Percutaneous Laser Disc Decompression Research Articles

Clinical Outcomes at Two-Year Follow-Up Comparing Open Surgery and Percutaneous Laser Disc Decompression for Radicular Sciatic Pain Patients

Clinical Outcomes at Two-Year Follow-Up Comparing Open Surgery and Percutaneous Laser Disc Decompression for Radicular Sciatic Pain Patients

Efficacy of Percutaneous Laser Disc Decompression (PLDD) Combined with an Oral Food Supplement for Lumbar Disc Herniation.

Background: In recent years, minimally invasive treatment options for lumbar disc herniation, such as percutaneous laser disc decompression (PLDD), have been introduced to avoid more invasive surgical methods. Combining these minimally invasive approaches with nutraceuticals that are effective in neuroprotection and pain management may lead to better long-term outcomes. Methods: The present study evaluated the beneficial effects of a new oral food supplement composed of acetyl-L-carnitine, α-lipoic acid, quercetin, bromelain, pantothenic acid, and vitamins C, B1, B2, B6, and B12 in patients with neuropathic pain due to herniated lumbar discs treated with PLDD. Patients were divided into two groups of 26 patients each: group A underwent PLDD alone, while group B underwent PLDD followed by a dietary supplement for two months after surgery. Preoperative VAS scores for leg pain were recorded for both groups and no significant difference was observed (8.7 for Group A and 8.6 for Group B). Results: In Group A, the mean postoperative VAS score for leg pain at a 1-month follow-up was 2.5, which remained stable at 3 months. In Group B, the mean postoperative VAS score was 2.0 at 1-month and improved to 1.6 at the 3-month follow-up. According to self-reported leg pain assessments, 66.5% of the patients using the dietary supplement reported a significantly better pain condition, and 43.5% reported a somewhat better situation. In contrast, 7.7% of the patients who underwent PLDD alone reported no changes in leg pain at the final follow-up. Conclusions: The results of our study indicate that the oral food supplement could provide a safe and effective treatment in patients with painful radiculopathy, enhancing the recovery of sensory fiber function in lumbar nerve roots after surgical lumbar disc decompression.

Interventional Therapy and Surgical Management of Lumbar Disc Herniation in Spine Surgery: A Narrative Review.

Significant advancements in lumbar disc herniation (LDH) management have been made in interventional pain therapy, operative therapy, peri-operative management, and cost analysis of various procedures. The present review aims to provide a concise narrative of all these topics, current trends, and possible future directions in the management of LDH. Interventional pain management using intradiscal injections often serves as a minimally invasive non-surgical approach. Surgical modalities vary, including traditional open laminectomy, microdiscectomy, endoscopic discectomy, tubular discectomy, percutaneous laser disc decompression, and transforaminal foraminotomy. Prevention of infections during surgery is paramount and is often done via a single-dose preoperative antibiotic prophylaxis. Recurrence of LDH post-surgery is commonly observed and thus mitigative strategies for prevention have been proposed including the use of annular closure devices. Finally, all treatments are well-associated with clear as well as hidden costs to the health system and society as described by billing codes and loss of patients' quality-adjusted life-years. Our summary of recent literature regarding LDH may allow physicians to employ up-to-date evidence-based practice in clinical settings and can help drive future advancements in LDH management. Future longitudinal and comprehensive studies elucidating how each type of treatments fare against different types of herniations are warranted.

A narrative review of percutaneous laser disc decompression - early experience in Lagos, Nigeria

