Lasers in percutaneous disc surgery: Beneficial technology or gimmick?

Percutaneous Endoscopic Laser Discectomy

“…Evidence obtained from comparative studies with historical control, two or more single-arm studies or interrupted time series without a parallel control group IV Evidence obtained from case series, either post-test or pre-test and post-test prior to the review. 2,4,6,7,[9][10][11][12][13][14][15][16] The subsequent 12-month literature search failed to locate any additional papers. None of the papers offered high-quality evidence.…”

“…Three papers were time series studies (level III-3 evidence), 7,9,10 two papers were case series, post-test (level IV evidence). 2,6 Seven articles could not be classified using the hierarchy of evidence table. 4,[11][12][13][14][15][16] Five of these were descriptions of the technique, 4,11,12,15,16 three of which repeated results described elsewhere 4,11,12 but with no additional results and insufficient detail to aid the review.…”

“…The case series described in the papers by Mayer et al 2,6 described a technique that differed significantly from that used by Casper et al In addition to laser ablation, mechanical shavers and cutters were used. As a consequence it would appear unrealistic to compare outcomes.…”

“…Techniques also vary according to whether mechanical instruments are used together with laser ablation to remove disc material, 6 or whether laser ablation is the only method of treatment. 7 The number of people affected by symptomatic lumbar disc prolapse ensures that public interest in new treatments remains high.…”

Salvage Operation for Persistent Low Back Pain and Sciatica Induced by Percutaneous Laser Disc Decompression Performed at Outside Institution: Correlation of Magnetic Resonance Imaging and Intraoperative and Pathological Findings

“…Some recent reports describe patients treated surgically for complications of percutaneous laser disc decompression (PLDD). [17][18][19][20][21][22] We have not yet introduced this procedure into practice and have recently encountered an increasing number of patients with serious complications or unsatisfactory therapeutic outcomes of PLDD that are attributable to use of inappropriate irradiation condition or wrong selection of patients treated with this procedure. To clearly identify current problems with PLDD, we compared the clinical and magnetic resonance (MR) findings as well as the pathological features of resected herniated masses in those patients who had failed with PLDD performed elsewhere and underwent salvage operations at our hospital or any of its related institutions.…”