Percutaneous Laser Disc Decompression Research Articles

Percutaneous laser disc decompression for cervical vertigo

To investigate the curative effect and mechanism of transcutaneous laser disc decompression for the treatment of cervical vertigo. From October 2000 to October 2004, 42 patients with cervical vertigo were treated with percutaneous laser disc decompression by applying a Nd: YAG laser (wavelength is 1064 nm). The postoperative follow-up period was more than 2 months, the change of patients' vertigo were observed. All the patients were followed up. The mean follow-up period was 7.5 months (from 2 to 36 months). After 2 months of postoperative, 28 patients' vertigo disappeared (67%), 6 patients' vertigo improved (14%), 8 patients' vertigo did not improve. The effective rate was 81%, there was no complication (infection and nerve injury). Cervical intervertebral disc protrusion and cervical spine instability irrigate the neck sympathetic nerve, result in the spasm of vertebral artery, which is the main cause of cervical vertigo. Percutaneous laser disc decompression can decrease intradiscal pressure, increase local temperature, remove the spasm of the vertebral artery. The therapeutic effect for the treatment of cervical vertigo was remarkable.

Magnetic resonance–guided percutaneous laser disk decompression for lumbar disk herniation—relationship between clinical results and location of needle tip

Background Magnetic resonance–guided PLDD has been performed for patients with single-level contained focal disk herniation. We investigated the clinical results of our PLDD practice in reference to the site of the needle tip. Methods Thirty-two patients (24 male patients and 8 female patients; mean age, 35 years) who presented with low back pain and signs of monoradiculopathy underwent MR-guided PLDD. The final location of the needle tip was plotted on a T 1-weighted axial plane of the targeted disk. An axial image of the targeted disk was divided into 4 quadrants in a cruciform fashion and into 3 zones in a concentric circle. The clinical results as evaluated by MacNab's criteria 6 months after PLDD were investigated in each subdivided area where the needle tip was located. Results The overall success rate of our PLDD practice was 68.8%. The success rate in the 27 patients who had the needle tip in the DL quadrant of the targeted disk was 70.4%. Among them, 14 patients who had the needle tip in the middle zone showed a favorable outcome (77.8%). Conclusions The final location of the needle tip was demonstrated in all cases. Although our MR imaging study was not sufficient to determine the exact position of the needle tip because of MR image distortion, such error seems to be acceptable in the results of our study obtained from the relative positioning of the needle tip in the disk space. This study suggests that the middle zone in the DL quadrant of the targeted disk space seems to be a favorable target to obtain better clinical outcomes.

Percutaneous Laser Disc Decompression for the Treatment of Lumbar Disc Herniation: A Review

Discontinuation of the marketing of chymodactin has reawakened interest in other percutaneous techniques for treating lumbar disc herniation. Developed in the 1980s, the concept of laser disc decompression is based on the percutaneous introduction of an optical fiber into the intervertebral disc and administering laser energy. The procedure allows for the vaporization of a small amount of the nucleus pulposus and hence a reduction in the intradisc pressure and relief of radicular pain. To review of the literature and summarize the technical modalities, mechanism, indications for, and results of percutaneous laser disc decompression for treating lumbar disc herniation. We identified studies of percutaneous laser disc decompression published between January 1980 and June 2006 in the MEDLINE, EMBASE, and Cochrane Library databases. The search terms used were percutaneous laser disc decompression, laser, and spine or lumbar, disc or disk. The articles underwent a stepwise selection process on the basis of their title, abstract, and full text. Experimental and clinical studies have investigated the modality of percutaneous laser disc decompression, but no consensus exists on the type of laser to use, the wavelength, duration of application, or appropriate energy applied. Studies have evaluated the impact of different techniques on the amount of disc removed, intradisc pressure, and damage to neighboring tissue. Several open studies have been published, but their methodology and conclusions are questionable, and no controlled study has been performed. Although the concept of laser disc nucleotomy is appealing, this treatment cannot be considered validated for disc herniation-associated radiculopathy resistant to medical treatment.

