PLDD, Percutaneous Laser Disc Decompression – pro

The percutaneous laser discectomy is a procedure which consists of passing a side firing laser probe into specific regions of a lumbar or cervical disc under X-Ray visualization. The lasery is then directed at the “degenerate” tissues, with the purported effect to reduce inflammation in the disc and to reduce pressure upon nerves passing over the disc protrusion.

A recent review(Schenk et al) states that the success rates in the larger studies varied from 75% (95% confidence interval [CI], 69%–81%)17 to 87% (95% CI, 80%–94%). The definition of “successful outcome” varied strongly between the different studies, depending on the outcome measures used. The duration of follow-up ranged from 310 to 8412 months. Because of insufficient improvement of symptoms or recurrent herniation, 4.4%20 to 25% of patients received additional surgical treatment. In most cases, surgery revealed the presence of free fragments in the spinal canal.

I quote teh conclusion of this review: “No randomized, controlled trials were available. Almost all trials were case series, with a relatively low strength of evidence. Furthermore, the sample size in most trials was relatively small, resulting in broad 95% CIs that made interpretation of success rates difficult. Generalization of the results into general practice remains difficult, because of the different inclusion and exclusion criteria, laser types, and outcome measures used and the large variation in duration of follow-up. These individual differences impair the mutual comparability of the studies and, more important, limit the possibilities for a valid comparison to studies evaluating the outcome of conventional surgical treatment for lumbar disk herniation.

Despite the fact that PLDD has been around for almost 20 years, scientific proof of its efficacy still remains relatively poor, though the potential medical and economic benefits of PLDD are too high to justify discarding it as experimental or ineffective on the sole basis of insufficient scientific proof. Well-designed research of sufficient scientific strength, comparing PLDD to both conventional surgery and conservative management of lumbar disk herniation, is needed to determine whether PLDD deserves a prominent place in the treatment arsenal for lumbar disk herniation. ”

The PLDD method has not been subjected to ar igorous designed trila and reported success rates are poorly defined. Pain control is a notoriously poor predictor of success in back conditions. There are no ongoing US trials but there is a comparative trail ongoing in England, Current Controlled Trials ISRCTN25884790.

B. Schenk et al, Percutaneous Laser Disk Decompression: A Review of the Literature American Journal of Neuroradiology 27:232-235, January 2006

Gibson JN, Grant IC, Waddell G. Surgery for lumbar disc prolapse (Cochrane review). Cochrane Database Syst Rev. 2000;(3):CD001350.

Patrick A Brouwer et al,  Effectiveness of percutaneous laser disc decompression versus conventional open discectomy in the treatment of lumbar disc herniation; design of a prospective randomized controlled trial BMC Musculoskeletal Disorders 2009, 10:49


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