Cervical percutaneous laser disc decompression: preliminary results of an ongoing prospective outcome study.

OBJECTIVE: This study identifies the efficacy of laser disc ablation and compares the relative efficacy of Holmium2100; YAG and KTP532 laser wavelengths in the treatment of broad-based cervical disc protrusions presenting with cervical axial pain with compressive or noncompressive radicular symptoms. BACKGROUND: A preliminary report on a prospective outcome study of cervical laser disc ablation and decompression in the management of cervical disc prolapse and discographically confirmed discogenic pain in association with radicular pain. METHODS: Patients with chronic cervical pain and radicular symptoms unresponsive to conservative treatment were assessed with magnetic resonance (MR) scans. Those with broad-based disc bulge or discal degeneration were assessed with provocative discography to isolate the source of pain. Percutaneous laser disc decompression was performed as a day case procedure on 105 patients at 108 levels under X-ray control via the anterior approach with side-firing probes in patients. RESULTS: At a minimum follow up of 24 months, 51% of patients demonstrated a sustained significant clinical benefit with an additional 25% in whom functional improvement was noted. No difference in outcome was identified either with the wavelengths used or with laser annealing or painful discal tears. The cohort integrity of the study was 80%. CONCLUSION: The sustained nature of the benefit (mean 3.5 years at final follow up) after long-term preoperative symptoms (mean 3.9 years) in 76% patients rules out placebo effect. Benefits occurred independently of the wavelength of laser used.

Endoscopic foraminoplasty: a prospective study on 250 consecutive patients with independent evaluation.

OBJECTIVE: This study focused on the efficacy of endoscopic decompression of the foramen guided by endoscopic aware-state pain source definition. BACKGROUND DATA: Endoscopic foraminoplasty consists of undercutting of the facet joint and endoscopic discectomy, mobilization and neurolysis of the exiting and transiting nerves, and ablation of osteophytes. This study sought the outcome of endoscopic foraminoplasty in 250 consecutive patients followed for a minimum of 2 years, reviewed and assessed by an external independent assessor. It was applied to patients with back pain and sciatica in multilevel degenerative disc disease and also to those with prior surgery. METHODS: A prospective study of endoscopic laser foraminoplasty was performed on 121 males and 129 females with an average age of 48 years (21-86 years), followed for an average period of 30 months (26-43 months). The average preoperative duration of back, buttock, or leg pain was 6.1 years (5-11 years). A total of 30% had undergone prior open spinal surgery. RESULTS: The cohort integrity at follow up was 97%. Outcome was analyzed using the percentage change in Oswestry Disability Scores and visual analogue pain scores. Clinically relevant change in pain and disability was observed in 73%. Using a percentage change in Oswestry Disability Score of 50 or more to determine good and excellent outcomes, 60% of patients exceeded this score. A total of 95% patients required no further surgical intervention. CONCLUSIONS: Endoscopic laser foraminoplasty provides a minimalist means of exploring the extraforaminal zone, the foramen, the disc, and the epidural space and performing discectomy, lateral recess decompression, osteophytectomy, and neural mobilization. Performed in the aware state, it serves to identify and localize precisely the causal source of pain in multilevel disc disease, in revision surgery, and in the infirm and elderly without open fusion or decompression.

Comparative outcome of Holmium: YAG and KTP laser disc ablation in degenerative cervical disc disease: results of an ongoing study.

Objective. This prospective study was designer to identify the relative efficacy of Holmium2100: YAG and KTP532 laser wavelengths in the treatment of broad based cervical disc protrusions presenting with cervical axial pain with compressive or non compressive radicular symptoms.
Methods. Patients with chronic cervical pain and radicular symptoms unresponsive to conservative treatment were assessed with MR scans. Those with broad based disc bulges were assessed with provocative discography to isolate the source of pain. Percutaneous laser disc decompression was performad as a day case procedure on 105 patients at 108 levels under X-ray control via the anterior approach with side firing probes. Vernon-Mior cervical disability and visual analogue pain indices were used to assess the outcome of the procedures.
Results. At a minimum follow up of 12 months 50% of patients demonstrated a sustained significant (excellent to good) clinical benefit with an index value of 50% or more while an additional 25% demonstrated functional improvement. No difference in outcome was identified with either wavelength utilized or with laser annealing or painful discal tears. At this juncture the cohort integrity of the study is 74%.
Conclusion. The outcome of treatment for cervical degenerative disc disease with compressive or non compressive radicular symptoms with KTP or Holmium: YAG laser is identical. The sustained nature of the benefit after long term preoperative symptoms (mean 3,4 years) rules out placebo effect.