Percutaneous Laser Disc Nucleotomy

Abstract

In September 1988, the first laser decompression of a symptomatic contained bulging disc was performed in the United States. This author participated in a case study of 333 patients treated with the neodymium (Nd)-impregnated yttrium aluminum garnet (YAG) laser of 1064-nm wavelength. He also treated 117 patients with the potassium titanyl phosphate (KTP) laser of 532-nm wavelength. Detailed surgical techniques and followup statistics of the 117 patients treated with the KTP laser are presented and compared with those of a subset of 36 of the 333 patients treated with the Nd:YAG laser. Of the 117 patients treated with the KTP laser, 23 patients were at the 2-year followup, and 46 patients at the 1-year followup, at the time of this writing. A statistically significant reduction in overall average patient pain was documented by disc level as a function of followup duration. Variation in average specific neurologic findings (knee jerk, reflex, toe strength, ankle jerk, pinprick, and Lasague's sign) by disc level as a function of followup duration was not significant. These procedures were accomplished with no major complications. The success rate based on a 2-year followup was 72%. The success rate with the Nd:YAG laser was very similar, at 70%. These data provide encouraging information substantiating the validity of laser surgery for percutaneous disc nucleotomy.