nucleus pulposus under local anesthesia and fluoroscopic monitoring. The small volume of nucleus vaporized results in a sharp fall of intradiscal pressure, with consequent migration of the herniation away from the nerve root. First proposed by the author in 1984, this concept was validated by 2 years of in vitro experiments. Our aim was to apply this concept to a large series of patients with herniated disc disease. A nonrandomized, nonblinded study was conducted in male and female patients with symptomatic, image-documented intervertebral herniated discs in a 12-year period using PLDD as the only treatment modality. The author's own series consists of 752 intervertebral discs in 518 patients over a period of 12 years. The overall success rate ranged from 75% to 89% with a complication rate of less than 1%. PLDD has proven to be safe and effective. It is minimally invasive, is performed in an outpatient setting, requires no general anesthesia, results in no scarring or spinal instability, reduces rehabilitation time, is repeatable, and does not preclude open surgery should that become necessary.