DOCTOR GIAN PAOLO TASSI

PLDD= Percutaneous Laser
Disc Decompression

+39-3286136369

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FAQ QUESTIONS AND ANSWERS

QUESTION: WHAT  IS PLDD?

ANSWER:

The pldd (percutaneous laser disc decompression) is a not-surgical technique but  truly minimal  invasive  interventional procedure  for the treatment of a 70% of the disc hernia and 90% of the disc  protrusions (these are small   disc  hernia  that  sometimes  are  very painful  and  do not respond to the most conservative therapies as  pain killers, cortisonic  and physical therapies  and so on).

 

QUESTION: HOW DOES THE PLDD WORK?

ANSWER:

It uses local anesthesia, a  tiny  needle  and a laser optical fiber. It is practicated into  the operating room with the patient in the lateral position or prone  (for  lumbar  disk) or supin (for cervical). Firstly the local anesthesia in an exact point of the back (if lumbar) or of the neck (if cervical)  is done, then a tiny  needle is inserted through  the skin and muscles  and this, under radiological control, reaches the center of the disc (called  nucleus pulposus).  At this point the laser optical fiber is inserted inside the tiny needle and i start to delivery the laser energy (heat) that vaporizes a very  small  amount  of the nucleus  pulposus. This determines a decrease of 50-60% of the intra discal pressure and therefore also the pressure that disc hernia  or protrusion exercises on the nerve  root (cause of pain).

 

QUESTION: HOW MUCH TIME TAKES THE PLDD? IS A SINGLE SESSION ?

ANSWER:

Every pldd (i  can also treat  2 disks at the same time) takes  from 30 to 45 minutes and there is  only one session .

 

QUESTION: PATIENT FEEL PAIN DURING PLDD?

ANSWER:

If made in  experienced  hands  the pain during the pldd is minimum and  only for few seconds:  it comes at the time when the  needle  cross the anulus fibrous of the disc (the most  external part of the disc). The patient, who is always awake and collaborating, must be adviced  at that time to avoid  rapid and unexpected  movement of the body which he / she could make in reaction at the same short pain. Many patients do not feel pain during all the procedure.

 

QUESTION: DOES  PLDD HAVE IMMEDIATE RESULTS?

ANSWER:

In 30% of cases the patient feels immediate improvement of pain  that then improves further and  gradually  in the following  4 to 6  weeks. In 70% of cases often there  are "up  and down  pain" with "old" and "new" pain  in the following 4 – 6  weeks and a serious and reliable judgment on the success of pldd  is given  only after 6 weeks. When the success is positive, the improvements can continue up to 11 months after the procedure.

 

QUESTION: DOES  PLDD REQUIRE THE LONG HOSPITAL STAY ?

ANSWER:

Personally i prefer that the patient stay t the hospital  for 24 or  maximum 48 hours.

 

QUESTION: IS IT A NEW TECHNIQUE?

ANSWER:

It isn’t  a new technique because  its inventor, prof. Daniel s. J. Choy of the new york columbia university, has invented it in   mid ’80  and the first case on a patient was  performed in february 1986 in austria by prof. Choy and  prof. Peter asher (director of the department of neurosurgery at  the university of graz). The fda (foods and drugs administration) american approved the pldd, after 5 years of deepened scientific investigations, in 1991. The important facts   are two  about this issue :
1)  it is  un known not only by patients but also by many doctors. The pldd has over 27 years of scientific background  and  it  is  estimate that more than 150,000 patients today have been treated with  pldd worldwide .
2) the use  of  pldd has been strongly  adversed  in italy but also in other countries of the world because, unfortunately, there are huge  economic interests regarding the "disc  hernia " chapter.

 

QUESTION: WHAT ARE THE RESULTS?

ANSWER:

Results, in about 100 scientific  publications with  high scientific impact  factor , vary from author to author  from 70%  up to almost 90%. Personally, after more than 4,000 patients treated from 2002 to 2018, i have  85% of positive results.

 

QUESTION: DO YOU CHECK CASES OF RECURRENCE ?

ANSWER:

Yes. The recurrence s  vary  from 4 up to 10%. In my experience  it is 4% in a period of 16 years. Many times, if it happens, pldd can be  repeaed.

 

QUESTION: ARE THERE RISKS AND COMPLICATIONS?

ANSWER:

Yes but are very low statistically and those serious  happen  only if pldd is carried out by doctors  without  experience and without  a long and reliable  trainig. I want to point out  a very serious fact which is coming to be in italy but also in the united kingdom, in russian federation , in  gulf  countries, in ukraine, india, pakistan, bangladesh, china and other countries: there are doctors practicing  pldd without having adequate training and this put at risk seriously  firstly the health of patients and secondarily the good  name of technique.  I am receiving  emails   monthly on this  issue  from patients worldwide.

 

QUESTION: WHAT ARE THE COMPLICATIONS AND  ITS STATISTIC ?

ANSWER:

Personally the only one  complication on more than 4,000 patients  i treated  in 16 years is the discitis  in  0.1% (1 case  every one thousand).   Discitis  ( the infection of disc treated ) in 99% of cases  has positive  course  with 6 weeks of antibiotic therapy  and 15 days of bed rest.

 

QUESTION: CAN  PATIENTS WHO  DO NOT HAVE POSITIVE RESULTS WITH  PLDD BE TREATED WITH  OTHER  KINDS  OF SURGERIES  FOR  DISC  HERNIA?

ANSWER:

Sure,  these other kinds of surgeries  can be made  according to the state of the art because  pldd uses only  a tiny needle  without cutting skin, without dissection of  muscles from bone, without removing, even if in a  small   amount , of bone  from  the vertebral laminas and without removing legaments. The pldd aim is only  to vaporize 20 - 30 milligrams of nucleus pulposus . Often it is not true the contrary  : patients that have had unsuccessful  surgical treatment (you can read the most important publications regarding  the wide  scientific  chapter  called  "failed back surgery syndrome" ) with the other techniques (traditional  o r endoscopic  surgery) cannot always  fit  pldd.

 

QUESTION: HOW DOES THE CONVALESCENCE COME AND WHEN CAN  PATIENT  GO BACK TO WORK?

ANSWER:

The patient  can  stand up  about  6 - 8 hours after  pldd and the recovery of the daily activities must   to  be  very gradually - step by step - in the 3 weeks. The comimg back  work will vary from 15 to 45 days (depending on the type of patient’s  job ). It is mandatory  that the patient always  respects  few rules for  those who suffer or suffered for  disc  hernia:
1 - never  make  efforts in general;
2- avoid  too many and continue flows and / or torsions of the spine ;
3- avoid activities with jumps ;
4- avoid overweight; 
5- avoid many sports or some kinds  of  bad exercises at gym  or home that are very dangerous on a  medium long time  for the spine;
6- avoid  uncorrect   body positions;
7- avoid  to seat  for long time (it is a gold  rule every one hour  of sitting  to stand up  5 minutes).
I want to point out  that almost  all  sports  are healthy for body but keeping in mind that  two structures of our body can  suffer  in  a very harmful manner  practicing them : the spine  and the knees.  To  walk  is the most  healthy physical  activity. In 90% of cases  also  swim ( back  style  and free style) and  stretching with  spine  in axis and  unloading are very useful.

 

Dr. Gian Paolo Tassi



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© 2014-2019 Copyright © Doctor Gian Paolo Tassi - registration number on the Surgeons General Medical Council (GMC) of Ascoli Piceno Province, Italy: 02262
VAT CODE: IT 01773120447


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