FAQ QUESTIONS AND ANSWERS
QUESTION: WHAT IS PLDD?
The pldd (percutaneous laser disc decompression) is a not-surgical technique but truly minimal invasive interventional procedure for the treatment of a 70% of the disc hernia and 90% of the disc protrusions (these are small disc hernia that sometimes are very painful and do not respond to the most conservative therapies as pain killers, cortisonic and physical therapies and so on).
QUESTION: HOW DOES THE PLDD WORK?
It uses local anesthesia, a tiny needle and a laser optical fiber. It is practicated into the operating room with the patient in the lateral position or prone (for lumbar disk) or supin (for cervical). Firstly the local anesthesia in an exact point of the back (if lumbar) or of the neck (if cervical) is done, then a tiny needle is inserted through the skin and muscles and this, under radiological control, reaches the center of the disc (called nucleus pulposus). At this point the laser optical fiber is inserted inside the tiny needle and i start to delivery the laser energy (heat) that vaporizes a very small amount of the nucleus pulposus. This determines a decrease of 50-60% of the intra discal pressure and therefore also the pressure that disc hernia or protrusion exercises on the nerve root (cause of pain).
QUESTION: HOW MUCH TIME TAKES THE PLDD? IS A SINGLE SESSION ?
Every pldd (i can also treat 2 disks at the same time) takes from 30 to 45 minutes and there is only one session .
QUESTION: PATIENT FEEL PAIN DURING PLDD?
If made in experienced hands the pain during the pldd is minimum and only for few seconds: it comes at the time when the needle cross the anulus fibrous of the disc (the most external part of the disc). The patient, who is always awake and collaborating, must be adviced at that time to avoid rapid and unexpected movement of the body which he / she could make in reaction at the same short pain. Many patients do not feel pain during all the procedure.
QUESTION: DOES PLDD HAVE IMMEDIATE RESULTS?
In 30% of cases the patient feels immediate improvement of pain that then improves further and gradually in the following 4 to 6 weeks. In 70% of cases often there are "up and down pain" with "old" and "new" pain in the following 4 – 6 weeks and a serious and reliable judgment on the success of pldd is given only after 6 weeks. When the success is positive, the improvements can continue up to 11 months after the procedure.
QUESTION: DOES PLDD REQUIRE THE LONG HOSPITAL STAY ?
Personally i prefer that the patient stay t the hospital for 24 or maximum 48 hours.
QUESTION: IS IT A NEW TECHNIQUE?
It isn’t a new technique because its inventor, prof. Daniel s. J. Choy of the new york columbia university, has invented it in mid ’80 and the first case on a patient was performed in february 1986 in austria by prof. Choy and prof. Peter asher (director of the department of neurosurgery at the university of graz). The fda (foods and drugs administration) american approved the pldd, after 5 years of deepened scientific investigations, in 1991. The important facts are two about this issue :
1) it is un known not only by patients but also by many doctors. The pldd has over 27 years of scientific background and it is estimate that more than 150,000 patients today have been treated with pldd worldwide .
2) the use of pldd has been strongly adversed in italy but also in other countries of the world because, unfortunately, there are huge economic interests regarding the "disc hernia " chapter.
QUESTION: WHAT ARE THE RESULTS?
Results, in about 100 scientific publications with high scientific impact factor , vary from author to author from 70% up to almost 90%. Personally, after more than 4,000 patients treated from 2002 to 2018, i have 85% of positive results.
QUESTION: DO YOU CHECK CASES OF RECURRENCE ?
Yes. The recurrence s vary from 4 up to 10%. In my experience it is 4% in a period of 16 years. Many times, if it happens, pldd can be repeaed.
QUESTION: ARE THERE RISKS AND COMPLICATIONS?
Yes but are very low statistically and those serious happen only if pldd is carried out by doctors without experience and without a long and reliable trainig. I want to point out a very serious fact which is coming to be in italy but also in the united kingdom, in russian federation , in gulf countries, in ukraine, india, pakistan, bangladesh, china and other countries: there are doctors practicing pldd without having adequate training and this put at risk seriously firstly the health of patients and secondarily the good name of technique. I am receiving emails monthly on this issue from patients worldwide.
QUESTION: WHAT ARE THE COMPLICATIONS AND ITS STATISTIC ?
Personally the only one complication on more than 4,000 patients i treated in 16 years is the discitis in 0.1% (1 case every one thousand). Discitis ( the infection of disc treated ) in 99% of cases has positive course with 6 weeks of antibiotic therapy and 15 days of bed rest.
QUESTION: CAN PATIENTS WHO DO NOT HAVE POSITIVE RESULTS WITH PLDD BE TREATED WITH OTHER KINDS OF SURGERIES FOR DISC HERNIA?
Sure, these other kinds of surgeries can be made according to the state of the art because pldd uses only a tiny needle without cutting skin, without dissection of muscles from bone, without removing, even if in a small amount , of bone from the vertebral laminas and without removing legaments. The pldd aim is only to vaporize 20 - 30 milligrams of nucleus pulposus . Often it is not true the contrary : patients that have had unsuccessful surgical treatment (you can read the most important publications regarding the wide scientific chapter called "failed back surgery syndrome" ) with the other techniques (traditional o r endoscopic surgery) cannot always fit pldd.
QUESTION: HOW DOES THE CONVALESCENCE COME AND WHEN CAN PATIENT GO BACK TO WORK?
The patient can stand up about 6 - 8 hours after pldd and the recovery of the daily activities must to be very gradually - step by step - in the 3 weeks. The comimg back work will vary from 15 to 45 days (depending on the type of patient’s job ). It is mandatory that the patient always respects few rules for those who suffer or suffered for disc hernia:
1 - never make efforts in general;
2- avoid too many and continue flows and / or torsions of the spine ;
3- avoid activities with jumps ;
4- avoid overweight;
5- avoid many sports or some kinds of bad exercises at gym or home that are very dangerous on a medium long time for the spine;
6- avoid uncorrect body positions;
7- avoid to seat for long time (it is a gold rule every one hour of sitting to stand up 5 minutes).
I want to point out that almost all sports are healthy for body but keeping in mind that two structures of our body can suffer in a very harmful manner practicing them : the spine and the knees. To walk is the most healthy physical activity. In 90% of cases also swim ( back style and free style) and stretching with spine in axis and unloading are very useful.
Dr. Gian Paolo Tassi