Percutaneous laser disc decompression: A minimally invasive procedure for the treatment of intervertebral disc prolapse – the Bangladesh perspective/Perkutane Laser-Diskusdekompression: Ein minimal-invasives Verfahren zur Behandlung von Bandscheibenvorfall – Ein Erfahrungsbericht aus Bangladesch

Abstract

The purpose of this paper is to assess the clinical effectiveness of percutaneous laser disc decompression (PLDD) for patients with radicular pain due to intervertebral disc hernia and to describe our experience in this field in Bangladesh.PLDD is a procedure in which herniated intervertebral discs are treated by the reduction of intradiscal pressure by laser energy. This is introduced by a needle inserted into the nucleus pulposus under local anesthesia and fluoroscopic monitoring. Small volume nucleus vaporization results in a sharp fall in intradiscal pressure, with the consequent migration of herniation away from the nerve root. PLDD has been reported to be a safe, effective, minimally invasive treatment option for patients with a herniated disc.This observational random prospective analysis was carried out during the period from November 2007 to December 2011. PLDD was performed on 4622 herniated discs of 2580 patients (1420, male; 1160, female), whose age ranged between 18 and 85 years. A total of 47 cases were failed back surgery syndrome (FBSS). All patients were followed up (ranging from 1 month to 36 months, with a median of 12 months) and were evaluated according to MacNab criteria.Amongst the 2580 patients, 2296 (89.0%) reported immediate pain relief, 230 (8.9%) patients were uncertain and the remaining 54 (2.1%) did not have immediate pain relief. In the subsequent follow up, according to MacNab criteria a good response was seen in 1935 (75.0%) cases and a fair response in 335 (13.0%) cases. The response to the treatment was poor in 310 patients (12.0%). A second session of PLDD was performed on 292 (11.3%) patients made up of 162 patients (6.3%) due to multi-level (>2 discs) prolapse, 102 patients (3.9%) due to an extensive prolapse of one or two discs and 28 patients (1.0%) because of a relapse. In two cases of a prolapsed dorsal spine (TPLDD is an effective and minimally invasive procedure which has almost no side effects or complications, can be performed under local anesthesia, results in no scarring or spinal instability, and still does not hinder the scope of open surgery in failed cases. PLDD is also effective in cases of FBSS.