Percutaneous laser disc decompression (PLDD) has been regarded as an effective alternative to microdiscectomy for the treatment of contained lumbar disc herniations.
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 1).
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 2).
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 outcomes 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 3).
Robot-assisted percutaneous laser vaporization decompression for lumbar disc herniation 4).