Overview. Managing chronic pain arising from the degenerative disc disease of the spine has remained a huge challenge while choosing from within a vast array of treatment armamentarium ranging from the use of medications only or in combination with other physical treatment options, minimally invasive heat therapy, and operative interventions. Patients with chronic pain referred to as ‘contained disc’ in cervical, thoracic, and lumbar disc pathology have been successfully managed with percutaneous laser disc ablative therapy. This approach is only for selected patients and advantages derivable from this approach are the preservation of soft tissue anatomy, minimal post-procedure pain, less metabolic responses, and no blood loss when compared to open surgical procedures. Methodology. This is a one-year retrospective narrative study of six adult patients who presented with chronic low back pain related to the spine and had a lumbosacral spine magnetic resonance imaging (MRI) scan with findings of contained disc herniation. Patients’ brief clinical evaluation which involves biodata, history of pain, and pain scores using the visual analogue scale (VAS) pre and post-intervention and Oswestry disability index to assess disability from chronic pain. A narration of these patient’s progression to follow-up six months after the procedure was documented. Results. The results showed significant improvement in the VAS and ODI scores in five of the 6 patients, with one showing marginal improvement. Conclusion. Percutaneous lumbar disc decompression is effective in the management of chronic low back with concordant clinical and radiological evidence of contained disc pathology.

The role of spine adipose index in predicting the risk for septic spondylodiscitis after lumbar percutaneous laser disc decompression

The aim. To analyze the role of the spine adipose index (SAI) in predicting the risk of septic spondylodiscitis after lumbar percutaneous laser disk decompression (PLDD).Material and methods. A retrospective observational single-center study was performed. Various clinical and instrumental parameters have been studied, including the spine adipose index, which are potential risk factors for the development of postprocedural septic spondylodiscitis.Results. The study included 219 patients who underwent PLDD for degenerative lumbar disk disease. The average period of postoperative observation was 30.8 ± 13.3 months. Signs of septic spondylodiscitis were detected in 5 (2.28%) cases. Multivariate analysis showed that III degree of anesthesiological risk by the American Society of Anesthesiologists (ASA) scale (p = 0.021), a high value of body mass index (more than 25 kg/m2) (p = 0.043) and a high value of SAI (over 0.7) (p = 0.037) are statistically significantly associated with the development of septic spondylodiscitis in patients who underwent lumbar PLDD.Conclusion. The value of SAI is statistically significantly associated with the development of spondylodiscitis in patients who underwent PLDD for degenerative lumbar disk disease.

Comparison of Clinical Effectiveness between the Management of Cervical and Lumbar Disc Herniation with Percutaneous Laser Disc Decompression Followed by Interlaminar Cervical Epidural and Lumbar Transforaminal Epidural Steroid Injection Respectively

Background: Different treatments for discogenic axial back/neck pain or radicular pain to limbs are there from conservative therapies and minimally invasive therapies to open spine surgeries with lots of controversial outcomes. Percutaneous laser disc decompression (PLDD) is one of the minimally invasive therapies which is done under local anesthesia and has been successfully performed in many selected patients for their lumbar and cervical disc herniation problems. In PLDD, a part of the nucleus pulposus is vaporized with the help of laser energy to reduce the intradiscal pressure of the diseased discs causing nerve compression. In this case series after a 1-year follow-up, the clinical effectiveness of PLDD with epidural steroid injection is assessed in selected lumbar and cervical disc herniation cases. Materials and Methods: Ninety-six patients underwent the PLDD procedure at the cervical and lumbar disc with epidural steroid injections for their disc herniation causing radicular pain in the upper and lower limbs, respectively. The patients were followed at 8 weeks, 3 months, 6 months, and 1 year. The main outcome measures were done through the visual analog scores (VASs) and the Oswestry Disability Index (ODI) for upper and lower limb pain. Results: The primary outcome showed that there is a significant clinically relevant difference between the two groups at a 1-year follow-up. VAS and mean disability score based on the ODI were significantly lower in cervical disc herniation patients. The reoperation rate in the cervical group is also much less than the lumbar group. Conclusion: Like all other surgical modalities for disc herniation, PLDD has its own advantages and disadvantages. However, compared to lumbar disc herniation, it may give better results in cervical disc herniation. In selected cases, combined PLDD with epidural steroid injection can be chosen as a “first-choice-minimally-invasive-treatment,” when standard conservative therapies do not give satisfactory outcome.

Percutaneous Laser Disc Decompression for Lumbar Radicular Pain: A Systematic Review of Pubmed in the Last Five Years

Percutaneous Laser Disc Decompression for Lumbar Radicular Pain: A Systematic Review of Pubmed in the Last Five Years

Ultrasound-guided Percutaneous Laser Disc Decompression (PLDD) with Fluoroscopic Validation for the Treatment of Cervical Disc Herniation: Technical Note.

