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Background: Different treatments for discogenic axial back/neck pain or radicular pain to limbs are there from conservative therapies and minimally invasive therapies to open spine surgeries with lots of controversial outcomes. Percutaneous laser disc decompression (PLDD) is one of the minimally invasive therapies which is done under local anesthesia and has been successfully performed in many selected patients for their lumbar and cervical disc herniation problems. In PLDD, a part of the nucleus pulposus is vaporized with the help of laser energy to reduce the intradiscal pressure of the diseased discs causing nerve compression. In this case series after a 1-year follow-up, the clinical effectiveness of PLDD with epidural steroid injection is assessed in selected lumbar and cervical disc herniation cases. Materials and Methods: Ninety-six patients underwent the PLDD procedure at the cervical and lumbar disc with epidural steroid injections for their disc herniation causing radicular pain in the upper and lower limbs, respectively. The patients were followed at 8 weeks, 3 months, 6 months, and 1 year. The main outcome measures were done through the visual analog scores (VASs) and the Oswestry Disability Index (ODI) for upper and lower limb pain. Results: The primary outcome showed that there is a significant clinically relevant difference between the two groups at a 1-year follow-up. VAS and mean disability score based on the ODI were significantly lower in cervical disc herniation patients. The reoperation rate in the cervical group is also much less than the lumbar group. Conclusion: Like all other surgical modalities for disc herniation, PLDD has its own advantages and disadvantages. However, compared to lumbar disc herniation, it may give better results in cervical disc herniation. In selected cases, combined PLDD with epidural steroid injection can be chosen as a "first-choice-minimally-invasive-treatment," when standard conservative therapies do not give satisfactory outcome. [ABSTRACT FROM AUTHOR]

Background: Different treatments for discogenic axial back/neck pain or radicular pain to limbs are there from conservative therapies and minimally invasive therapies to open spine surgeries with lots of controversial outcomes. Percutaneous laser disc decompression (PLDD) is one of the minimally invasive therapies which is done under local anesthesia and has been successfully performed in many selected patients for their lumbar and cervical disc herniation problems. In PLDD, a part of the nucleus pulposus is vaporized with the help of laser energy to reduce the intradiscal pressure of the diseased discs causing nerve compression. In this case series after a 1-year follow-up, the clinical effectiveness of PLDD with epidural steroid injection is assessed in selected lumbar and cervical disc herniation cases. Materials and Methods: Ninety-six patients underwent the PLDD procedure at the cervical and lumbar disc with epidural steroid injections for their disc herniation causing radicular pain in the upper and lower limbs, respectively. The patients were followed at 8 weeks, 3 months, 6 months, and 1 year. The main outcome measures were done through the visual analog scores (VASs) and the Oswestry Disability Index (ODI) for upper and lower limb pain. Results: The primary outcome showed that there is a significant clinically relevant difference between the two groups at a 1-year follow-up. VAS and mean disability score based on the ODI were significantly lower in cervical disc herniation patients. The reoperation rate in the cervical group is also much less than the lumbar group. Conclusion: Like all other surgical modalities for disc herniation, PLDD has its own advantages and disadvantages. However, compared to lumbar disc herniation, it may give better results in cervical disc herniation. In selected cases, combined PLDD with epidural steroid injection can be chosen as a “first-choice-minimally-invasive-treatment,” when standard conservative therapies do not give satisfactory outcome.

The most common causes of lumbar radicular pain are pathological changes in the intervertebral disc. Lumbar disc herniation (LDH) is the most common cause of lumbosacral radicular syndrome. It affects 1-2% of the general population, burdening health services and the economy worldwide. Excessive scar tissue after lumbar microdiscectomy can increase postoperative pain. Postoperative fibrosis is one of the most important causes of failed back surgery syndrome after lumbar disc surgery. Percutaneous laser disc decompression (PLDD) is a minimally invasive procedure in which thermal energy produced by a LASER probe is used to reduce the intervertebral disc herniation located within the annulus fibrosus. Evaporation of a small volume in a closed hydraulic space (nucleus pulposus) leads to decreased intradiscal pressure. It causes a thermal “shrinkage effect” with the retreat of the herniated disc and the decompression of the nerve root, which reduces lumbar radicular pain. Previous research has shown effective reduction of pain after PLDD and only a small number of complications of the procedure itself. PLDD is a safe and effective procedure in well-selected patients. Unfortunately, there is still a need for extensive, randomized prospective studies on PLDD in lumbar radicular pain in order to confirm or dispute the results obtained so far.

