What Is PLDD Laser Spine Surgery?

Are you struggling with a disc herniation or disc protrusion that causes sciatic pain and/or persistent back pain, and medications and physical therapy have not been successful? If so, PLDD may be the minimally invasive solution you have been looking for.

PLDD = Percutaneous Laser Disc Decompression

PLDD (Percutaneous Laser Disc Decompression), performed according to Prof. Daniel S. J. Choy’s method, can help resolve symptoms with a high success rate (over 85%), a true minimally invasive approach, and a very low complication rate when compared with other surgical techniques.

PLDD is a minimally invasive technique for treating disc herniations and protrusions. It uses only a thin needle through which an optical fiber is inserted, and it is performed under local anesthesia. In lumbar cases, the needle is introduced from the back; in cervical cases, it is introduced from the front-right lateral side of the neck, using an exact entry point. Under continuous radiological guidance, the needle is advanced carefully until it reaches the center of the disc from which the herniation originates.

How PLDD Relieves Pain

At that point, laser pulses are delivered. These must be individualized for each patient using precise parameters (single-pulse power, pause time in seconds between one pulse and the next, and total laser energy delivered). The laser vaporizes a very small amount of the disc center (the nucleus pulposus, which is rich in water). This produces a marked reduction of pressure inside the disc and, as a consequence, reduces the pressure that the hernia exerts on the nerve root — which is the real cause of the patient’s pain.

It is important to understand that the goal of PLDD is not to make the herniated disc “disappear,” but to reduce the pressure it exerts on the nerve. A simple example: if we imagine the hernia as a very puffy balloon pressing on the nerve, PLDD aims to deflate the balloon and therefore remove the pressure on the nerve. For this reason, the procedure is called “decompression.”

There are no cuts through skin, muscles, or ligaments, and no bone removal as in “classical” open surgery or endoscopic techniques.

Who Can Benefit?

About 80% of disc herniations and almost all disc protrusions (small herniations that can be very bothersome) may be treated with PLDD, depending on the clinical picture and MRI findings.

PLDD is performed in the operating room and usually takes 30–40 minutes. The patient is typically hospitalized for 24–48 hours, can begin getting out of bed after about 12 hours, and may resume common daily activities over the next 20 days, very gradually. Return to work usually occurs within 20–40 days, depending on the type of job.

Results are positive in over 85% of cases. Recurrences within 20 years from the procedure are reported around 4% (and in many cases PLDD can be repeated). Complications are rare — around 0.1% (about one case per 1,000), mainly represented by discitis (infection of the treated disc), even though preventive antibiotic therapy is used.

For comparison, recurrence or failure rates in traditional surgery are reported between 5% and 20% in different scientific studies, with complication rates around 0.5% to 2%.

What If You Have Had Previous Surgery?

Some recurrent hernias after classical surgery or after endoscopy can be treated with PLDD. On the other hand, if PLDD does not solve the problem, the patient can still undergo classical or endoscopic surgery according to current best practice. PLDD, in fact, vaporizes only a very small amount of nucleus pulposus through a fine needle.

With PLDD, there is no risk of forming adhesions that compress the nerve and no risk of vertebral instability that may occur after classic surgery and sometimes requires much more complex procedures with higher risks.