Percutaneous laser disc decompression (PLDD) has been regarded as an effective alternative for the treatment of cervical soft disc herniations. Repeated X-Ray scanning is essential when performing this technique. Technical note. We present a new method for the treatment of cervical disc herniation using ultrasound to guide the needle entry to the cervical disc, to avoid excess of radiation exposure during the surgical procedure. We evaluated the efficacy of this cervical approach. We retrospectively reviewed the clinical data of 14 cases who underwent a PLDD under ultrasound guidance for the treatment of contained cervical disc herniation using a 1,470 Nm diode laser. The lower cervical discs (C5-C6 and C6-C7) were the most affected sites, accounting for 78.6% of surgical discs. A significant NRS reduction between baseline and 1 month (P = .0002) and between baseline and 12 months (P = .0007) was observed. Our results support the conclusion that ultrasound guided PLDD with fluoroscopic validation is a minimally invasive technique for patients affected by herniated cervical discs, but proper choice of patients is critical. This approach should not be performed except after adequate training under close supervision of surgeons experienced in this procedure and in interventional US.

Percutaneous Laser Disc Decompression (PLDD) for the Treatment of Contained Lumbar Disc Herniation.

Lumbar disc herniation is a common cause of back and radicular leg pain. A bulging annulus and contained herniated disc can compress a nearby exiting root as it enters the neuroforamen and may cause pain and neurological symptoms. Percutaneous laser disc decompression (PLDD) has been regarded as an effective alternative to microdiscectomy for the treatment of contained lumbar disc herniations. However, there is no consensus regarding the type of laser to use, the ideal wavelength, or the energy applied. The ideal laser irradiation should have a high water absorption coefficient and low tissue pervasion, to limit thermal injury. The 1470 nm wavelength of the diode laser is absorbed by water 40 times more effectively than the 980 nm wavelength. We conducted this study to evaluate the efficacy and safety of PLDD using a 1470 nm diode laser. We retrospectively reviewed the clinical data of 27 patients with radicular pain who underwent PLDD for the treatment of contained lumbar disc herniation during a 12-month period. The 1470 nm diode laser produces smaller local lesions, but greater tissue variations around the nucleus pulposus. This higher affinity for water lessens the formation of a carbonization zone, which results in less thermal injury of the adjacent nervous tissue. According to the MacNab criteria, 85.2% of the cases were improved at 6-month follow-up. Pain decreased from VAS 8.1 preoperatively to VAS 3.1 postoperatively. There is no consensus in the international literature regarding the ideal wavelength. Our results support the conclusion that PLDD using a 1470 nm diode laser is a safe and effective minimally invasive technique for patients with radicular pain affected by contained herniated lumbar discs.

Percutaneous laser nucleoplasty at lumbar level: Literature review

The purpose of the study – to present an analysis of clinical trials to study the clinical efficacy and safety of the technique of percutaneous laser decompression of intervertebral discs based on a review of Russian and foreign studies.The review article presents modern literature data covering the issues of indications, contraindications, technique, efficacy and safety of percutaneous laser disc decompression in patients with degenerative disease of the lumbar intervertebral discs. The publication present modern data on the choice of the most rational tactics for surgical treatment of patients with this pathology. Relevant, unresolved issues are indicated, which dictates the need for large randomized placebo-controlled clinical trials, with the inclusion of the latter’s results in systematic reviews and meta-analyzes.

Role of Percutaneous Laser Disc Decompression in Patients with Lumbar Disc Herniation on Pain Relief: A Quasi-Experimental Pilot Study:.

