Percutaneous Laser Disc Decompression (PLDD)

Percutaneous Laser Disc Decompression (PLDD) is a state-of-the-art procedure aimed at relieving pressure from the intervertebral disc using laser technology.

PLDD is a minimally invasive technique designed to treat disc herniation. As a result, this procedure is labeled minimally invasive due to its small incision size, with the access path to the disc numbed using local anesthetic. Consequently, the patient remains conscious during the operation, unlike conventional spine surgeries. A significant advantage of PLDD is the shortened hospitalization period and faster rehabilitation compared to other disc protrusion treatment methods. This low-risk approach avoids the need to open the spinal canal and minimizes damage to surrounding tissues. It's important to note that PLDD is not a novel treatment; it was first employed in 1987 and has been continuously evolving and improving ever since.

During PLDD, the protruding section of the disc is contracted, relieving pressure on the nerves. Even partial contraction of the protrusion can lead to reduced pain and alleviation of other associated symptoms.

The appropriateness of using PLDD for treatment depends on the physician's diagnosis and opinion. It may not be suitable for all types of disc herniation.

Unlike several other minimally invasive methods like block fast, ozone therapy, discogel, and transsacral epidural (SELD), PLDD is supported by valid and documented studies approved by the FDA (Food and Drug Administration). Other FDA-approved minimally invasive percutaneous methods include epidural and foraminal injections.

To determine the applicability of PLDD, medical treatments such as weight loss, lifestyle modifications, exercise, or medication are initially considered. However, if these treatments prove insufficient, PLDD can be employed for disc protrusion without rupture in the cervical and lumbar spine after two to four months of unresponsive medical treatment.

PLDD is a highly effective treatment approach, with a success rate of approximately 80% when patients are selected appropriately by the doctor. Since this procedure does not require anesthesia, it is suitable for patients with heart conditions or those contraindicated for anesthesia.

During the PLDD procedure, which typically lasts between 20 to 40 minutes, there is no need for a skin incision. A specialized hollow needle, about 2mm in diameter, is placed in the center of the disc under X-ray (fluoroscopy) guidance. A thin laser fiber is then inserted through the needle, delivering controlled heat to the disc's center. This process reduces disc volume, alleviating protrusion and pressure on the nerve root.

Following the operation, patients must maintain a proper position to avoid exerting pressure on the treated disc. Depending on the location of the operation, patients may wear a neck brace or belt for 1 to 3 weeks and avoid bending, twisting, or lifting heavy objects during this period. The recovery period varies based on individual circumstances, with some patients returning to work between two to four weeks after surgery and resuming driving and exercise after 6 to 8 weeks.

A herniated disc occurs when the outer annulus fibrosus of the intervertebral disc develops small cracks, causing it to bulge or herniate. The most commonly affected areas are the cervical and lumbar spine, leading to acute or chronic back pain that necessitates immediate treatment.

Definitive treatment for lumbar disc herniation using laser is a minimally invasive procedure conducted under computed tomography (CT) guidance in five steps, involving puncturing the damaged intervertebral disc under local anesthesia, injecting contrast material, treating local pain in the disc's core, decompressing the nerve roots, and removing the necessary intervertebral disc tissue.

Percutaneous Laser Disc Decompression (PLDD) offers a promising alternative to traditional invasive lumbar disc surgery, with a significantly shorter recovery time. The procedure involves evaporating excess fluid in the nucleus pulposus, thereby reducing pressure on the sciatic nerve and providing relief. Performed under fluoroscopy, the needle is inserted into the disc using local anesthesia, and the laser fiber vaporizes the fluid. Patients can usually return to their regular activities within days after the procedure, making it a safe and effective outpatient treatment option without any scarring or spinal instability. In case of future issues, PLDD does not hinder the patient's ability to seek other treatments, even if prior surgical methods were unsuccessful.