====== Percutaneous laser disc decompression for lumbar disc herniation ======

[[Percutaneous laser disc decompression]] (PLDD) has been regarded as an effective alternative to [[microdiscectomy]] for the treatment of contained [[lumbar disc herniation]]s. 

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
((Terai H, Tamai K, Iwamae M, Kaneda K, Katsuda H, Shimada N, Nakamura H. Characteristics and Short-Term Surgical Outcomes of Patients with Recurrent Lumbar Disc Herniation after Percutaneous Laser Disc Decompression. Medicina (Kaunas). 2021 Nov 10;57(11):1225. doi: 10.3390/medicina57111225. PMID: 34833443; PMCID: PMC8623925.)).

===== Laser type =====

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 effective than the 980 nm wavelength. They 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 the 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
((Gazzeri R, Tribuzi S, Galarza M, Occhigrossi F. Percutaneous Laser Disc Decompression (PLDD) for the Treatment of Contained Lumbar Disc Herniation. Surg Technol Int. 2022 Oct 21;41:sti41/1639. doi: 10.52198/22.STI.41.NS1639. Epub ahead of print. PMID: 36269671.)).

===== Case series =====
The clinical study included 82 patients who underwent PLDD for lumbar intervertebral disc degenerative disease. The mean postoperative follow-up period was 30.8±13.3 months. In 22 (26%) patients, unsatisfactory clinical outcomes were observed. According to the binary logistic regression model, comorbidities (p=0.03), duration of disease over 12 months (p=0.03), low preoperative quality of life according to ODI score (more than 50%) (p=0.04), high [[body mass index]] (over 25 kg/m2) (p=0.02), severe [[intervertebral disc degeneration]] (p=0.04) and [[facet joint degeneration]] (p=0.01) and intervertebral [[disc height]] decrease more than 50% (p=0.01) were significantly associated with unsatisfactory [[clinical outcome]]s after lumbar PLDD for degenerative spine disease.

Identification of these risk factors of unsatisfactory clinical outcomes is important to the stage of preoperative preparation in patients scheduled for lumbar PLDD
((Beloborodov VA, Stepanov IA. Faktory riska neudovletvoritel'nykh rezul'tatov posle chreskozhnoi lazernoi dekompressii poyasnichnykh mezhpozvonkovykh diskov [Risk factors of unsatisfactory outcomes after percutaneous laser decompression of lumbar intervertebral discs]. Khirurgiia (Mosk). 2022;(1):15-22. Russian. doi: 10.17116/hirurgia202201115. PMID: 35080822.)).




===== Case reports =====
Robot-assisted percutaneous laser vaporization decompression for lumbar disc herniation
((Zhang YJ, Luo LZ, Guo TF, Wei MJ, Du KR, Liu XX, Li JM, Deng Q. [Robot assisted percutaneous laser vaporization decompression for lumbar disc herniation:a case report]. Zhongguo Gu Shang. 2022 Feb 25;35(2):162-5. Chinese. doi: 10.12200/j.issn.1003-0034.2022.02.014. PMID: 35191270.)).