Background: Disc herniation is broadly defined as a localized or focal displacement of disc material beyond the limits of the intervertebral disc space. The disc material may be the nucleus, cartilage, fragmented apophyseal bone, annular tissue, or any combination thereof. Laser surgery is one of the treatment modalities for treating patients with lumbar disc herniation. This study aims to examine the effect of Percutaneous Laser Disc Decompression (PLDD) in patients with lumbar disc herniation. Materials and Methods: This study was conducted on 58 patients who underwent PLDD (optical fiber inserted through an 18G needle, 8 joules, and 8 watts). Individuals were monitored before and after treatment using the comparing visual analog scale (VAS) pain score (from 0 [no pain] to 10 [severe pain]). Results: The mean age of participants was 63.19±13.48 years. Regarding gender, 24 patients (41.4%) were female. The mean VAS score before surgery was 8.73±1.29, and VAS score after surgery was 55.2±2.71, which means pain was significantly reduced (P0.001). Conclusion: The patients' post-PLDD pain may decrease; hence, PLDD can use as an appropriate method for treating lumbar disc herniation.

Percutaneous Laser Disc Decompression: In Low Back Pain or in Radicular Pain

Objective: The efficacy of percutaneous laser disc decompression is still controversial due to inconsistencies between the studies. However, the reason for this discrepancy may be due to having different success levels in low back pain and leg pain. In this study, the response of both pain modalities to percutaneous laser disc decompression was examined separately. Material and Methods: Results of 49 patients who underwent percutaneous laser disc decompression only for low back pain and 36 patients who underwent percutaneous laser disc decompression only for radicular pain were analyzed retrospectively. It was investigated on which pain type that percutaneous laser disc decompression was more effective. In addition, by examining the magnetic resonance images of the patients, it was determined whether there was a change in the size of the disc herniation. Reults: Although statistically percutaneous laser disc decompression was effective in both types of pain, this effect was much more pronounced in the low back pain group. It was determined that percutaneous laser disc decompression did not reduce the size of the disc herniation, but still provided some reduction in radicular pain. It was determined that it was much more effective in low back without reducing the size of the disc herniation. Conclusion: percutaneous laser disc decompression is more effective in low back pain. However, a reduction in the size of the disc herniation should not be expected.

The Effect of Initial Visual Analog Scale Score on Results in Cervical Laser Discectomy

Objective There is disagreement as to whether percutaneous laser disc decompression (PLDD) is effective. This may be attributed to incorrect patient selection because of the need of additional criteria. This study is investigating whether initial visual analog scale (VAS) score has an effect on outcomes of cervical PLDD and whether it could be a patient selection criterion. Material and Methods: Cervical PLDD patients were divided into 3 groups according to initial VAS scores as Group-I (VAS:3-5), Group-IIa (VAS:6-7) and Group-IIb (VAS:8-9). Datas analyzed retrospectively and compared with the VAS scores during 12-month follow-up. Relationship between initial VAS scores and success of procedure was investigated. Patient satisfaction was also evaluated according to Odom criteria. Results: In sum, 79.16 % of the patients were satisfied from the procedure. However, the satisfaction rate was 96.15% in Group-I, 76.47 % in Group-IIa, and 0.0 % in Group-IIb. The mean initial VAS scores of patients who were satisfied with the procedure was 5.08 but 7.30 of dissatisfied ones. Number of affected discs and patient age have no effect on the results. Conclusion: Initial VAS scores are directly correlated with patient outcomes. Patients with higher than initial VAS scores of 5, must be rejected for the procedure.

Evaluation of Visual Analogue Scale, Oswestry Disability Macnab Index and Criteria Post Action Percutaneous Laser Disc Decompression (Pldd) on Types of Lumbal Disc Herniation in Rsud Dr. Moewardi Surakarta

Percutaneous Laser Disc Decompression (PLDD) is a minimally invasive procedure for disc herniation that is known to be faster and effective. This retrospective study is analytic observational. The study was conducted at the Regional General Hospital Dr. Moewardi Surakarta. Subjects were patients who had PLDD from January 2020 to December 2020 with total sample of 30 respondents. Evaluation of the Visual Analogue Scale (VAS) and The Oswestry Disability Index (ODI) was performed before the PLDD action was carried out, 1 month, and 3 months after. The Macnab criteria was evaluated 3 months after the PLDD action. There was a significant difference in VAS between before and after PLDD, 1 month, and 3 months. There was a significant difference in the ODI score before and after 1 month and 3 months, but not in the ODI value after 1 month and 3 months. Twenty patients (66.7%) showed good good satisfaction following PLDD with Macnab criteria. The significant improvement in VAS of patients with lumbar disc herniation after PLDD were directly as a result of decreasing intradiscal pressure due to vaporization by laser energy, especially in the herniated area and tissue pressure. As the pain subsided, ODI scores in this patients would improve. PLDD in patients with intact lumbar disc herniation led to a significant improvement in VAS and ODI scores. PLDD can be used as an option in the management of patients with low back pain due to an intact lumbar disc herniation.

