Percutaneous Laser Disc Decompression for the Treatment of Lumbar Disc Herniation: A Review

Goupille, Philippe; Mulleman, Denis; Mammou, Saloua; Griffoul, Isabelle; Valat, Jean‐Pierre

doi:10.1016/j.semarthrit.2007.01.006

Cited by 36 publications

(28 citation statements)

References 67 publications

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“…[481011131617] Alternatively, the “cons” the (e.g., lack of efficacy of these PELD/PLDD/T-PLLD operations) against these procedures have been well-established in multiple well-designed prospective randomized clinical trials [Tables 1 and 2]. [127101215] We then ask, should pain management specialists or even spine surgeons perform PELD/PLDD/T-PLDD: What do you think?…”

Section: Discussionmentioning

confidence: 99%

“…[271215] In 2007, Goupille et al . looked at multiple PELD/PLDD studies (1980–2006) in the MEDLINE EMBASE databases [Table 2].…”

Section: Introductionmentioning

confidence: 99%

“…[7] They found no uniformity in the technical performance of these procedures due to the “lack of control studies,” and concluded that “this treatment cannot be considered validated for disc herniation-associated radiculopathy resistant to medical treatment” [Table 2]. [7] In a randomized controlled trial, Postacchini and Postacchini noted transforaminal endoscopic diskectomy yielded comparable results vs. routine microdiskectomy, as long as the “surgeon is expert enough in the technique, which implies a long learning curve in order to perform the operation effectively, with no complications” [Table 2]. [12] However, they noted that the “success rate ranges from 60 to 70% for the former vs. 90% seen with microdiskectomy.” Utilizing multiple major databases, Singh et al .…”

Section: Introductionmentioning

confidence: 99%

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Should anyone perform percutaneous endoscopic laser diskectomy and percutaneous lumbar disc decompressions?

Epstein

2016

Surg Neurol Int

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Background:Increasingly, pain management specialists (P-S) (e.g., anesthesiologists, radiologists, or physiatrists), who are not spinal surgeons, are performing percutaneous endoscopic laser diskectomy (PELD), percutaneous lumbar disc decompression (PLDD), and target percutaneous laser disc decompression (T-PLDD) in patients with minimal/mild disc herniations. Here, theoretically, the laser vaporizes/shrinks a small portion of disc tissue that lowers intradiscal pressure/volume, and thereby provides “symptomatic relief” (e.g., low back pain/radiculopathy). Nevertheless, the vast majority of these patients experience spontaneous relief of their complaints over several months without any intervention.Methods:A literature review revealed that P-S specialists are performing PELD/PLDD/T-PLDD to address minimal/mild disc herniations. However, multiple well-designed studies confirmed that PELD/PLDD/T-PLDD were ineffective for managing acute/chronic pain in these patients.Results:Several randomized clinical trials documented the lack of clinical efficacy of PELD/PLDD/T-PLLD procedures over microdiskectomy. PELD/PLDD/T-PLDD correlated with only 60–70% success rates with higher reoperation rates (e.g., up to 38%) vs. 90% success rates for routine microdiskectomy (e.g., with faster recovery and only 16% reoperation rates). Nevertheless, without surgical training, P-S are performing these procedures and are, therefore, unable to adddress perioperative/postoperative PELD/PLDD/T-PLDD surgical complications.Conclusions:Pain management specialists, who are not trained spinal surgeons, should not perform PELD/PLDD/T-PLDD surgery to treat minimal/mild disc herniations. Not only do most of these discs resolve spontaneously over several months but also they are largely ineffective. Furthermore, there is no evidence to support the superiority of PELD/PLDD/T-PLDD procedures over microdiskectomy even if performed by spinal specialists.

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Section: Discussionmentioning

confidence: 99%

“…[271215] In 2007, Goupille et al . looked at multiple PELD/PLDD studies (1980–2006) in the MEDLINE EMBASE databases [Table 2].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Should anyone perform percutaneous endoscopic laser diskectomy and percutaneous lumbar disc decompressions?

Epstein

2016

Surg Neurol Int

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“…However, surgical intervention has more rapid rates of pain relief and recovery. It is likely that microdiscectomy with less invasive surgical intervention involving the paravertebral muscles and soft tissues has advantages in athletes when it comes to maintaining muscle function and strength in the lower back and thereby an early return to participation in sporting activities (Goupille et al 2007;Watters and McGirt 2009).…”

Section: Treatmentmentioning

confidence: 99%

Thoracolumbar Injuries in Pediatric Athletes: Diagnosis, Treatment, Rehabilitation, and Prevention

Baranto

2015

Sports Injuries

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“…PLDD was first used in 1986 and received approval from the U.S. Food and Drug Administration in 1991 1. Based on the reduced risk associated with less invasive procedures, PLDD has increased in popularity, with reportedly over 30,000 PLDD procedures performed in 2001 2.…”

Section: Background and Objectivesmentioning

confidence: 99%

Percutaneous laser disc decompression for thoracic disc disease: report of 10 cases

Haufe¹,

Mork²,

Pyne³

et al. 2010

Int. J. Med. Sci.

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Background: Discogenic pain or herniation causing neural impingement of the thoracic vertebrae is less common than that in the cervical or lumbar regions. Treatment of thoracic discogenic pain usually involves conservative measures. If this fails, conventional fusion or discectomy can be considered, but these procedures carry significant risk.Objectives: To assess the efficacy and safety of percutaneous laser disc decompression (PLDD) for the treatment of thoracic disc disease.Methods: Ten patients with thoracic discogenic pain who were unresponsive to conservative intervention underwent the PLDD procedure. Thoracic pain was assessed using the Visual Analog Scale (VAS) scores preoperatively and at 6-month intervals with a minimum of 18-months follow-up. Patients were diagnosed and chosen for enrollment based on abnormal MRI findings and positive provocative discograms. Patients with gross herniations were not included.Results: Length of follow-up ranged from 18 to 31 months (mean: 24.2 mo). Median pretreatment thoracic VAS score was 8.5 (range: 5-10) and median VAS score at final follow-up was 3.8 (range: 0-9). Postoperative improvement was significant with a 99% confidence interval. Of interest, patients generally fell into two groups, those with significant pain reduction and those with little to no improvement. Although complications such as pneumothorax, discitis, or nerve damage were possible, no adverse events occurred during the procedures.Limitations: The study is limited by its small size and lack of a sham group. Larger controlled studies are warranted.Conclusions: With further clinical evidence, PLDD could be considered a viable option with a low risk of complication for the treatment of thoracic discogenic pain that does not resolve with conservative treatment.

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Percutaneous Laser Disc Decompression for the Treatment of Lumbar Disc Herniation: A Review

Cited by 36 publications

References 67 publications

Should anyone perform percutaneous endoscopic laser diskectomy and percutaneous lumbar disc decompressions?

Should anyone perform percutaneous endoscopic laser diskectomy and percutaneous lumbar disc decompressions?

Thoracolumbar Injuries in Pediatric Athletes: Diagnosis, Treatment, Rehabilitation, and Prevention

Percutaneous laser disc decompression for thoracic disc disease: report of 10 cases

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