Objective Percutaneous laser disc decompression (PLDD) has been regarded as an effective alternative for the treatment of cervical soft disc herniations. Repeated X-Ray scanning is essential when performing this technique. Design Technical note. Methods We present a new method for the treatment of cervical disc herniation using ultrasound to guide the needle entry to the cervical disc, to avoid excess of radiation exposure during the surgical procedure. We evaluated the efficacy of this cervical approach. We retrospectively reviewed the clinical data of 14 cases who underwent a PLDD under ultrasound guidance for the treatment of contained cervical disc herniation using a 1,470 Nm diode laser. The lower cervical discs (C5–C6 and C6–C7) were the most affected sites, accounting for 78.6% of surgical discs. A significant NRS reduction between baseline and 1 month (P  = .0002) and between baseline and 12 months (P  = .0007) was observed. Conclusions Our results support the conclusion that ultrasound guided PLDD with fluoroscopic validation is a minimally invasive technique for patients affected by herniated cervical discs, but proper choice of patients is critical. This approach should not be performed except after adequate training under close supervision of surgeons experienced in this procedure and in interventional US. [ABSTRACT FROM AUTHOR]

Degenerative disc disease (DDD) is a common cause of low back pain, often leading to significant discomfort for patients. Current treatment options such as spinal fusion and physical therapy focus on symptom management rather than addressing the underlying degeneration. Percutaneous laser disc decompression (PLDD) has shown efficacy in treating radicular pain associated with disc herniation. However, there is a growing interest in utilizing tissue engineering approaches to reverse the pathological process of DDD. While results in larger vertebrates have been inconsistent, mesenchymal stem cells (MSCs) have demonstrated promise in small animal models. A 46-year-old male presented with low back pain as well as urinary and fecal incontinence. Magnetic resonance imaging revealed disc bulging and foraminal stenosis at the L2-L4 levels. The patient underwent PLDD combined with umbilical cord-derived mesenchymal stem cells (UC-MSCs) injection, which later resulted in significant pain reduction and improved motor function. At six months of follow-up, the patient reported sustained pain relief and functional improvement. Percutaneous decompression techniques not only substantially reduce intradiscal pressure and facilitate the implosion of herniation inward but also concurrently expedite the degeneration of the intervertebral disc. Therefore, in addition to performing PLDD, stem cell injection is also carried out. This report underscores the importance of integrating mechanical and biological interventions for degenerative disc diseases, suggesting PLDD combined with MSC therapy as a promising strategy for managing DDD and potentially reversing its progression. We found that the patient had decreased pain postoperatively; he no longer complained of pain after six months of follow-up. PLDD combined with UC-MSCs might be an alternative treatment for patients with DDD. In addition to mechanical treatment, biological treatment with MSC injections is believed to be a potent combination for treating degenerative diseases such as DDD. • Treating intervertebral disc degeneration with tissue engineering offers a chance to reverse the pathological process. • We treated a 46-year-old male with degenerative disc disease using percutaneous laser disc decompression combined with umbilical cord-derived mesenchymal stem cells • This combined technique offers a minimally-invasive method that may be successful in treating degenerative disc disease [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) is a debilitating medical condition that possesses the potential to exert a substantial influence on an individual's quality of life. Traditional treatments involve surgery, however a less invasive alternative is Percutaneous Laser Disc Decompression (PLDD), which offers several advantages over conventional surgery, including reduced invasiveness, shorter hospitalization periods, and faster recovery rates. A 64-year-old male presented with bilateral limb weakness and back pain. The patient underwent PLDD of L2–3 and L3–4, was followed by the administration of Umbilical Cord-Derived Mesenchymal Stem Cell (UC-MSC) secretomes at multiple sites. Postoperatively, the patient had significant reduction in discomfort (VAS score: 2), improved motor strength, and enhanced postural stability. Monthly assessments demonstrated continued pain reduction, bone rebuilding, and positive outcomes in bone mineral density (BMD) at the 3 and 6-month follow-ups. At one year of follow-up, the patient could walk without walking aid, and there was no complication. PLDD, conducted within 24 h, significantly alleviated the patient's discomfort. Subsequently, UC-MSC secretomes were administered to enhance the regenerative process. This intervention demonstrated safety advantages and, when combined with PLDD, led to increased bone mineral density (BMD) over three to six months, indicating ongoing spine regeneration. The secretome's anti-inflammatory properties further contributed to disc regeneration. We found that PLDD combined with UC-MSC secretomes may help in the regenerative process of SCI. The approach not only provides immediate relief but also contributes to long-term spinal quality improvement, presenting a promising option for those at higher surgical risks. • Spinal cord injury (SCI) is a debilitating medical condition that possesses the potential to exert a substantial influence on an individual's quality of life • The percutaneous laser disc decompression (PLDD) offers several advantages over conventional surgery, including reduced invasiveness, shorter hospitalization periods, and faster recovery rates • We reported a case of a 64-year-old male with SCI treated using PLDD combined with secretome of umbilical cord-derived mesenchymal stem cells [ABSTRACT FROM AUTHOR]

