What is Percutaneous Laser Disc Decompression (PLDD)?
Minimally invasive procedures for refractory sciatica and discogenic pain caused by disc herniation include percutaneous therapies under local anesthesia. These procedures are gaining attention. One of these treatments is Percutaneous Laser Disc Decompression (PLDD).
Percutaneous Laser Disc Decompression (PLDD) can be carried out in an outpatient setting and swift recovery and return to daily routine are suggested. If you suffer from agonizing back or neck pain as a result of a herniated disc, Percutaneous Laser Disc Decompression (PLDD) offers quick relief without surgery.
Approved by the FDA and recognized by the AMA, Percutaneous Laser Disc Decompression (PLDD) is a minimally invasive laser treatment performed on an outpatient basis using only local anesthesia. During the procedure, a laser beam vaporizes a tiny portion of the disc, decompressing it. Patients typically get off the table and go home. There is no hospital stay, no long recovery period, and Percutaneous Laser Disc Decompression (PLDD) costs many thousands of dollars less than surgery.
A herniated disc is one of the major causes of lower back pain. Herniated disc is a condition where the intervertebral discs of the backbone are denatured by aging and external forces and compresses the nerve roots or spinal cord causing pain and numbness of the legs.
Who Should Consider Percutaneous Laser Disc Decompression (PLDD)?
Percutaneous Laser Disc Decompression (PLDD) is specifically designed for patients with disc problems accompanied by the following:
Severe arm, neck, leg, or lower back pain.
Pain that has not responded to six weeks of conservative treatments like rest, medications, or physical therapy.
Herniated lumbar discs confirmed by x-ray studies that may include one or more of the following: Magnetic Resonance Imaging (MRI), CAT Scanning, Myelography, Discography.
Other conditions, which makes you a good candidate for Percutaneous Laser Disc Decompression (PLDD) are discogenic spinal stenosis, discogenic pain syndrome, chronic facet and sacroiliac joint syndrome etc.
Percutaneous Laser Disc Decompression (PLDD) Procedure Details: PLDD vs. Open Discectomy
This surgery will be performed under general or spinal anesthesia depending on the surgeon’s or the patient’s preferences. The patients will be positioned prone and the affected disc level is verified with fluoroscopy. A small midline incision (2–3 cm) will be made and the paravertebral muscles will be dissected unilaterally. Laminotomy will be performed when deemed necessary. In order to decompress the nerve root, the herniated disc will be removed as much as possible through a unilateral transflaval approach. The wound will be closed in layers with a suction drain when necessary. Patients will be operated with loupe magnification or microscope depending on the surgeon’s preference. The participating surgeons have large experience in the technique. A standardized case record form (CRF) will register the surgeon’s findings and will be sent to the data center. Patients will be admitted to hospital for 2–7 days depending on the usual care.
The patient will be instructed to take a prone position on the table of the CT-scan. After placing sterile drapes the level of treatment is identified by a scan. The needle entry point is anesthetized by local lidocaine injection no deeper than the facet joint. Subsequently the 18G needle is placed centrally in the nucleus pulposus, and parallel to the endplates by means of a posterolateral approach. Through the needle, a glass fiber is placed in the disc, enabling the application of laser energy (980 nm, 7 W, 0,6 s pulses, interval 1 second). After a total energy of 1500 J is delivered (2000 J for level L4-5), the PLDD procedure is finished. A control CT scan is performed to assess gas formation in the disc space. After the treatment the patient is allowed to drink tea or coffee and is observed for 15 minutes before he/she can return home.
Recovery Period Following Percutaneous Laser Disc Decompression (PLDD)
The recovery period for Percutaneous Laser Disc Decompression (PLDD) is much shorter than open spine herniated disc procedures. This shortened recovery is largely because minimally invasive procedures don’t require the large incisions and muscle disruption that open spine surgeries require.
Benefits of Percutaneous Laser Disc Decompression (PLDD) Surgery
- No soft tissue injury
- No risk of epidural fibrosis or scarring
- No extensive hospitalization (on outpatient basis possible)
- No general anesthesia, local anesthesia with mild sedation
- Minimal recovery time
- Lower costs
Percutaneous Laser Disc Decompression (PLDD) is an attractive treatment because of the minimally invasive nature and therefore the assumed decrease in risk of structural damage to the muscles, bone, ligaments and nerves. Furthermore, the patients undergoing Percutaneous Laser Disc Decompression (PLDD) are expected to have less back pain, shorter hospitalization and a shorter reconvalescence period than with conventional surgery. The actual recovery of the sciatica however, might take more time than after conventional surgery, although immediate resolution of the symptoms does occur.
In conclusion, Percutaneous Laser Disc Decompression (PLDD) has proven to be safe and effective. It is minimally invasive, is performed in an outpatient setting, requires no general anesthesia, results in no scarring or spinal instability, reduces rehabilitation time, is repeatable, and does not preclude open surgery should that become necessary.