PLDD (Percutaneous Laser Disc Decompression) is a minimally invasive procedure (not traditional surgery) used, in appropriately selected cases, to treat many disc herniations and the majority of disc protrusions. Protrusions are “small” herniations that can still be very painful and may not respond to conservative treatments (pain relief/anti-inflammatory medication, corticosteroids, physiotherapy, etc.).

The procedure is performed under local anaesthesia using a very fine needle and a laser optical fibre, in an operating theatre and under radiological guidance.

The patient is positioned prone or on the side for the lumbar spine and supine for the cervical spine. After local anaesthesia, the needle is guided to the centre of the disc (the nucleus pulposus). A laser fibre is then introduced through the needle and vapourises a very small amount of nucleus pulposus. This can reduce intradiscal pressure and, consequently, lessen compression/irritation of the nerve root responsible for pain.

PLDD typically takes 30–45 minutes. In some cases, two discs can be treated during the same session. The procedure usually involves a single session.

In experienced hands, discomfort during PLDD is usually minimal and, if present, tends to last only a few seconds, especially as the needle passes through the annulus fibrosus (the outer portion of the disc). The patient remains awake and cooperative and is advised to avoid sudden movements. Many patients report no pain throughout the procedure.

In around 30% of cases, pain relief may be noticed quickly and then improves gradually over the following 4–6 weeks. In about 70% of cases, symptoms can fluctuate (“good days and bad days”) during the first 4–6 weeks.

A reliable assessment of outcome is usually made after 6 weeks. When the response is positive, improvement may continue for up to 11 months after the procedure.

Depending on clinical organisation and individual circumstances, hospital observation for 24 hours may be recommended, occasionally up to a maximum of 48 hours.

No. PLDD was developed in the mid-1980s by Prof. Daniel S. J. Choy (Columbia University, New York). The first “in vivo” case was performed in February 1986 at the University of Graz (Austria). The U.S. FDA approved PLDD in 1991 after several years of evaluation.

Despite its long scientific background, PLDD is still not widely known among many patients and even within parts of the medical community. In several countries it has also faced strong opposition, partly related