Treatment of protrusion of Lumbar Intervertebral Disc (LID) with percutaneous laser disc decompression - a follow-up study of 108 patients

To study the long-term clinical efficacy of protrusion of lumbar intervertebral disc with percutaneous laser disc decompression (PLDD). A statistics was conducted on 108 patients who had been treated with percutaneous laser disc decompression, the intervertebral height of related lesion spaces of patients in different time points after treatment and the intervertebral height ratio was calculated respectively; moreover, a statistics was conducted on VAS evaluation of patients in different time points, and the long-term efficacy after treatment with percutaneous laser disc decompression was evaluated with statistical method. The patients with follow-up period after operation respectively up to 5, 8 and 10 years and those in 3 years after operation were analyzed statistically in intervertebral height ratio and VAS scoring, and the difference was without significant statistical significance. Single-factor was analyzed to the factors likely to influence the effect of operation to get the authenticity of influence of age, disease duration and disease stage on the postoperative efficacy. Percutaneous laser disc decompression was featured by safety, efficacy and fewer complications in treatment of protrusion of lumbar intervertebral disc, and also it had no obvious influence on the spinal stability, and long-term postoperative efficacy was stable.

Percutaneous laser disc decompression with O-arm: clinical results and irradiation

Percutaneous laser disc decompression with O-arm: clinical results and irradiation

Characteristics and Short-Term Surgical Outcomes of Patients with Recurrent Lumbar Disc Herniation after Percutaneous Laser Disc Decompression.

Background and Objectives: Although percutaneous laser disc decompression (PLDD) is one of the common treatment methods for patients with lumbar disc herniation (LDH), the recurrence of LDH after PLDD is estimated at 4–5%. This study compares the preoperative clinical data and clinical outcomes of patients who underwent primary microendoscopic discectomy (MED) or MED following PLDD. Materials and Methods: We retrospectively analyzed 2678 patients who underwent MED for LDH. The PLDD group included patients with previous PLDD history at the same level of LDH, and a matched control group was created using propensity score matching for age, sex, and body mass index. Preoperative data, preoperative radiographic findings, and surgical data of the groups were compared. To compare postoperative changes in clinical scores between the groups, a mixed-effect model was used. Results: As a result, 42 patients (1.6%) had previously undergone PLDD, and a control group with 42 patients were created. The disc degeneration severity was not significantly different between the groups. However, Modic changes were more frequent in the PLDD group than in the matched control group (p = 0.028). There were no significant differences in dural adhesion rate or surgery-related complications including dural injury, length of stay, and recurrence rate of LDH after surgery. In addition, the improvement of clinical scores did not significantly differ between the two groups (p = 0.112, 0.913, respectively). Conclusions: We concluded that patients with recurrent LDH after PLDD have advanced endplate degeneration, which may reflect endplate injury from a previous PLDD. However, a previous history of PLDD does not have a negative impact on the clinical result of MED.

Retraction of lumbar disc herniation achieved by noninvasive techniques: A case report