Treatment of herniated lumbar disc by percutaneous laser disc decompression combined with synchronous suction technique through syringe

Objective To compare the outcomes of percutaneous laser disc decompression (PLDD) and PLDD with synchronous suction through syringe in the patients with herniated lumbar disc (HLD). Methods Forty-two patients with HLD on MRI and those who did not respond to conservative treatment for 6 weeks were randomly divided into group A and group B. In group A, the patients were treated with PLDD and those in group B with PLDD and synchronous suction through syringe. GaAIAS diode laser at 810 nm was used for the ablation in both groups. The treatment effect was evaluated by modified MacNab's criteria on the 7 th, 30 th and 90 th day. Results Evaluated by modified MacNab's criteria, the percentages of the excellent and good cases in total patients treated for group B and A were 80.95% and 57.14% on the 7 th follow-up day, 85.71% and 66.67% on the 30 th follow-up day, and 95.24% and 71.43% on the 90 th follow-up day, respectively. Conclusion Synchronous suction technique through syringe during PLDD improves the overall outcome in the treatment of herniated lumbar disc.

A CASE OF NERVE ROOT HEAT INJURY INDUCED BY PERCUTANEOUS LASER DISC DECOMPRESSION PERFORMED AT AN OUTSIDE INSTITUTION

In recent years, percutaneous laser disc decompression (PLDD) has become a routine surgical procedure because it can be performed under local anesthesia and is minimally invasive. However, there is a risk of nerve root and endplate injury owing to heat generated by laser irradiation during PLDD. We recently performed salvage surgery on a patient with heat injury to the L5 nerve root that developed after PLDD. One month before presenting to our hospital, the patient underwent two sessions of PLDD for lumbar vertebral disk herniation at another institution. The patient developed worsening sciatica, as well as bowel and urinary problems after the PLDD. We performed salvage surgery after PLDD. The intraoperative findings in the present case included carbon spots in the dura mater of the nerve root and a disc herniation strongly adherent to the nerve roots. These findings indicate that the area adjacent to the nerve roots was damaged by excessive heat during laser irradiation. When salvage surgery is performed after a PLDD procedure, disc and nerve root injuries owing to laser heat energy must be considered.

Percutaneous Laser Disc Decompression for Lumbar Disc Hernia: Indications Based on Lasegue's Sign

The present study was conducted to establish reasonable indications of patient neurological manifestations for use of percutaneous laser disc decompression (PLDD). PLDD is a less invasive surgical procedure for lumbar disc hernia, whose indications have been described on the basis of radiographical findings. Sixty-five consecutive patients (45 men and 20 women) with lumbar disc hernia were treated with PLDD by applying a diode laser (wavelength 805 nm). A total of 450-1,205 joules (average, 805.5 joules) were delivered per disc. All patients suffered from radicular pain. They were divided based on the presence of Lasegue's sign. The post-procedure results at 1 week and 1 year were compared between the groups. PLDD was effective for patients with Lasegue's sign (80.0%), but ineffective for those without the sign. The present study suggests that Lasegue's sign in patients is an indication of PLDD for lumbar disc hernia.

Percutaneous Laser Disc Decompression

Herniated disc disease has an incidence of 1.7% in the U.S. Heretofore, open operative procedures were the rule for this condition when conservative measures were ineffective. Choy and Ascher introduced this new technique in February 1986 using a Nd:YAG laser introduced into the disc through an optical fiber in a needle. Percutaneous laser disc decompression is based on the principle that in an enclosed hydraulic space, such as an intact disc, a small reduction in volume is associated with a disproportionate fall in pressure. In the disc, this partial vacuum causes the herniated portion to move away from the nerve root back toward the center of the disc. This technique has been taught worldwide and is being performed in most of Europe, Japan, the United States, and Korea. In this special issue devoted to percutaneous laser disc decompression (PLDD), we will set forth the basic science of PLDD, patient selection, use of the holmium:YAG, and the Nd:YAG lasers, operative technique, and results.

