Percutaneous Laser Disc Decompression (PLDD)

The declining popularity of chemonucleolysis and APLD led to the emergence of alternative techniques thatemployed thermal energy techniques such as laser and radiofrequency nucleotomy. Arguably, the advantageof thermal techniques is that they provide a combination of mechanical decompres- sion and modification ofintradiscal biochemical milieu, which can lead to the reduction of neuropathic (radiculopathic) and nociceptivepain, respectively.ProcedureThe first clinical application of PLDD occurred in ۱۹۸۶. Various types of lasers have since been described inthe literature, including those with wavelengths close to the infrared region (Nd:YAG, Ho:YAG, and diodelasers) and those with visible green radiation (potassium-titanyl-phosphate (KTP) laser).The working principle of PLDD is similar to other decompression techniques; access to intervertebral disc isachieved similar to other percutaneous techniques except with a smaller diameter needle (۱۸- gauge needle),followed by the introduction of ۴۰۰-μm optical fiber for transmission of laser energy. Different protocols havebeen reported in the literature in terms of the type of laser, duration of the treatment, and impulsion energyused to achieve decompression. Gangi and coworkers reported that the application of a ۱,۰۶۴-nm Nd:YAGlaser in short pulses of ۰.۵–۱ s with pauses of ۴–۱۰ s was effective, while Choy and coworkers reported theuse of a ۱,۰۶۴-nm Nd:YAG laser in short pulses of ۱ s and pauses of ۱ s led to a favorable outcome. As withAPLD, the patient is then allowed to recover and dis- charged home on the day of the procedure.Evidence of EfficacyTo date, most observational studies on PLDD have reported favorable outcomes. Tassi, Choy, and coworkersreported a success rate of ۷۰–۸۹ % based on the results from multiple centers and approximately ۲۰,۰۰۰procedures. The complication rate (complications were mainly discitis) ranged from ۰.۳ to ۱.۰ %, and therewas a recurrence rate of ۴–۵ % over a ۲۳-year follow-up period. In a systematic review that encompassed ۱۴observational studies, Singh