BACKGROUNDLumbar disc herniation (LDH) has emerged as one of the most common causes of low back pain. The routine treatment approach involves chemonucleolysis therapy, discectomy by percutaneous endoscopy, and percutaneous laser disc decompression. Unfortunately, all of these methods carry inherent risk of causing harm to the patient and, as such, there is an unmet but urgent need for an effective and safe noninvasive treatment for LDH. The purpose of this report is to describe a non-invasive method for re-absorption of LDH. CASE SUMMARYA 34-year-old woman was admitted with a complaint of waist pain that she reported as having become acutely aggravated over the past 3 d and accompanied by discomfort in the right lower limb. Her self-reported medical history included persistent postpartum low back pain from 7 years prior. Physical exam showed positivity for neck flexion test (Lindner sign) and supine abdomen test; the straight leg-raising test showed right 60(+) and left 80(-). Findings from standard imaging (magnetic resonance) and collective physical examinations indicated a L5/S1 herniated lumbar disc. Treatment consisted of three-dimensional (balanced regulating) spinal manipulation and acupuncture, upon which the LDH resolved by retraction.CONCLUSIONFollowing L5/S1 herniated lumbar disc diagnosis, three-dimensional (balanced regulating) spinal manipulation combined with acupuncture therapy is an effective treatment.

Eight Surgical Interventions for Lumbar Disc Herniation: A Network Pooling Evaluation

Objective: Therapeutic options for lumbar disc surgery (LDH) have been rapidly evolved worldwide. Conventional pair meta-analysis has shown inconsistent results of safety of different surgical interventions for LDH. A network pooling evaluation of randomized controlled trials (RCT) was conducted to compare eight surgical interventions for patients with LDH. Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for RCT from inception to June 2020, with a registration in PROSPERO (CRD42020176821). This study is conducted in accordance with Cochrane guideline. Primary outcomes include intra-operation, out-operation and overall complications, reoperation, operation time, and blood loss. Results: A total of 27 RCT with 2948 participants and eight interventions, including automated percutaneous lumber discectomy (APLD), chemonucleolysis (CN), microdiscectomy (MD), micro-endoscopic discectomy (MED), open discectomy (OD), percutaneous endoscopic lumbar discectomy (PELD), percutaneous laser disc decompression (PLDD), and tubular discectomy (TD) were enrolled. The pooling results suggested that PELD and PLDD are with lower intra-operative and out-operative complication rate, respectively. TD, PELD, PLDD, and MED were the safest procedures for LDH according to complications, reoperation, operation time and blood loss. Conclusion: The results of this NMA provided evidence that PELD and PLDD were with lower intra-operative and out-operative complication rate, respectively. TD, PELD, PLDD and MED were the safest procedures for LDH according to complications, reoperation, operation time and blood loss. This study was registered in PROSPERO (CRD42020176821). Funding Information: This work was supported by grants from the National Natural Science Foundation of China (No. 81871818). Declaration of Interests: All authors declare that they have no conflict of interest.

The Long-term Effects of Percutaneous Laser Disc Decompression (PLDD) Treatment on Lumbar Disc Protrusion: A 2-Year Follow-up.

Introduction: Nowadays many physicians have focused their attention on using low invasive methods for the treatment of disc protrusion. Thus, the current study was carried out to evaluate the effect and therapeutic outcomes of clinical percutaneous laser disc decompression (PLDD) in the treatment of chronic low back pain caused by disc protrusion during a two-year follow-up. Methods: This historical cohort study was conducted on 40 patients, who were suffering from chronic low back pain caused by disc protrusion diagnosed, and referred to the pain clinic of Akhtar Hospital from March to August 2016 were treated with PLDD and were followed up for at least two years after performing PLDD (from 2018 to 2019). All the information has been extracted using medical records and patient interview. The severity of pain was measured by the Numeric Rating Scale (NRS), and the Oswestry disability index (ODI) was measured before and two years after the treatment. Results: The most common sites for two-level PLDD were L4-S1 and L3-L5, and the most common sites for one-level PLDD were L5-S1 and L4-L5. Overall, the levels of pain and functional disability two years after PLDD showed significant improvements (P =0.0001). The results revealed no statistically significant differences in NRS and ODI scores between the two groups of men and women two years after PLDD (P >0.05). Furthermore, they indicated no statistically significant differences in NRS and ODI scores between the different disc protrusion levels two years after PLDD (P >0.05). Conclusion: It seems that the PLDD is a low-invasive, safe, and effective method that can be used in patients with chronic low back pain caused by a disc protrusion. Therefore, it can be considered as a suitable choice in treating patients with chronic low back pain caused by a disc protrusion.