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Percutaneous Laser Disc Decompression for lumbar discogenic


Abstract
. Purpose: The aim of our study was to directly evaluate the effectiveness of percutaneous laser disc decompression (PLDD) for the treatment of lumbar discogenic radicular pain.

. Materials and methods: From June 2006 through July 2009, 205 patients with contained disc herniation demonstrated on computed tomography (CT) or magnetic resonance, concordance between the radicular pain and the nerve root compressed by the herniated disc, neurological findings referring to a single nerve root and no improvement after conservative therapy for a minimum of six weeks were enrolled. All patients were treated with PLDD under CT guidance and local anesthesia. Follow-up was scheduled at 1, 2 days, 3, 6 months. Subsequent follow-ups at 12, 24 and 36 months were carried out through visits or by telephone. Clinical outcome was quantified using the MacNab criteria.

. Results: The age of patients ranged from 27 to 78 years (mean 58±11 years). The levels of involvement were 18 cases at L3---L4, 123 cases at L4---L5 and 64 cases at L5---S1. Using the MacNab criteria, the results were as follows: 67% (n = 137) showed a good outcome and 9% (n = 18) a fair outcome. There were no serious complications in our series.

. Conclusion: PLDD is effective treatment for lumbar discogenic radicular pain, associated with only minimal discomfort to the patient. This minimally invasive technique is a valid alternative for those patients not responding to conservative medical treatment, allowing in many cases to obviate the need of spine surgery. Descompresión percutánea discal con láser para el tratamiento del dolor lumbo-radicular de origen discal

. Objetivos: El objetivo de nuestro estudio fue evaluar la eficacia de la descompresión percutánea discal con láser (DPDL) en el tratamiento del dolor lumbo-radicular de origen discal.

 

Introduction
The lifetime prevalence of chronic low back pain has been reported as high as 80%.1 Discogenic lumbar radicular pain due to lumbar disc prolapse, protrusion, or herniation accounts for less than 5% of low back problems.2 However, it is estimated that 90% of cases of radicular pain are due to disc herniation with nerve entrapment or compression.3

The majority of patients with acute sciatica recover within two to six weeks of conservative treatment and may avoid surgery.4

However, about 20% of patients do not respond to conservative treatment and usually undergo surgery.5 Some absolute indications for surgery include bladder dysfunction and progressive muscle weakness, although fortunately these complications are rare.6

Minimally invasive intradiscal techniques have been developed in order to reduce tissue trauma and the relatively high rate of complications and the necessity of repeated surgery.

In the last two decades, more than 500,000 percutaneous disc decompression procedures6 have been performed, including chemonucleolysis, automated and manual percutaneous discectomy, posterolateral endoscopic discectomy, laparoscopic discectomy and fusion, intradiscal electrothermal annuloplasty therapy (IDET®), percutaneous discectomy with the DeKompressor® probe, nucleoplasty using radiofrequency, intradiscal ozone therapy and percutaneous laser disc decompression (PLDD).7

PLDD was first introduced in the 1980s and the concept is based on the fact that a small reduction in volume of the nucleus pulposus results in a significant reduction in intradiscal pressure.8 This is achieved by introducing an optical fiber into the intervertebral disc under image-guidance and local anesthesia and laser energy is released, vaporizing a small volume of the nucleus pulposus. Treatment of the first patient with PLLD took place in 19859 and from then until 2011, more than 30,000 patients have been treated with this procedure.10 US Food and Drug Administration (FDA) approved PLDD in 1991.

The aim of this study is to evaluate the therapeutic effect of PLDD for the treatment of discogenic lumbar radicular pain, presenting the clinical outcome of a series of 200 patients.