Treatment of Lumbar Intervertebral Disc Herniation Using C-Arm Fluoroscopy Guided Target Percutaneous Laser Disc Decompression

To evaluate the safety and therapeutic efficacy of target percutaneous laser disc decompression (T-PLDD) for the treatment of lumbar disc herniation

PLDD usess laser energy to vaporize a small volume of the nucleus pulposus, which reduces the pressure between the nucleus pulposus and the peridiscal tissue. This pressure loss induces retraction of the herniation away from the nerve root, thus reducing nerve root compression. However, in cases of extruded but nonsequestered lumbar intervertebral disc herniations, the continuity of the annulus fibrosus was damaged. It remains unknown whether an intradisc pressure decrease causes the extruded nucleus pulposus to significantly retract. Zhao et al⁴ showed that in both the extrusion and lumbar canal stenosis groups, the excellent and good clinical outcome rate was 55.9% in patients treated with PLDD. The comparable group (contained lumbar intervertebral disc herniations) had an excellent and good rating of 82%. This demonstrates that intradiscal decompression has minimal effects on the extruded nucleus pulposus.

A group of 25 patients with extruded but nonsequestered lumbar intervertebral disc herniation during the study period (January–November 2008) were involved in this trial. The average age of the patients was 44±9 years (range 29–73). The 19 male patients were 29–73 years old (average age 43.7 years), and the 6 female patients were 32–68 years old (average age 46.4 years). A total of 21 L5/S1 extruded discs and 4 L4/L5 extruded discs were treated by T-PLDD. Three patients also had an additional contained disc herniation in another segment, which was treated with PLDD using the dorsolateral approach. All the patients met the inclusion and exclusion criteria, and all signed the informed consent for the treatment.

Twenty-five patients underwent an MRI scan at 12 months after the minimal invasive operation. In these patients, we obtained 23 excellent and good clinical outcomes and 2 fair and poor clinical outcomes. Four of the patients with clinical excellent and good outcomes showed a reduction in the disc protrusion by >4 mm, and 17 of these patients showed a reduction in the disc protrusion by 3 mm. In 2 patients, the disc protrusion was reduced by ≤2 mm. The thecal cross-sectional area increased in all the clinically successful patients. The clinically fair and poor patients showed no appreciable change in the disc protrusion and the thecal cross-sectional area. No obvious intervertebral disc height loss and end plate damage were found in this group of patients.

Extruded but nonsequestered disc herniations can be treated with T-PLDD, a much simpler and less invasive procedure than traditional laminectomy and discectomy.

Treatment of Lumbar Intervertebral Disc Herniation Using C-Arm Fluoroscopy Guided Target Percutaneous Laser Disc Decompression

لورم ایپسوم متن ساختگی با تولید سادگی نامفهوم از صنعت چاپ و با استفاده از طراحان گرافیک است. چاپگرها و متون بلکه روزنامه و مجله در ستون و سطرآنچنان که لازم است و برای شرایط فعلی تکنولوژی مورد نیاز و کاربردهای متنوع با هدف بهبود ابزارهای کاربردی می باشد.

لورم ایپسوم متن ساختگی با تولید سادگی نامفهوم از صنعت چاپ و با استفاده از طراحان گرافیک است. چاپگرها و متون بلکه روزنامه و مجله در ستون و سطرآنچنان که لازم است و برای شرایط فعلی تکنولوژی مورد نیاز و کاربردهای متنوع با هدف بهبود ابزارهای کاربردی می باشد.

لورم ایپسوم متن ساختگی با تولید سادگی نامفهوم از صنعت چاپ و با استفاده از طراحان گرافیک است.