Comparison of Results of 500 Microdiscectomies and 500 Percutaneous Laser Disc Decompression Procedures for Lumbar Disc Herniation

This article aimed to analyze the neurosurgical results of 500 patients treated with microdiscectomies and 500 patients treated with percutaneous laser disc decompression. It has been suggested in the literature that percutaneous laser disc decompression might be considered a serious and valid alternative to microdiscectomy in the treatment of patients with discogenic pain caused by herniated lumbar disc. Patients with herniated discs were treated by microdiscectomy (n = 500) according to the Caspar technique, and patients with discogenic pain were treated with percutaneous laser disc decompression (n = 500) according to the Choy technique. The inclusion and exclusion criteria were the same for both groups of patients. Age, gender distribution, multiple levels involved, and associated pathologies were not statistically different. The results were evaluated for both groups with the MacNab criteria. The follow-up period was 2 years (+/-1 year). In the microdiscectomy group, 85.6% of patients (n = 428) had a good or excellent outcome; in the percutaneous laser disc decompression group, 83.8% of patients (n = 419) had a good or excellent outcome. Complications occurred in 2.2% (n = 11) in the microdiscectomy group and in 0% in the percutaneous laser disc decompression group. The analysis of results for the two groups supports the conclusion that percutaneous laser disc decompression is a safe, minimally invasive, and strong alternative treatment to microdiscectomy in patients affected by herniated discs.

Experimental basis of percutaneous laser disc decompression (PLDD): a review of literature

Percutaneous laser disc decompression (PLDD) is one of the so-called “minimally invasive” treatment modalities for lumbar disc herniation. The treatment is performed percutaneously; therefore, morbidity and convalescence period are postulated to be less than for conventional surgery. Because of the minimally invasive nature and the fact that return to work is usually possible within a few days after treatment, PLDD appears to be an interesting alternative to conventional surgery. However, PLDD still encounters a considerable amount of skepticism. Opponents usually dismiss PLDD as being an experimental treatment with unproven efficacy, while those advocating the use of PLDD tend to present it as some kind of miracle treatment. While well-designed clinical trials focusing primarily on the efficacy of PLDD are scarce [1], the amount of preclinical studies investigating the technical and biophysical aspects of PLDD has been growing steadily since its introduction in the late 1980s. By grouping the results of these preclinical trials, this review attempts to provide a comprehensive basis for further clinical research.

Immediate Pain Improvement Is a Useful Predictor of Long-Term Favorable Outcome after Percutaneous Laser Disc Decompression for Cervical Disc Herniation

The purpose of this study was to evaluate the long-term clinical outcome of percutaneous laser disc decompression (PLDD) for cervical disc herniation and to identify factors affecting long-term favorable outcome. PLDD using the Ho:YAG laser has been regarded as an effective alternative for soft disc herniation. However, little is known about long-term favorable outcome parameters. We retrospectively reviewed the clinical and radiological data of 60 patients who underwent PLDD with laser-assisted spinal endoscopy (LASE) for contained cervical soft disc herniation from January 1998 to January 2000. The clinical outcome was measured using the Macnab criteria. Statistical analysis was performed using Fisher's exact test. Sex, age, operated level and location of disc herniation, amount of laser energy, and time for symptom improvement were selected as parameters. The mean follow-up period was 71.0 months (range, 59-83 months). The mean age was 45.7 years (range, 26-68 years), and the mean symptom duration was 13.0 months (range, 2-60 months). The Visual Analogue Scale (VAS) score was significantly improved from 7.9 preoperatively to 2.6 at the final follow-up (p < 0.001). At the final follow-up, 51 (85.0%) patients achieved a favorable outcome. Immediate (within 24 h) pain relief was achieved in 19 patients, and it was strongly related to long-term success (p = 0.006). The long-term clinical outcome of PLDD with LASE was fairly good, with a success rate of 85%. Immediate pain relief is a useful prognostic factor predicting favorable outcome following the procedure.

