ABSTRACT
OBJECTIVE: In mid-February 1986, Peter Ascher and Daniel Choy performed the first percutaneous laser disc decompression (PLDD) procedure at the Neurosurgical Department, University of Graz, Graz, Austria. It was planned to deliver 1000 J of energy with an Nd:YAG laser to a herniated L4-L5 disc causing sciatica. At 600 J the procedure was terminated because the pain was gone. BACKGROUND DATA: Since then PLDD has spread all over the world, with procedures being performed on the entire spine except for T1-T4 because these discs do not permit percutaneous access with a needle. The success rate has ranged from 70-89%, and the complication rate, chiefly discitis, ranges from 0.3-1.0%. When successful, average time to return to normal activities is 1 wk. Long-term follow-up at 23 y yields a recurrence rate of 4-5%. METHODS: Laser surgeons active in PLDD were canvassed to obtain their best clinical data. RESULTS: PLDD patients treated with the Nd:YAG laser, the diode laser, and the combination Ho:YAG laser and endoscope were included. CONCLUSIONS: The McNab results for the three groups indicate that PLDD is safe, effective, and minimally invasive.
Subject(s)
Intervertebral Disc Displacement/surgery , Laser Therapy/methods , Decompression, Surgical , Humans , Intervertebral Disc Displacement/complications , Sciatica/etiology , Sciatica/surgeryABSTRACT
OBJECTIVE: Our objective was to present a method of performing thoracolumbar MRI with intervertebral disk pressure at 150 kPa without the patient being seated. CONCLUSION: Spine MRI with compression is more physiologic and will produce a higher yield than standard supine MRI.
Subject(s)
Image Enhancement/instrumentation , Intervertebral Disc Displacement/diagnosis , Magnetic Resonance Imaging/instrumentation , Restraint, Physical/instrumentation , Thoracic Vertebrae/pathology , Adult , Female , Humans , Image Enhancement/methods , Magnetic Resonance Imaging/methods , Male , Middle Aged , Reproducibility of Results , Restraint, Physical/methods , Sensitivity and SpecificityABSTRACT
OBJECTIVE: This article aimed to analyze the neurosurgical results of 500 patients treated with microdiscectomies and 500 patients treated with percutaneous laser disc decompression. BACKGROUND DATA: 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. METHODS: 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). RESULTS: 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. CONCLUSION: 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.
Subject(s)
Decompression, Surgical/methods , Diskectomy/methods , Intervertebral Disc Displacement/surgery , Lumbar Vertebrae/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
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.