The PLDD is a minimally invasive technique for the treatment of disc herniations. It uses only a thin needle in which an optical fiber is inserted and it uses local anesthesia. The needle is introduced posteriorly in the lumbar cases and at the anterior right lateral level of the neck for cervicl cases, at an exact entry point. The needle is pushed forward carefully, under radiological control, to reach the center of the disk from which the disc herniation originates.
At this point, laser pulses are delivered and these must to be individualized from patient to patient with precise parameters (single pulse power, pause time in seconds between one pulse and the next one, total laser energy delivered). The laser pulses vaporize a very small amount of the center of the disk (called nucleus pulposus that is rich in water) and this produces a marked reduction of the pressure inside the disc and consequently also a reduction of the pressure that the hernia exerts on the nerve root (cause of the patient's pain). It should be noted that the goal of PLDD is not the disappearance of the herniated disc, but to reduce the pressure it exerts on the nerve. An example that makes good sense is if we consider hernia as a very puffy balloon that presses on the nerve. The PLDD aims to deflate the balloon and thus to eliminate the pressure exerted on the nerve (for this reason it is called "decompression"). There are no cuts of the skin, muscles, ligaments and bone removing as in the "classical" or endoscopic surgical technique.
About 80% of the disc hernias and almost all disc protrusions (they are small herniated discs but can be very bothersome) can be treated with PLDD. The PLDD is performed in the operating room and takes 30 to 40 minutes. The patient must be hospitalized for 24 to 48 hours, can start getting out of bed after 12 hours and then he can resume the common daily activities in the following 20 days VERY GRADUALLY. Return to work takes place within 20-40 days (depending on the type of job). The results are positive in over 85% of cases, while recurrences within 20 years from the procedure are around 4% (many times the PLDD can be repeated in this case); the complications are of 0.1% that means one case every 1,000 and is mainly represented by the discitis or infection of the disc treated even if is practiced antibiotic prevention therapy (for comparison, just think that recurrences or failure in traditional surgery vary from 5 to 20% according to different scientific studies and complications from 0.5 to 2%).
Also some recurring hernias after classical surgery or after endoscopy can be treated with PLDD while all cases of failure after PLDD can be treated with classical or endoscopic surgery according to the state of the art because the PLDD, I repeat, aims only to vaporize a very small amount of the nucleus pulposus and with a fine needle. With PLDD there is no risk of formation of adhesions that compress the nerve nor the risk of vertebral instability, which may occur in the classic intervention, and which then often requires very complex interventions with greater risk of complications.