Salvage Operation for Persistent Low Back Pain and Sciatica Induced by Percutaneous Laser Disc Decompression Performed at Outside Institution: Correlation of Magnetic Resonance Imaging and Intraoperative and Pathological Findings

We identified several problems associated with percutaneous lumbar disc decompression (PLDD) based on a study of patients who required salvage operations for complications after undergoing PLDD at an outside institution. PLDD has been performed as a new treatment for intervertebral disc herniation in recent years, and its safety and effectiveness are in the process of being established. Because the procedure is simple to perform under local anesthesia, inappropriate irradiation and application to patients for whom it is not indicated have sometimes resulted in a poor outcome and serious complications. The patients comprised 10 with lumbar disc herniation and three with lumbar spondylolisthesis. We analyzed the magnetic resonance (MR) imaging and operative findings as well as the pathological features of surgically obtained disc specimens and studied their relationships with the clinical outcomes of the operations. Initial examination of all patients at our hospital showed that PLDD had no effect on low back pain or sciatica. In patients who showed MR signal changes in the end-plate, the pathological examination revealed extensive necrosis of cartilage and bone. During salvage operations, severe adhesion of herniated masses to nerve roots was often observed, with carbonized disc tissue surrounding the nerve roots and might have their nerve root injured thermally. PLDD is associated with significant risk of disc, end-plate, and nerve root injuries, contrary to the general belief that the procedure is minimally invasive. Our findings highlight the need for careful diagnosis and sufficient technical skill when selecting PLDD as a treatment option.

Treatment of lumbar intervertebral disc prolapse with X-ray guided Nd :YAG Laser interposing percutaneous laser disc decompression

目的 探讨在X线电视监控下采用日本产Nd:YAG Laser CL-50激光器行经皮激光腰椎间盘减压(PLDD)术.方法分析378例术后病例,病程1个月至16年.L2～3椎间盘突出17例,L3～4椎间盘突出35例,L4～5椎间盘突出140例,L5～S1椎间盘突出116例,2个椎间盘同时突出60例,3个椎间盘同时突出10例,共施行PLDD术458个椎间盘.所选病例均经CT或MR检查及临床症状、体征符合腰椎间盘突出症的诊断标准.结果行PLDD术后1个月治愈268例,治愈率70.90%;3个月治愈259例,治愈率68.52%;6个月治愈260例,治愈率68.25%,治疗效果满意率、有效率及失败率是稳定的.结论 X线导向下行经皮激光介入椎间盘减压术有微创、患者痛苦小、恢复快、效果较稳定的特点,治疗的近期临床效果较佳,远期临床效果也很理想。

The Effect of Laser Irradiation for Nucleus Pulposus: an Experimental Study

Background: The radicular pain caused by disc herniation can be explained by two mechanisms: the compression of the nerve root by the herniated disc or the irritation of the nerve root due to chemical factors. Percutaneous laser disc decompression (PLDD) was introduced for the treatment of lumbar disc hernias in the 1980s. Decompression of the nerve root is assumed to be an effective therapeutic mechanism for PLDD. However, laser irradiation might reduce the chemical factors that cause nerve root irritation by altering intra–disc proteins. We used nerve conduction velocities (NCV) and levels of two chemical factors to evaluate the differences between the two groups in this in vivo study.Methods: All rabbits had the nerve root in contact with the leakage from the nucleus pulposus. One group underwent laser irradiation for the leaking nucleus pulposus including the incision site of the disc and nucleus pulposus itself. The levels of two chemical factors, prostaglandin E2 and phospholipase E2, in the intervertebral disc were measured before and after laser irradiation.Results: NCV in the laser–irradiated group was significantly faster than in the non–laser–irradiated group. The levels of chemical factors were significantly reduced after laser irradiation.Conclusions: One of the mechanisms thought to be responsible for PLDD's effectiveness is a decrease in the chemical factors through protein alteration in the intervertebral disc by laser irradiation.

