Overview

Approved by the FDA in 1991 and recognized by the AMA (American Medical Association), PLDD is a truly minimally invasive laser treatment performed on an outpatient basis (or with a 24-hour hospital stay) using only local anaesthesia.

How PLDD Works

A herniated disc can be compared to a balloon with a weak spot. When inflated, it may develop a bulge (protrusion) or a herniation. Pain occurs when the bulge/herniation presses against a nerve root within the spinal canal. During the procedure, a thin needle is inserted into the affected disc (the target is the centre, called the nucleus pulposus) under X-ray guidance.

An optical fibre is inserted through the needle, and laser energy is delivered through the fibre, vaporizing a tiny portion of the disc nucleus. This creates a partial vacuum, which draws the herniation away from the nerve root, thereby relieving pain.

Recovery

The effect is sometimes immediate; however, in some cases it may take a few weeks (from 1 to 6 weeks). Patients leave the table with only a small adhesive bandage and return home within 24 hours. They then begin progressive ambulation, gradually increasing walking up to a mile. Most patients return to work within 15–30 days.

Advantages

• No incision and no scarring (a thin needle is used).
• No cutting of muscles or ligaments and no bone drilling.
• Only a tiny amount of disc material is vaporized, so there is no subsequent spinal instability.
• Most complications associated with open surgery are avoided.

Who Can Be Treated

Not all disc herniations can be treated with PLDD (approximately 70% yes, 30% no). This depends on inclusion and exclusion criteria.

Contraindications

• Haemorrhagic disorders or infections
• Fractures
• Tumours near the disc to be treated

History and Evidence

This procedure was invented by Prof. Daniel S. J. Choy, Emeritus Professor of Medicine at Columbia University, New York City, USA, in the mid-1980s. The first in vivo case in a patient was performed in February 1986 at the Neurosurgical Department of Graz University (Austria).

Since 1986, nearly 150,000 PLDD procedures have been performed successfully worldwide, and scientific papers on PLDD have appeared in journals such as The New England Journal of Medicine, Spine, Neurosurgery, Clinical Orthopedics and Related Research, and The Journal of Clinical Lasers in Medicine and Surgery (renamed Photomedicine and Laser Surgery).

Training and Patient Safety

It is important to note that some patients have been treated with “PLDD” by doctors who have not undergone serious training under qualified tutors. The learning curve is long. This situation has been reported because it can put patients’ health at risk and may harm the reputation of true PLDD.

Outcomes and Complications

Reported success rates range between 70% and 89%, with a complication rate of 0.1%–1% (mainly discitis—an infection of the disc; if it occurs, it can be cured in 99% of cases with 15 days of bed rest and 6 weeks of antibiotics). The recurrence rate is around 4% with long-term follow-up (up to 26 years).

If PLDD Is Not Successful

If PLDD is unsuccessful, patients can be treated with open or endoscopic surgery according to current standards of care. By contrast, patients who undergo open or endoscopic surgery as the first-line treatment cannot always be treated with PLDD afterwards.

Dr. Tassi — November 2019