Percutaneous Laser Disc Decompression

Minimally Invasive
No cutting
No scarring
No general anesthesia
No hospital stay
Shorter recovery
Costs 75% less than conventional disc surgery
Less than a half of 1% complication rate over 18 years

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WHAT IS PLDD?

Percutaneous Laser Disc Decompression (PLDD) is a conservative, minimally invasive surgical procedure which uses laser energy to ablate a small volume of disc material. This reduces the pressure within a herniated disc, relieving symptoms by decompressing the spinal nerve as it exits the spinal cord (figure 3).

The entire procedure is performed under local anesthesia. Under X-ray guidance, a needle, less than one mm in diameter, is inserted into the disc. The laser fiber is inserted through this needle.

PLDD is different from open surgery as it does not involve general anesthesia and has a much faster recovery rate.

The primary advantage of PLDD is that there is no interference with the muscles, bones or joints, and there is no manipulation of the nerves in the lower back. Since the insertion of the needle through muscle is only a small puncture, there is little or no scarring postprocedure. The small size of the needle minimizes any pain and allows the surgeon to perform the procedure very quickly. Additionally, the procedure is performed as an outpatient procedure, thereby allowing the patient to return home the same day of the procedure. The healing process usually occurs over a period of several weeks.

Following PLDD the patient will be required to rest for a day. The patient should not participate in active sports, heavy lifting or strenuous exercises until released by the physician to do so. The patient will then participate in a physical therapy program. It is reasonable to expect mild postprocedure pain. The use of ice packs or oral antiinflammatory drugs (such as Advil), can be very effective in reducing symptoms.

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WHO ARE CANDIDATES FOR PLDD?

If your herniated disc pain continues for a period of three months, your physician may recommend a surgical procedure. Surgical options include: laminectomy, microdiscectomy and percutaneous laser disc decompression (PLDD). Your physician will make his recommendation based upon your diagnosis.

The lumbar disc is comprised of the nucleus pulposus which is surrounded by and contained within the annulus. Increased pressure inside the disc can cause the disc to herniate. Pressure on one or more of the spinal nerves may occur, resulting in the symptoms of pain and numbness or tingling in the lower back, neck, leg, arm or foot.

In some cases, the herniation may be held within the annulus. This is termed a contained herniation. In other patients, the herniation may cause a tear in the annulus, and in some instances, fragments of the disc material may actually break away from the disc.

PLDD is specifically designed for patients with herniated discs and accompanied by the following:

Severe leg/arm pain and/or lower back/neck pain
Pain which has not responded to conservative treatments, i.e. - bed rest analgesics, physical therapy and muscle relaxants.
Herniated discs which are confirmed by MRI studies.

Patients who are NOT considered candidates for PLDD are those who have:

Lower back pain not caused by a herniated disc
Arthritis of the spinal joints, or bone spurs that may cause similar pain
Fragment of the nucleus pulposus tissue outside of the disc
Severe spinal stenosis (build-up of bone in the spinal canal).

Only patients with clinical symptoms confirmed by physical examination, conservative treatment therapies and MRI studies are considered suitable candidates for the PLDD procedure.

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ABOUT THE PROCEDURE

PLDD is performed in an outpatient setting under local anesthesia with the patient awake.

After the local anesthesia has been given, a small needle is inserted through the skin into the affected disc. This is done under X-ray guidance. The laser fiber is inserted through the needle and the treatment is begun. The laser energy is then delivered to the disc, with the physician continuously assessing the patient's status as the procedure progresses.

Once the correct amount of laser energy has been applied, the laser fiber and needle are removed from the patient and an adhesive bandage is applied to the needle puncture site. The procedure takes approximately 1 to 1 1/2 hours, during which time the patient is comfortable and experiences little pain. Following the procedure, the patient is usually monitored for 15 to 30 minutes before being discharged home.

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Frequently Asked Questions

Will I be put to sleep?

No, you will not be put to sleep. This is a minimally invasive procedure that is done using local anesthetic to prevent the sensation of pain as well as medication to help you relax.

How long will the procedure take?

The actual procedure takes anywhere from 45 minutes to 2 hours, depending on the number of discs that require treatment. Immediately prior to the procedure you will be given intravenous antibiotics, which takes an additional 30 minutes. After the procedure there is no "recovery time".

Will I feel any pain during the procedure?

Local anesthetic (numbing) medication is used to prevent the sensation of pain. There may be few instances when pain is felt. This will be explained to you during your initial consultation.

How long will it take me to feel better?

The majority of patients feel some pain relief immediately after the procedure. During the first week, you will experience some localized swelling which will be controlled with ice and medications. In one week, you will start to participate in a 6-week physical therapy program at your local physical therapy center. This will promote improved functioning and maximize recovery. A very small number of patients take up to eleven months for full recovery.

Most office workers can go back to work within one week. If your job consists of manual work, depending on the demands of the job, it could take up to one month.

What tests are needed to decide if I'm a candidate for the procedure?

Normally, an MRI performed within the last 6 months is a minimum. Diagnostic procedures such as an electromyogram, discogram or CT scan may also be helpful, although usually not required.

What condition is PLDD used to treat?

PLDD is an effective treatment for a herniated disc with or without sciatica in the lumbar, cervical or thoracic spine. It is not effective for pain or weakness caused by bone spurs, arthritis, or bony spinal stenosis.

Is the procedure covered by my insurance?

We accept all workers compensation claims. We participate in Medicare and Medicaid and we file with most insurance companies; however, each case is different and requires individual attention. Please contact us and let us discuss your case further.

My insurance company wants to know what the CPT (common procedure terminology) code is for PLDD.

The CPT code for PLDD is 62287.

What is the success rate?

It varies from 80% to 89%. When it is not successful, we believe it is usually due to a free fragment that is not detectable in a small number of cases by even the best MRIs worldwide.

What have been the complications?

In a series of over 2000 procedures in 18 years, post procedure discitis (disc infection) in 0.4% of cases. All of these patients got well with antibiotics.

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HOW CAN A HERNIATED DISC BE TREATED?

Lower back pain is a major health problem in the United States. It is reported that 85% of the population in the United States experience back pain at some point in their lifetime, and an estimated $8 billion is spent annually on back care. Lower back pain is the second greatest cause of lost work days.

The human spine is comprised of 26 vertebrae. Intervertebral discs are the structures which serve as shock absorbers between the vertebrae in the lower back and neck. The center of the disc, called the nucleus pulposus, is soft and springy to absorb the shock of everyday activities. The outer ring of the disc, commonly called the annulus, provides both structure and strength to the disc.

Following a complete physical and radiologic examination, including a MRI, your physician will suggest several forms of treatment. Initially, the most common treatment is termed "conservative therapy." This consists of bed rest, physical therapy and muscle relaxants or nonsterodial anti-inflammatory drugs (NSAIDs).

PLDD is different from open surgery as it does not involve general anesthesia and has a much faster recovery rate.

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