Percutaneous Laser Disc Decompression (PLDD)

Principle

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.

Introduction

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.

The Features of PLDD

・hardly bleeding

・Local anesthesia

・Surgery takes about 15 minutes per spot

・Almost no scar will remain

・No hospitalization needed after surgery

・Not suitable for all types of herniation

・Improvement rate is approximately 80% (Numbness in lower limb may remains)

・In some cases, multiple courses of treatment are required

・There is a possibility of causing a reactive radiculitis, intervertebral disc inflammation or infection in the rare thermal stimulation.

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.

FAQ

1.What is a “heat denaturation”?
If add a heat energy to protein materials, a protein reacts to this heat and changes the properties.
When we cook a baked chicken, this chicken becomes smaller than before cooking, but the total volume of chicken does not change. Only an amount of moisture is decreased by the heat energy, and chicken becomes tighten up and shrinks.
A same reaction happens to the herniated disc at the PLDD. By the heat of laser energy, this heat denaturation happens and herniated disc becomes tighten up and shrinks.

2.After the herniated disc becomes tighten up and shrinks by PLDD,the intervertebral space becomes thinner?
If patient undergoes Discectomy surgery, the intervertebral disc is completely extracted. It means that after
Discectomy surgery, the intervertebral space is easy to be narrow. Also if put some metallic medical device into the space, there is a possibility that the spine movement gets harden.
However, at this PLDD, there is a possibility that the intervertebral space to be narrow a little bit, but the total volume of disc is not changed. It means that PLDD does not makes the intervertebral space thinner like a Discectomy surgery.

3.Are there any possibility that the disc herniation relapse after PLDD?
After PLDD, the intervertebral disc becomes stronger than before with reaction of heat denaturation (tighten up and shrinks). Therefore, basically it never relapse.

4.How long it takes a time to recovery the symptoms?
After the internal pressure of herniated disc has decreased, the disc herniation is getting smaller gradually. But there is an individual differences between each patient in the term of recovery.
If the disc herniation happened a long time ago, this herniated disc has been harden. In that case, it takes a time or hard to be tighten up or shrinks. But the effect of PLDD occurs steadily, also the disc keeps shrinking for around 6 months after the procedure. Therefore, the postoperative patient needs to be observed for 6 months.