Outcomes of Percutaneous Laser Disc Decompression for Lumbar Disc Herniation: A Systematic Review and Meta-Analysis.

Abstract

Background: Percutaneous laser disc decompression (PLDD) is a minimally invasive treatment option for carefully selected patients with lumbar disc herniations (LDH) whose condition does not respond to conservative therapy but who may not require surgical decompression. Although PLDD has been increasingly adopted, reported outcomes vary widely across studies. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of PLDD in adults with LDH.

Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted through November 2025. Adult PLDD studies reporting clinical outcomes were included. Random-effects models pooled continuous and binary outcomes. Primary outcomes were visual analog scale (VAS) improvement and clinical success. Secondary outcomes were Oswestry Disability Index (ODI) change, reoperation rates, and complications. Heterogeneity was assessed with I², and risk of bias with the Risk of Bias in Non-randomized Studies of Interventions.

Results: Fifteen publications reporting 14 unique PLDD cohorts were included. Eight studies (n=506) reported VAS outcomes, showing a pooled pain reduction of 4.33 points on a 0-10 scale (95% confidence interval [CI] 3.03-5.64; I²=98.8%). Three studies (n=128) reported ODI outcomes, with a pooled improvement of 20.1 points, but with substantial uncertainty (95% CI -21.7 to 61.9; I²=99.6%). Five studies (n=298) reported clinical success, yielding a pooled success rate of 73.8% (95% CI 55.9%-86.2%; I²=91.0%). The pooled reoperation rate across eight cohorts (n=650) was 10.3% (95% CI 6.3%-16.5%; I²=65.8%), and the pooled complication rate across ten studies (n=750) was 1.3% (95% CI 0.4%-3.9%; I²=1.0%). Most studies had moderate risk of bias due to non-randomized, single-arm designs.

Conclusions: PLDD is associated with meaningful pain reduction and moderate clinical success with a very low complication rate in selected patients with LDH. Functional outcomes and reoperation rates varied across studies. Further high-quality comparative research is needed to better define long-term results and optimal patient selection.