Percutaneous Lumbar Disc Decompression
Purpose of the Study
To identify the efficacy of laser disc ablation and compare the relative efficacy of Holmium 2100: YAG and KTP532 laser wavelengths in the treatment of broad based cervical disc protrusions presenting with cervical axial pain with compressive or non compressive radicular symptoms.
Background
A preliminary report on a prospective outcome study of cervical laser disc ablation and decompression in the management of cervical disc prolapse and discographically confirmed discogenic pain in association with radicular pain.
Methods
Patients with chronic cervical pain and radicular symptoms unresponsive to conservative treatment were assessed with MR scans. Those with broad based disc bulge or discal degeneration were assessed with provocative discography to isolate the source of pain. Percutaneous laser disc decompression was performed as a day case procedure on 105 patients at 108 levels under X-ray control via anterior approach with side firing probes in patients.
Results
At a minimum follow up of 24 months 51% of patients demonstrated a sustained significant clinical benefit with an additional 25% in whom functional improvement was noted. No difference in outcome was identified either with the wavelengths utilised or with laser annealing or painful discal tears. The cohort integrity of the study was 80%.
Conclusion
The sustained nature of the benefit (mean 3.5 years at final follow up) after long term preoperative symptoms (mean 3.9 years) in 76% patients rules out placebo effect. Benefits occurred independent of the wavelength of laser used.
