OrthoNeuroSpine & Pain Institute
Laser Disc Decompression
In 1986, Ascher and Choy first used laser energy to destroy (vaporize) portions of the nucleus pulposus (proteoglycans) in order to reduce the volume of the disc, in hopes of reducing the size of a small contained disc herniation (sucks it back inside). This volume reduction in turn is thought to remove nerve root compression, as well as relieve pressure upon the pain-carrying sinuvertebral nerves of the posterolateral annulus fibrosis.
The beauty of this system was that a very smaller cannula could be used (~ 3mm) to delivery of the 400-nm laser fiber to the center of the disc, which mitigates complication rates such as discitis and epidural fibrosis. Another exciting development was the fact that most of the lasers included a fiber-optic channel so the surgeon could view just what he was vaporizing.
Percutaneous laser disc decompression (PLDD) is a type of surgery in which a laser probe is inserted into the intervertebral disc space and laser energy applied for achieving decompression and neuromodulation thereby relieving the pain. PLDD is a minimally invasive procedure that falls into the category of percutaneous intervertebral surgeries with the aim to significantly reduce the patient’s pain and recover neurological deficit. It is performed under local anesthesia. By a specially designed laser, with a coefficient of absorbing energy adjusted for soft discus tissue, specific amount of heat is sent to achieve the evaporation of the water from the disc without additional thermal damage thus achieving decompression and creation of a stable intradiscal scar that will prevent herniation from reoccurring.
If you suffer from agonizing back or neck pain as a result of a herniated disc, PLDD (Percutaneous Laser Disc Decompression) offers quick relief without surgery.
Approved by the FDA and recognized by the AMA, 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 PLDD costs many thousands of dollars less than surgery.
PLDD is the minimally-invasive medical procedure developed by Dr. Daniel S.J. Choy in 1986 that uses a laser beam to treat back and neck pain caused by a herniated disc. A herniated disc is like a balloon with a weak spot. Inflating it will cause a bulge (herniation). Pain results from the bulge pressing against nerves in the spinal column.
The PLDD treatment is performed on an outpatient basis using only local anesthesia. During the procedure, a thin needle is inserted into the herniated disc under x-ray guidance. An optical fiber is inserted through the needle and laser energy is sent through the fiber, vaporizing a tiny portion of the disc nucleus. This creates a partial vacuum which draws the herniation away from the nerve root, thereby relieving the pain. The effect usually is immediate.
Patients get off the table with just a small adhesive bandage and return home for 24 hours of bed rest. Then patients begin progressive ambulation, walking up to a mile. Most return to work in four to five days.
Because only a thin needle is used, there is no cutting and no scarring. Since only a tiny amount of disc is vaporized, there is no subsequent spinal instability. PLDD is different from open lumbar disc surgery because there is no damage to the back muscle, no bone removal or large skin incision. Most of the complications that may occur with open surgery are eliminated with the PLDD procedure.
Who should consider PLDD?
- This procedure is specifically designed for patients with disc problems accompanied by the following:
- Severe leg, arm, neck or lower back pain.
- Pain that has not responded to six weeks of conservative treatments- rest, meds 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.
Percuteneous Laser Disc Decompression alias PLDD is a medical procedure that uses laser beams to treat back and neck pain caused by disc herniations. Over the past 70 years, the traditional laminectomy and discectomy procedures were performed. As technology improved, minimally invasive approaches evolved. The first of its kind, Percuteneous Laser Disc Decompression (PLDD) started in the early 80’s and over time was fine-tuned to be a very useful procedure. The Percutaneous Laser Decopression is done by introducing a fibre optic wire inserted in the disc under X-ray guidance. The laser reduces the small portion of the inside disc material called nucleus pulposes. Thousands of PLDD procedures were done around the world with success.
PLDD procedure reduces the incidence of conventional back surgery (laminectomy). In suitably selected patients the procedure dramatically minimizes the incidence of scarring and other complications of laminectomy. It is established that PLDD reduces the intradiscal pressure and the discogenic pain and the nerve compression pain diminishes and largely disappears.
In 1984, Dr. Choi and co-workers introduced laser energy into herniated/protruded disc to vaporize a small volume of nucleus pulposis reducing the intradiscal pressure. Pressure reduction creates a pressure gradient leading to migration of the herniated portion away from the involved nerve root. This is based on a physical principal of Pascal Law. In an enclosed hydraulic space, small change in volume will result in a large change in pressure. This model was tested successfully in Columbia University, College of Physicians and Surgeons in New York City and in the neurological institute in Austria.
Suitable patients with herniated disc were chosen and through a series of experiments the doses of energy were calculated. The laser was calibrated to deliver 10 - 20 watts at 1.0 second bursts to allow heat to dissipate