DESCRIPTION OF CONDITION:

Percutaneous laser disc decompression (PLDD) is a minimally invasive procedure to treat herniated disks. This procedure is used on patients who are therapy-resistant to conservative treatment.

SYMPTOMS:

A slipped disk presses on a nerve, causing pain, numbness, or weakness in the area of the body triggered by the nerve. Depending on the position of the herniated disc, pain could arise in the front of the thigh, shoulders, arms, or chest. Sciatica may develop, which is pain that travels through the buttocks and down a leg to the ankle. Lower back pain may accompany the leg pain.

INCIDENCE AND CAUSES:

40 % of the residents of industrialized countries experience back pain at least once in a life time. The annual incidence rate for herniated disks is 150 out of 100,000 residents. 61 of them are usually treated by surgery.

Genetic disposition is often related to the occurrence of disk herniation. Other causes include single-sided permanent exposure during professional or leisure activities, muscular incompetence or a traumatic event like an accident are more direct causes for a disk to slip. Due to wear, a crack can develop in the outer layer of the disk. The jellylike material inside the disk (nucleus) is forced out through the crack in the capsule. This causes the disk to bulge. This often happens due to sudden heavy strain or a sudden twisting movement. The bulge then presses on a nerve causing pain. The herniated disk can also break open (rupture), or break into fragments. The average age of incidence for this disease is around 40. Most frequently, the lumbar region is affected.

ANATOMY:

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PROCEDURE:

During an initial consultation a physician will ask for case history and make several movement tests. If the symptoms described above exist, diagnostic imaging will be crucial to confirm a disc herniation.

If a herniated disk is diagnosed, the first step is conservative therapy. This therapy could include treatment with heat (Fango) for loosening the muscles, analgesics, massage, active exercise therapy or a combination of treatments. If conservative therapy does not show marked improvement of the symptoms over 6 – 8 weeks a surgical treatment may be discussed.

During the minimally invasive PLDD surgery using the Dornier fibertom 8100 the patient receives local anesthesia.  If pain becomes too great for the patient during treatment an anesthesiologist should administer further analgesic.  The doctor inserts a needle in the bulgy disc using x-ray monitoring. The laser fiber is introduced into the nucleus through the needle. Laser light is then applied in short pulses. The absorption of the laser light causes the cells of the bulged disk to shrink. This results in the relief of pressure on the nerve roots (“decompression”) which reduces the symptoms of pain and numbness.

POST PROCEDURE PROTOCOL:

PLDD surgery may be performed as an inpatient or an outpatient procedure.

An active treatment with physical therapy or specialized workout for the back is recommended.

International clinical studies have shown the success rate of percutaneous laser disc decompression to be around 80 % with an extremely low complication rate. The use of PLDD can therefore avoid open surgery for many intervertebral disc patients.

ALTERNATIVE TREATMENT OPTIONS:

• Laminectomy (open decompression) - The laminectomy surgery is the process of removing a small portion of the bone either over the nerve root (disc material) or from under the nerve root or both to give more space to the nerve root. The incision is long and muscle stripping must be performed. The healing process is relatively long. The surgery often causes instability of the spine and is therefore refused today.

• Microdiscectomy – The microdiscectomy differs from laminectomy only in a smaller incision and less muscle stripping. Therefore morbidity is less. The results of both techniques are similar.

• Chemonucleolysis – During this minimally invasive treatment, the gas ozone is injected with a percutanous needle through a puncture in the herniated disk. The ozone improves blood circulation within the disc and healing of inflammations. The results are a reduction of the water content, a reduction of the volume of the disk and a decrease in pain. This method could cause various side effects and is thus not recommended.

• Percutaneous Nucleotomy – After local anesthesia is administered, a thin probe is inserted in the herniated disk, similar to the PLDD method. With an automated discector, which is a suction shaver that can perform controlled removal of disc material, the volume of the herniated disk is reduced. Due to insufficient results this method is not used.