Percutaneous laser disc decompression: history and scientific rationale

This is a summary of the basic science experiments leading up to the actual clinical application of Percutaneous Laser Disc Decompression (PLDD) in human patients. The basic premise underlying PLDD is that the nucleus pulposus is mostly water (60-80%, depending on age). Water being noncompressible, a small reduction in volume in a contained hydraulic vessel such as an intervertebral disc results in a disproportionate fall in pressure. A 1 mL change in an intact intervertebral disc will produce a change of 312 KPa (1 KPa = 7.5 mm Hg pressure). Two years of laboratory experiments at Columbia University confirmed this thesis. The first PLDD in a human patient was performed at the Neurosurgical Institute of the University of Graz, Graz, Austria in collaboration with Dr. Peter Ascher in mid-February 1986. Since then, PLDD is being performed world wide, with approximately 55,000 procedures performed in Western Europe, South America, Korea, Japan, China, India, and the U.S. The author has performed more than 2500 lumbar disc, more than 12 thoracic disc and more than 350 cervical disc PLDDs. The complication rate is 0.4% and consists of only discitis, all of which have responded to parenteral antibiotics. There have been no deaths, no instances of cord damage, or nerve root damage in the author’s series. Spinal stenosis responds when it is due to disc protrusion, as does back pain without a radicular component. Extruded discs also respond as long as there is communication with the parent disc. Emergency PLDD is possible for acute cauda equina syndrome, but must be followed immediately by emergency surgery if the PLDD is unsuccessful. The chief contraindication for PLDD is free fragments. The success rate according to the MacNab criteria worldwide is 89% to 90%. The worldwide complication rate is 1%. The necessity of repeat PLDD is 5%, and is usually due to re-injury. PLDD should supplant the 70-year-old laminectomy and discectomy, which weaken an already weakened posterior wall and annulus that makes herniated disc disease a familial disease. Annunen of Finland has established that there is a genetic mutation involving cross linkages of the collagen triple strands in Finnish men with HNP disease. The high success rate and low complication rate and outpatient application without hospitalization make PLDD a viable first option, main-line therapy for herniated disc disease in the 21st century.

Microendoscopic discectomy as a revision surgery after percutaneous laser disc decompression

Microendoscopic discectomy as a revision surgery after percutaneous laser disc decompression

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

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.

Preliminary Italian Experience of Lumbar Spine Percutaneous Laser Disc Decompression According to Choy's Method

Objective: The purpose of this paper is to describe the preliminary first Italian experience on lumbar spine percutaneous laser disc decompression (PLDD) using a Nd:YAG laser according to Choy's technique. Background Data: PLDD is a minimally invasive technique for the treatment of a widely selected group of patients affected by herniated disc problems. Several studies, using a variety of different lasers used, have demonstrated its safety and worth. The current study is the first large PLDD series reported in Italy. Materials and Methods: Lumbar PLDD procedures, according to Choy's method, were performed in 92 patients. There were 53 male and 39 female patients, and their ages ranged from 21 to 79 years. All the patients were treated in the operative room according to aseptic rules. Results: The overall results, evaluated with the MacNab criteria with a short follow-up (medium 5 months, maximum 12 months) were as follows: 76 patients (82.8%) showed excellent or good improvement, and 16 patients (17.2%) showed no or poor improvement. No complications were observed. Conclusion: These results, even though a longer follow-up is needed in future studies, have confirmed that PLDD (according to Choy's method) is a first-choice treatment for a large group of patients affected by herniated disc that is not responding to conservative treatment.

Preliminary Italian Experience of Lumbar Spine Percutaneous Laser Disc Decompression According to Choy's Method

The purpose of this paper is to describe the preliminary first Italian experience on lumbar spine percutaneous laser disc decompression (PLDD) using a Nd:YAG laser according to Choy's technique. PLDD is a minimally invasive technique for the treatment of a widely selected group of patients affected by herniated disc problems. Several studies, using a variety of different lasers used, have demonstrated its safety and worth. The current study is the first large PLDD series reported in Italy. Lumbar PLDD procedures, according to Choy's method, were performed in 92 patients. There were 53 male and 39 female patients, and their ages ranged from 21 to 79 years. All the patients were treated in the operative room according to aseptic rules. The overall results, evaluated with the MacNab criteria with a short follow-up (medium 5 months, maximum 12 months) were as follows: 76 patients (82.8%) showed excellent or good improvement, and 16 patients (17.2%) showed no or poor improvement. No complications were observed. These results, even though a longer follow-up is needed in future studies, have confirmed that PLDD (according to Choy's method) is a first-choice treatment for a large group of patients affected by herniated disc that is not responding to conservative treatment.

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

Our aim was to evaluate the short-term efficacy of percutaneous laser disc decompression (PLDD) for the treatment of lumbar discogenic pain and sciatica. 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. 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. 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. 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.

Cervical Disc Herniations and Percutaneous Laser Disc Decompression: A Case Report

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. 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. 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. 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.