Response of extruded intervertebral herniated discs to percutaneous laser disc decompression

Abstract

Objective: To describe the clinical features of 21 patients with extruded (but nonsequestered) herniated intervertebral discs before and after treatment with percutaneous laser disc decompression (PLDD).

Background data: PLDD was introduced in February, 1986, by Choy and Ascher. This relatively noninvasive technique for the treatment of herniated intervertebral discs has been extensively described elsewhere. Previously, only uncomplicated disc herniations were treated with PLDD, with a success rate according to the MacNab criteria of 89% and a complication rate of 0.4 to 1.0%. Until 1998, the author and others adhered to strict criteria of patient selection to produce "clean" data that could be analyzed without complications. However, after 12 years of accumulating clinical data, it became feasible and desirable to "expand the envelope" and attempt treatment of more complicated cases.

Methods: Twenty-one patients with magnetic resonance imaging (MRI)-documented extruded, but nonsequestered, herniated discs with appropriate pain syndromes were treated with PLDD.

Results: Eighteen of the 21 patients treated achieved the top category of the MacNab criteria, with good pain relief, and in some instances, reversal of neurologic deficits.

Conclusions: Patients with extruded but nonsequestered disc herniations may now be included in the group selected for PLDD.