Lumbar disc herniation is the most common cause of lumbosacral radicular syndrome. It affects 1-2% of the general population, burdening health services and the economy worldwide. The intravertebral disc has the properties of a narrow hydraulic space: the nucleus pulposus is surrounded by a relatively inelastic fibrous ring and the solid ends of the vertebrae. A slight increase in volume will regularly result in a significant increase in pressure and vice versa. Percutaneous laser disc decompression (PLDD) is a minimally invasive procedure in which thermal energy produced by a LASER probe is used to reduce intervertebral disc herniation. Evaporation of a small volume in a closed hydraulic space (nucleus pulposus) leads to decreased intradiscal pressure. It implies a thermal "shrinkage effect" with the retreat of the herniated disc and the nerve root's decompression, which reduces lumbar radicular pain. Pressure changes drastically in healthy discs but only slightly in degenerative discs. The photochemical effects of laser light also lead to the destruction of cytokines and neurokinins such as phospholipase A2, NO, TNF-a, IL-1a and substance P, which play an essential role in inflammation and pain. Previous research has shown an effective reduction of pain after PLDD and a small number of complications of the procedure itself. PLDD is a safe and effective procedure in well-selected patients. Unfortunately, there are still no extensive, randomised prospective studies on PLDD in lumbar radicular pain, and the studies mentioned above are needed in the future to confirm or dispute the results so far. [ABSTRACT FROM AUTHOR]

Background: Disc herniation is broadly defined as a localized or focal displacement of disc material beyond the limits of the intervertebral disc space. The disc material may be the nucleus, cartilage, fragmented apophyseal bone, annular tissue, or any combination thereof. Laser surgery is one of the treatment modalities for treating patients with lumbar disc herniation. This study aims to examine the effect of Percutaneous Laser Disc Decompression (PLDD) in patients with lumbar disc herniation. Materials and Methods: This study was conducted on 58 patients who underwent PLDD (optical fiber inserted through an 18G needle, 8 joules, and 8 watts). Individuals were monitored before and after treatment using the comparing visual analog scale (VAS) pain score (from 0 [no pain] to 10 [severe pain]). Results: The mean age of participants was 63.19±13.48 years. Regarding gender, 24 patients (41.4%) were female. The mean VAS score before surgery was 8.73±1.29, and VAS score after surgery was 55.2±2.71, which means pain was significantly reduced (P0.001). Conclusion: The patients' post-PLDD pain may decrease; hence, PLDD can use as an appropriate method for treating lumbar disc herniation., (Copyright© 2022, Galen Medical Journal.)

Objective: To study the risk factors of unsatisfactory clinical results after percutaneous laser decompression of the lumbar intervertebral disc (PLDD)., Material and Methods: A retrospective observational single-center study included medical records of patients who underwent lumbar PLDD for degenerative spine disease. We analyzed clinical and instrumental parameters potentially affecting the results of lumbar PLDD., Results: Clinical study included 82 patients who underwent PLDD for lumbar intervertebral disc degenerative disease. Mean postoperative follow-up period was 30.8±13.3 months. In 22 (26%) patients, unsatisfactory clinical outcomes were observed. According to binary logistic regression model, comorbidities ( p =0.03), duration of disease over 12 months ( p =0.03), low preoperative quality of life according to ODI score (more than 50%) ( p =0.04), high body mass index (over 25 kg/m 2 ) ( p =0.02), severe intervertebral disc ( p =0.04) and facet joint degeneration ( p =0.01) and intervertebral disc height decrease more than 50% ( p =0.01) were significantly associated with unsatisfactory clinical outcomes after lumbar PLDD for degenerative spine disease., Conclusion: Identification of these risk factors of unsatisfactory clinical outcomes is important stage of preoperative preparation in patients scheduled for lumbar PLDD.