Approved by the FDA in 1991 and recognized by the AMA (American Medical Association), PLDD is a true and pure minimal invasive laser treatment performed on an outpatient basis (or with 24 hours of hospital stay) using only local anesthesia.
The herniated disc is like a balloon with a wake spot. Inflating it will cause a buldge (protrusion) or the herniation. Pain results from the buldge / herniation against the nerve in the spinal column. During the procedure, a thin needle is inserted into the herniated disc (the target is its center called nucleus pulposus) under x-ray guidance.
An optical fiber is inserted through the needle and laser energy is sent through the fiber, vaporizing a tiny portion of the disc nucleus. This creates a partial vacuum which draws the herniation away from the nerve root, thereby relieving the pain.
The effect sometimes is immediate but sometimes it will need few weeks (1 till 6 weeks).
Patients get off the table with just a small adhesive bandage and return home within 24 hours. Then patients begin progressive ambulation, walking up to a mile. Most return to work in 15 – 30 days.
Because only a thin needle is used, there is no cutting and no scarring. No muscles or ligaments cutting, no bone drilling. Since only a tiny amount of disc is vaporized, there is no subsequent spinal instability. Most of the complications that may occur with open surgery are eliminated with PLDD.
Not all the disc herniation can be treated with PLDD (70% yes , 30% no). This depends on inclusion and exclusion criteria. Only few contra indications must to take in account: hemorrhagic pathologies or infections, fractures and tumors near the disc to be treated.
The inventor of this procedure was the Prof. Daniel S. J. Choy , Emeritus Professor of Medicine at the Columbia University, New York City, USA), in mid ’80. The first case in vivo on patient was done in February 1986 at the Neurosurgical Department of the Graz University (Austria).
Since 1986 almost 150,000 PLDDs were performed successfully worldwide and scientific papers about PLDD appeared in the New England Journal of Medicine, Spine, Neurosurgery, Clinical Orthopedics and Related Research, The Journal of Clinical Lasers in Medicine and Surgery (since few years it changed the name in “Photomedicine and Laser Surgery). It is very important to point out that many patients treated with " PLDD " by doctors who have not done serious training and with specialized tutors. These doctors wake up in the morning and decide to perform the PLDD without any experience. The learning curve is long. This is happening mainly in the UK, Poland, Turkey, Germany, Gulf Region, Russia, Eastern European countries but also in Italy, in Asia and South east Asia. This situation was reported few years ago by Prof. Daniel S. J. Choy because it puts firstly, at risk the health of patients and, secondarily, the good name of the pure and true PLDD.
The positive results range is between 70% and 89% and complication rate 0,1% - 1% (mainly discitis: infection of the disc; if it happens, 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 very long time follow up (till 26 years).
If PLDD is unsuccessful, patients can be treated with open surgery or endoscopy according to the state of the art. On the contrary, patients who have open surgery or endoscopy in the first instance cannot always go on to be treated with PLDD.