Percutaneous Laser Disc Decompression

Choy, Daniel S.J.; Ascher, P. W.; Saddekni, Souheil; Alkaitis, Daniel; Liebler, William A.; Hughes, James E. O.; Diwan, Sudhir; Altman, Peter

doi:10.1097/00007632-199208000-00014

Cited by 220 publications

(98 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…only reported complication was one case of discitis in a series of 333 procedures, which was described by Choy, et al 8 Other possible complications of laser-assisted discectomy can include perforation of the aorta, vena cava, iliac vessels, or abdominal organs, and cauda equina syndrome. To date, however, there are no reported prospective controlled studies involving percutaneous laser discectomy.…”

Section: Percutaneous Laser-assisted Discectomymentioning

confidence: 95%

Minimally invasive spinal surgery: a historical perspective

Thongtrangan¹,

Le²,

Park³

et al. 2004

FOC

View full text Add to dashboard Cite

The concept of minimally invasive spinal surgery embodies the goal of achieving clinical outcomes comparable to those of conventional open surgery, while minimizing the risk of iatrogenic injury that may be incurred during the exposure process. The development of microscopy, laser technology, endoscopy, and video and image guidance systems provided the foundation on which minimally invasive spinal surgery is based. Minimally invasive treatments have been undertaken in all areas of the spinal axis since the 20th century. Lumbar disc disease has been treated using chemonucleolysis, percutaneous discectomy, laser discectomy, intradiscal thermoablation, and minimally invasive microdiscectomy techniques. The initial use of thoracoscopy for thoracic discs and tumor biopsies has expanded to include deformity correction, sympathectomy, vertebrectomy with reconstruction and instrumentation, and resection of paraspinal neurogenic tumors. Laparoscopic techniques, such as those used for appendectomy or cholecystectomy by general surgeons, have evolved into procedures performed by spinal surgeons for anterior lumbar discectomy and fusion. Image-guided systems have been adapted to facilitate pedicle screw placement with increased accuracy. Over the past decade, minimally invasive treatment of cervical spinal disorders has become feasible by applying technologies similar to those developed for the thoracic and lumbar spine. Endoscope-assisted transoral surgery, cervical lam-inectomy, discectomy, and foraminotomy all represent the continual evolution of minimally invasive spinal surgery. Further improvement in optics and imaging resources, development of biological agents, and introduction of instrumentation systems designed for minimally invasive procedures will inevitably lead to further applications in minimally invasive spine surgery.

show abstract

Section: Percutaneous Laser-assisted Discectomymentioning

confidence: 95%

Minimally invasive spinal surgery: a historical perspective

Thongtrangan¹,

Le²,

Park³

et al. 2004

FOC

View full text Add to dashboard Cite

show abstract

“…These techniques involve the percutaneous removal of the nucleus pulposus by using a variety of chemical, thermal, or mechanical techniques [1,[9][10][11][12][13]. They are based on the study of Hijikata et al in 1975 concerning the role of intradiscal pressure, which stated, ''Reduction of intradiscal pressure reduced the irritation of the nerve root and the pain receptors in the annulus and peridiscal area'' [1].…”

Section: Introductionmentioning

confidence: 99%

Standards of Practice: Quality Assurance Guidelines for Percutaneous Treatments of Intervertebral Discs

Kelekis

Filippiadis

Martin

et al. 2010

Cardiovasc Intervent Radiol

View full text Add to dashboard Cite

Percutaneous treatments are used in the therapy of small-to medium-sized hernias of intervertebral discs to reduce the intradiscal pressure in the nucleus and theoretically create space for the herniated fragment to implode inward, thus reducing pain and improving mobility and quality of life. These techniques involve the percutaneous removal of the nucleus pulposus by using a variety of chemical, thermal, or mechanical techniques and consist of removal of all or part of nucleus pulposus to induce more rapid healing of the abnormal lumbar disc. These guidelines are written to be used in quality improvement programs for assessing fluoroscopy-and/or computed tomography-guided percutaneous intervertebral disc ablative techniques.

show abstract

“…In uncontrolled clinical studies it has been shown to be a safe procedure with no septic complications reported to date [3,6]. We believe that this is the first report of septic complications following this procedure.…”

Section: Discussionmentioning

confidence: 62%

Possible salmonella osteomyelitis of spine following laser disc decompression

Farrar

Walker

Cowling

1998

European Spine Journal

View full text Add to dashboard Cite

A 52-year-old Asian man was diagnosed clinically and with CT scan as having right sciatica due to an L4/5 disc protrusion causing pressure on the right L5 nerve root. Conservative management was unsuccessful and he underwent laser disc decompression with a KTP Laser delivering 1250 J energy (Laserscope, Gwent, UK).The patient had a past history of pulmonary tuberculosis, but bronchoscopy performed 2 months before the surgery was negative. His leg pain did not improve, and 1 month after the disc decompression he was admitted for bed rest. His straight leg raise was restricted at 40°, but there was no other neurological deficit. An MRI scan was performed (Fig. 1), which showed end plate oedema and disc changes, which were interpreted as being consistent with the operative procedure. His symptoms improved and he was discharged.The back and leg pain returned, and 6 months following the disc decompression further investigations were performed. The patient was afebrile; white cell count and differential, plasma viscosity, plasma protein electrophoresis, C-reactive protein and antistaphylococcal antibodies were normal. Three sets of samples of early morning urine, sputum and blood cultures taken for tuberculosis were negative.A second MRI scan was performed (Fig. 2), which showed signs of an acute or chronic discitis at L4/5 with destruction of the disc space and adjacent end plates anteriorly. There was minimal abscess formation and an enhancing soft tissue mass extending posteriorly to the theca. Blood cultures grew Salmonella typhimurium (phage type 104). Aspiration of the L4/5 disc space was attempted under local anaesthesia, but was unsuccessful. Stool culture was negative.Assuming the Salmonella to be the infecting organism, treatment was initiated with 2 g intravenous ceftriaxone once daily and 750 mg oral ciprofloxacin twice daily, to which the organism showed in vitro sensitivity. Symptoms improved with bed rest and plaster jacket, combination antibiotics were given for a total of 6 weeks and oral ciprofloxacin for a further 6 weeks. Three months after stopping antibiotics, the patient's back and leg pain had improved and MRI scan (Fig. 3) showed resolution of the soft tissue mass with progression towards osseous fusion between the L4 and L5 vertebral bodies. DiscussionPercutaneous laser disc decompression is a relatively new technique, and its clinical effectiveness is yet to be established. In uncontrolled clinical studies it has been shown to be a safe procedure with no septic complications reported to date [3,6]. We believe that this is the first report of septic complications following this procedure. AbstractWe report a case of chronic discitis and vertebral osteomyelitis that we believe was caused by Salmonella typhimurium following laser decompression of the L4/5 disc for symptomatic disc protrusion in a 50-year-old Asian man. The infection was successfully treated with intravenous ceftriaxone combined with oral ciprofloxacin. We believe this to be the only report of such a complication following this ...

show abstract

Percutaneous Laser Disc Decompression

Cited by 220 publications

References 0 publications

Minimally invasive spinal surgery: a historical perspective

Minimally invasive spinal surgery: a historical perspective

Standards of Practice: Quality Assurance Guidelines for Percutaneous Treatments of Intervertebral Discs

Possible salmonella osteomyelitis of spine following laser disc decompression

Contact Info

Product

Resources

About